Swimmer’s Ear: Causes, Symptoms, and Effective Treatments

Human Ear Anatomy

The human ear consists of the following main structures:

• The outer ear or pinna (the cup-shaped earlobe that’s visible) and the outer ear canal

• The tympanic membrane (eardrum) that separates the outer ear and middle ear 

• The middle ear contains small bones that amplify sound received from different directions. 

• The eustachian tube which connects the middle ear to the throat.

• The inner ear, which houses the cochlea, a structure that converts sound waves into electrical signals and transmits them to the brain through the cranial nerves. The inner ear also contains the vestibular system that helps maintain balance.

What is Swimmer’s Ear?

Swimmer's ear is an infection or inflammation of the outer ear canal (the part of the ear between the pinna and the middle ear). The medical term for this condition is otitis externa. 

Swimmer’s ear most commonly occurs due to a bacterial or fungal infection. It can also result from mechanical damage, chemical irritation, or the spread of a middle ear infection. The term swimmer’s ear is used because it is frequently caused by water remaining in the outer ear, providing a moist environment for bacteria to grow.

Causes of Swimmer’s Ear

Exposure to Water

Dirty or contaminated water can introduce infectious agents into the ear canal. Excess moisture can remain in the ear after swimming, in humid weather, and after heavy sweating. Moisture in the outer ear creates a hospitable environment for bacterial growth. Tiny scratches or abrasions in the skin of the ear can allow bacterial entry, resulting in an infected ear. Dermatitis (skin inflammation) is also more common in a wet ear canal. 

Swimmer’s ear is commonly caused by a bacterium called Pseudomonas (which is often found in hot tubs and swimming pools). It can also be caused by a bacterium called Staphylococcus (Staph).

Damage to the Outer Ear Canal

Cleaning the ears or removing ear wax from the outer ear using cotton buds (Q-tips), fingernails, bobby pins, or other objects can damage the delicate skin lining of the ear canal and cause otitis externa. Devices such as hearing aids can also cause damage.

Chemical Irritation

Chemicals in shampoos, hairsprays, or hair dyes can enter the ear canal and can cause irritation and inflammation.

Middle Ear Infection

Sometimes, otitis externa infection occurs when an infection spreads from the middle ear (this is called otitis media).

Diabetes 

People with diabetes (high blood sugar) have more alkaline earwax, which promotes the growth of bacteria and fungi. 

Folliculitis

Infection of a hair follicle in the ear canal can progress into a more widespread infection in nearby tissue and beyond. Find out the most effective medications to treat folliculitis.

Narrowed Ear Canals 

People with narrowed ear canals have less effective ear drainage and are more prone to swimmer’s ear (otitis externa). 

Skin Conditions

A skin condition such as eczema or psoriasis can increase the risk of ear infections.

Symptoms of Swimmer’s Ear

Common swimmer’s ear symptoms include:

• Redness and swelling of the outer ear

• Itching

• Ear pain, which may be worse when you move your head or pull on your ear

• A feeling of fullness in the ear due to fluid, swelling, and debris

• Drainage of clear, odorless fluid

• Bad-smelling yellow or green pus draining from the ear

• Transient hearing loss (muffled hearing)

• Buzzing or humming noises in the ear

People with severe swimmer’s ear (otitis externa) may have fever, severe redness and swelling, severe ear pain radiating to the face and neck, complete blockage of the ear canal, and enlarged lymph nodes in the neck.

Is it Swimmer’s Ear or an Ear Infection?

Swimmer’s Ear vs. Middle Ear Infection

Swimmer’s ear (otitis externa) is an infection or inflammation of the outer ear. It is often caused by bacteria or fungi. An “ear infection” usually refers to otitis media, which is an infection or inflammation of the middle ear (behind the eardrum). It is often caused by bacteria or viruses that enter the middle ear from the throat through the eustachian tube, for example, after a sore throat or cold.

Risk Factors for Otitis Externa and Otitis Media

Common causes and risk factors for otitis externa are listed above. Otitis media mainly affects young children. They have a narrower and more horizontally placed eustachian tube which allows secretions to accumulate in the middle ear. As children get older, the anatomy of the eustachian tube changes, decreasing the risk of middle ear infections. 

Note: Children are at greater risk, but adults can also get middle ear infections. 

Key Differences in Symptoms 

Otitis externa can cause severe ear pain and muffled hearing. But, dizziness is usually not present because the outer ear is separated from the inner ear by the middle ear. Middle ear infections are more likely to cause fever and dizziness.

Treatment of Swimmer’s Ear vs Middle Ear Infection

Swimmer’s ear (otitis externa) is usually treated with ear drops containing antibiotics to kill bacteria and corticosteroids to reduce swelling. 

Middle ear infections (otitis media) cannot be treated with ear drops because the eardrum acts as a barrier and prevents the medicine from reaching the infected part of the ear. Therefore, antibiotics must be taken by mouth to treat a middle ear infection. 

Note: Antibiotics are not always necessary to treat middle ear infections. In some cases, they may resolve on their own in a few days. 

Will Swimmer’s Ear Infection Go Away By Itself?

Unfortunately, no, swimmer’s ear does not go away by itself and must be treated with antibiotics. Leaving an outer ear infection untreated can result in complications such as temporary hearing loss, chronic otitis externa (long-lasting infection), damage to the bone and cartilage, and more widespread infection. For example, malignant otitis externa is an infection of the external ear that progresses to the temporal bone - it’s common in older adults with diabetes. Learn “What Are the Different Types of Hearing Loss?”

