Swimmer's ear (also called otitis externa) is a painful condition of the visible or outer portion of the ear and ear canal (outer ear). Males and females of all ages are affected by otitis externa equally, but children and teenagers most frequently develop this type of ear infection.
Swimmer's ear is an infection in the outer ear canal, which runs from your eardrum to the outside of your head.It's often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth.
Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer's ear by damaging the thin layer of skin lining your ear canal.
Swimmer's ear is also known as otitis externa. The most common cause of this infection is bacteria invading the skin inside your ear canal. Usually you can treat swimmer's ear with eardrops. Prompt treatment can help prevent complications and more-serious infections.
Swimmer's ear symptoms are usually mild at first, but they may get worse if your infection isn't treated or spreads. Doctors often classify swimmer's ear according to mild, moderate and advanced stages of progression.
Mild signs and symptoms
Itching in your ear canal
Slight redness inside your ear
Mild discomfort that's made worse by pulling on your outer ear (pinna, or auricle) or pushing on the little "bump" (tragus) in front of your ear
Some drainage of clear, odorless fluid
More intense itching
More extensive redness in your ear
Excessive fluid drainage
Discharge of pus
Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
Decreased or muffled hearing
Severe pain that may radiate to your face, neck or side of your head
Complete blockage of your ear canal
Redness or swelling of your outer ear
Swelling in the lymph nodes in your neck
When to see a doctor
Contact your doctor if you're experiencing any signs or symptoms of swimmer's ear, even if they're mild.
Call your doctor immediately or visit the emergency room if you have:
- Severe pain
Swimmer's ear is an infection that's usually caused by bacteria commonly found in water and soil. Infections caused by a fungus or a virus are less common.
Your ear's natural defenses
Your outer ear canals have natural defenses that help keep them clean and prevent infection. Protective features include:
- Glands that secrete a waxy substance (cerumen). These secretions form a thin, water-repellent film on the skin inside your ear. Cerumen is also slightly acidic, which helps further discourage bacterial growth. In addition, cerumen collects dirt, dead skin cells and other debris and helps move these particles out of your ear. The waxy clump that results is the familiar earwax you find at the opening of your ear canal.
- Downward slope of your ear canal. Your ear canal slopes down slightly from your middle ear to your outer ear, helping water drain out.
How the infection occurs
If you have swimmer's ear, your natural defenses have been overwhelmed. Conditions that can weaken your ear's defenses and promote bacterial growth include:
- Excess moisture in your ear. Heavy perspiration, prolonged humid weather or water that remains in your ear after swimming can create a favorable environment for bacteria.
- Scratches or abrasions in your ear canal. Cleaning your ear with a cotton swab or hairpin, scratching inside your ear with a finger, or wearing headphones or hearing aids can cause small breaks in the skin that allow bacteria to grow.
- Sensitivity reactions. Hair products or jewelry can cause allergies and skin conditions that promote infection.
Factors that may increase your risk of swimmer's ear include:
- Swimming in water with elevated bacteria levels, such as a lake rather than a well-maintained pool
- A narrow ear canal — for example, in a child — that can more easily trap water
- Aggressive cleaning of the ear canal with cotton swabs or other objects
- Use of certain devices, such as headphones or a hearing aid
- Skin allergies or irritation from jewelry, hair spray or hair dyes
Swimmer's ear usually isn't serious if treated promptly, but complications can occur.
- Temporary hearing loss. You may experience muffled hearing that usually gets better after the infection clears up.
- Long-term infection (chronic otitis externa). An outer ear infection is usually considered chronic if signs and symptoms persist for more than three months. Chronic infections are more common if there are conditions that make treatment difficult, such as a rare strain of bacteria, an allergic skin reaction, an allergic reaction to antibiotic eardrops, or a combination of a bacterial and fungal infection.
- Deep tissue infection (cellulitis). Rarely, swimmer's ear may result in the spread of infection into deep layers and connective tissues of the skin.
- Bone and cartilage damage (necrotizing otitis externa). An outer ear infection that spreads can cause inflammation and damage to the skin and cartilage of the outer ear and bones of the lower part of the skull, causing increasingly severe pain. Older adults, people with diabetes or people with weakened immune systems are at increased risk of this complication. Necrotizing otitis externa is also known as malignant otitis externa, but it's not a cancer.
- More widespread infection. If swimmer's ear develops into necrotizing otitis externa, the infection may spread and affect other parts of your body, such as the brain or nearby nerves. This rare complication can be life-threatening.
The goal of treatment is to stop the infection and allow your ear canal to heal.
Cleaning your outer ear canal is necessary to help eardrops flow to all infected areas. Your doctor will use a suction device or ear curette to clean away any discharge, clumps of earwax, flaky skin and other debris.
Medications for infection
For most cases of swimmer's ear, your doctor will prescribe eardrops that have some combination of the following ingredients, depending on the type and seriousness of your infection:
- Acidic solution to help restore your ear's normal antibacterial environment
- Steroid to reduce inflammation
- Antibiotic to fight bacteria
- Antifungal medication to fight an infection caused by a fungus
Ask your doctor about the best method for taking your eardrops. Some ideas that may help you use eardrops include the following:
- Reduce the discomfort of cool drops by holding the bottle in your hand for a few minutes to bring the temperature of the drops closer to body temperature.
- Lie on your side with your infected ear up for a few minutes to help medication travel through the full length of your ear canal.
- If possible, have someone help you put the drops in your ear.
If your ear canal is completely blocked by swelling, inflammation or excess discharge, your doctor may insert a wick made of cotton or gauze to promote drainage and help draw medication into your ear canal.
If your infection is more advanced or doesn't respond to treatment with eardrops, your doctor may prescribe oral antibiotics.
Medications for pain
Your doctor may recommend easing the discomfort of swimmer's ear with over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others) or acetaminophen (Tylenol, others).
If your pain is severe or your swimmer's ear is at a more advanced stage, your doctor may prescribe a stronger medication for pain relief.
Helping your treatment work
During treatment, the following steps will help keep your ears dry and avoid further irritation:
- Don't swim or scuba dive.
- Avoid flying.
- Don't wear an earplug, hearing aid or headphones before pain or discharge has stopped.
- Avoid getting water in your ear canal when bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a bath.