How is Swimmer’s Ear Diagnosed?

Your healthcare provider can make a diagnosis of swimmer’s ear (otitis externa) by looking at your ear canal with a lighted instrument called an otoscope. They can also check your tympanic membrane to make sure it isn’t torn or damaged. 

How Is Swimmer’s Ear Treated?

Over-the-Counter Treatments

• Over-the-counter pain medicines, such as acetaminophen (Tylenol), ibuprofen (Motrin IB, Advil), or naproxen sodium (Aleve, Naprosyn), can help reduce discomfort and ease pain.

• Over-the-counter swimmer’s ear drops. These typically contain glycerin and isopropyl alcohol to dry out your ear faster. However, they do not treat the infection itself. For this reason, OTC ear drops do not work as well as prescription ear drops for swimmer’s ear which contain antibiotics and/or steroids.

Prescription Treatments for Swimmer’s Ear

• Cleaning: Your doctor will clean your ear with a suction device or scoop instrument to remove earwax, discharge, skin flakes, and other debris.

• Prescription ear drops: These ear drops contain one or more of the following ingredients:

  • An antibiotic to treat a bacterial infection.

  • An antifungal to treat a fungal infection.

  • A corticosteroid to reduce inflammation.

  • An antihistamine if you have signs of an allergic reaction.

  • A solution to restore the natural acidic antibacterial environment in your ear.

• Oral antibiotics to be taken by mouth for more advanced infections

• Prescription pain medicine for more severe pain.

Note: Combination antibiotic and steroid drops are available, such as ear drops containing ciprofloxacin and dexamethasone.

How to Use Swimmer’s Ear Drops?

Your doctor will prescribe ear drops to treat swimmer’s ear. To use the ear drops, lie on your side with the infected ear facing up. Pull your ear back and up and instill the prescribed dose into your ear. Remain lying down for a few minutes to allow the medicine to travel the entire length of your ear canal. 

If your ear is completely blocked, your doctor may use a wick, cotton ball, or gauze to help your ear drain and to instill the medication into your ear canal. 

Take the following precautions until your infection clears: 

• During showers and baths, use cotton balls or cotton swabs coated with petroleum jelly to plug your ears and prevent water from getting in. 

• Don't swim or go scuba diving until your symptoms are gone.

• Don't wear earplugs or hearing aids or use Q-tips.

Home Remedies for Swimmer’s Ear

Warm Compresses

Warm compresses can help ease the discomfort associated with swimmer’s ear. Wet a washcloth in warm (but not hot) water, wring out any excess water, and hold it over the infected ear for 10-15 minutes at a time, several times a day.

Vinegar and Alcohol Mixture

As long as you don’t have a torn eardrum, you can make ear drops at home to use before and after swimming to prevent swimmer’s ear. Mix equal parts white vinegar and rubbing alcohol. Pour approximately 5 mL (1 teaspoon) of the mixture into each ear and allow it to drain out. Over-the-counter products containing these ingredients are also available at pharmacies. These drops dry out your ears and prevent bacterial and fungal growth. 

How to Prevent Swimmer’s Ear?

• Wear ear plugs or a swimming cap that covers your ears while swimming. Wear a shower cap while showering to keep your ears dry. 

• Tilt your head to the side after bathing and swimming to help the water drain out.

• Gently dry your outer ears with a soft towel. You can also use a hair dryer on the lowest setting, but make sure you hold it at least 12 inches away from your ear. 

• Avoid swimming in lakes or rivers on days when there are warnings of high bacterial counts.

• Put a cotton swab in your ear when using hair products to protect your ear from chemical irritants. 

• Consult your healthcare provider before going swimming if you have recently had an ear infection, ear surgery, or neck surgery.

• Never put objects such as cotton buds (Q-tips), hair pins, or paper clips into your ear. These objects can push earwax deeper into your ear canal and cause breaks in the skin of the ear, making it more prone to infection. 

Frequently Asked Questions

What is the best antibiotic for swimmer's ear?

A combination ear drop containing ciprofloxacin and dexamethasone (brand name Ciprodex) is one of the best antibiotics to treat ear infections such as acute otitis externa. Ciprofloxacin is an antibiotic that kills the bacteria. Dexamethasone is a steroid that relieves redness, swelling, and itching caused by an ear infection.

What is the strongest antibiotic for an ear infection?

Some of the strongest antibiotics used to treat ear infections include ciprofloxacin, cefuroxime, cefdinir, and amoxicillin. Your doctor will choose the best antibiotic for your ear infection based on the severity of the infection and the specific type of bacteria causing it.

How long does it take to recover from swimmer’s ear?

In most people, swimmer’s ear (external otitis) clears up in 7-10 days. You need to avoid swimming or getting your ear wet while you recover from the infection. 

Do you need to go to the doctor for swimmer’s ear?

You need to go to the doctor for swimmer’s ear because this infection does not clear on its own. Your doctor can prescribe antibiotic ear drops to kill bacteria causing the infection. They can also give you an antifungal medication if your infection is caused by a fungus. It’s especially important to seek medical care if you have symptoms such as fever, severe ear pain, or decreased hearing. Keep your follow-up appointment with your doctor, even if you feel well so that they can make sure the infection is gone.