Article Sections
Definition
Swimmer's ear is an infection of the ear canal. In most cases, bacteria cause this infection in the thin layer of skin lining the canal.
Your ears' protective features work best when they are dry. If your ear canals are exposed to excess moisture — for example, if you swim a lot — they're more likely to become infected. Swimmer's ear is also known as acute external otitis or otitis externa.
Swimmer's ear is usually easily treated. Prompt treatment of swimmer's ear can help prevent the development of more-serious complications and infections.
Symptoms
Swimmer's ear symptoms are usually mild at the onset of swimmer's ear, but they may get worse if the infection isn't treated or spreads.
First signs and symptoms
- Itching in ear canal
- Slight redness of skin in ear canal
- Mild discomfort
- Some drainage of odorless fluid
Moderate disease progression
- Redness of skin
- Excessive fluid drainage
- Discharge of pus
- Pain that worsens on moving your outer ear (pinna, or auricle) or pushing on the little "bump" (tragus) in front of your ear
- Feeling of fullness in your ear
- Decreased or muffled hearing
Severe disease progression
- Severe pain
- Swelling in your ear or lymph nodes in your neck
- Redness or swelling of outer ear
- Scaly or flaking skin of outer ear
When to see a doctor
See a doctor if you're experiencing any signs or symptoms of swimmer's ear, even if they are mild. If you're experiencing severe pain or have a fever, call your doctor right away or visit the emergency room.
Causes
Your ear canals have features that help keep them clean and prevent infection. Glands in the canal secrete a waxy substance (cerumen) that provides protection through several means:
- Cerumen creates a thin, water-repelling film on the skin of the ear canal.
- It's an acidic substance, which creates an unfriendly environment for bacterial growth.
- It contains some proteins that act as mild antibacterial agents.
- It collects dirt, dead skin cells and other debris and transports them out of the ear canal. This waxy clump is the familiar earwax you find at the opening of your ear canal.
Another protective feature of the ear canal is its shape. The canal slopes slightly downward from the middle ear to the outer ear. This helps water drain out of the ear.
A breakdown of defenses
If you have swimmer's ear, the defenses of the ear canal have been overrun. Bacteria have easier access to the skin of the inner ear if:
- Excess moisture in the ear — from a lot of swimming, trapped water or humid weather — has thinned out the cerumen and made it less acidic.
- There's a break or abrasion in the skin from scratching with a cotton swab, hairpin or other object in the ear.
- You have a rash caused by sensitivity to hair products or jewelry.
Swimmer's ear is most often an infection caused by bacteria that are common in the environment. Infections caused by fungi or viruses are less common.
Risk factors
Factors that may increase your risk of swimmer's ear include:
- Swimming
- Swimming in water with higher bacteria levels, such as a lake rather than a well-maintained pool
- Small ear canal, such as a child's ear canal, that can trap water more easily
- Excessive earwax that traps water in the ear canal
- Excessive cleaning of the ear canal
- Scraping or scratching of the ear canal with objects, such as cotton swabs
- Devices that may trap water, such as a hearing aid or swim cap
- Skin allergies from jewelry or other allergic agents
- Skin irritation from hair spray or hair dyes
Complications
Swimmer's ear usually isn't serious, but complications such as the following can occur:
- Temporary hearing loss. You may experience muffled hearing that usually goes away when the infection clears up.
- Long-term infections (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 an antibiotic, or a combination of a bacterial and fungal infection.
- Deep skin infection (cellulitis). Chronic 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. Another term for necrotizing otitis externa is malignant otitis externa, but it isn't a cancer (malignant).
- 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 infection can be life-threatening.
Preparing for your appointment
You're likely to see your family doctor or a general practitioner for treatment of an ear infection. Because appointments can be brief, it's a good idea to be prepared for your appointment.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to problems with your ears.
- Bring a list of all medications, as well as any vitamins or supplements, that you're taking.
- Write down any known allergies, such as skin allergies or drug allergies.
- Write down questions to ask your doctor.
If you're experiencing any signs or symptoms of swimmer's ear, some basic questions to ask your doctor include:
- What is likely causing problems with my ear?
- What is the best treatment?
- When should I expect improvement?
- Do I need to make a follow-up appointment?
- If I have swimmer's ear, how can I prevent getting it again?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you some of the following questions:
- When did you first begin experiencing symptoms?
- Have the symptoms changed?
- Have you ever had swimmer's ear before?
- How often is your ear exposed to water?
- Where have you gone swimming?
- How do you clean your ears?
- Have you put any devices or objects in your ear?
What you can do in the meantime
Before your appointment, keep your ear as dry as possible and don't go swimming.
To treat pain, you may take a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others), or an analgesic pain reliever such as acetaminophen (Tylenol, others).
Tests and diagnosis
Your doctor will likely be able to make a diagnosis based on questions he or she asks and an examination of your ear canal with a lighted instrument (otoscope). Your ear canal may appear red, swollen and scaly. Flakes of skin and other debris may be present in the ear canal.
Your doctor will also want to see the condition of the eardrum (tympanic membrane) to be sure it isn't damaged. If the view of the eardrum is blocked, he or she will clear the ear canal with a small suction device or an instrument with a tiny loop or scoop on the end (ear curette).
If your eardrum is damaged or torn, your doctor will likely refer you to an ear, nose and throat specialist (ENT, or otolaryngologist). The specialist will examine the condition of your middle ear and determine if the primary site of infection is there. This examination is important because some treatments intended for an infection in the ear canal aren't appropriate for treating the middle ear.
There probably won't be any need for a lab test at your first visit. If the infection doesn't respond to treatment, your doctor may take a sample of discharge or debris from your ear at a later appointment. This sample would be sent to a lab for identifying the exact cause of your infection.
Treatments and drugs
The goal of treatment is to stop the infection and allow your ear canal to heal.
Cleaning
Your doctor will use a suction device or ear curette to clean away any discharge, clumps of earwax, flaky skin and any other debris. Cleaning is necessary to help medications get to the infected areas of the skin.
Medications
Your doctor may prescribe eardrops that have some combination of the following ingredients, depending on the type and seriousness of the infection:
- Acidic solution to replicate your ear's normally acidic, antibacterial environment
- Steroid to reduce inflammation
- Antibiotic to fight the bacterial infection
- Antifungal medication to fight a fungal infection
Ask your doctor about the best method for taking the medication. Some ideas that may help include the following:
- To reduce discomfort of relatively cold drops in your ear, you can warm the eardrop solution by holding the bottle in your hand for a few minutes to bring it closer to your body temperature.
- If possible, have someone else put the drops in your ear.
- Lie down on your side with the infected ear up to help the medication travel to the site of the infection in your ear canal.
- Put a cotton ball in the "pocket" of your outer ear to absorb any excess fluid after you sit or stand up.
- If your ear canal is blocked by inflammation or excess discharge, your doctor may insert a wick that helps transport the medication into the ear canal.
If the infection is more advanced or doesn't respond to treatment with eardrops, your doctor may prescribe oral antibiotics.
Other treatments
You will need to keep your ear dry and avoid any irritation of the ear while you're treating swimmer's ear.
- Don't swim or scuba dive.
- Avoid flying.
- Don't wear an earplug or hearing aid 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 baths.
Prevention
Follow these tips to avoid swimmer's ear:
- Keep your ears dry. Dry your ears thoroughly after exposure to moisture from swimming or bathing. Dry only your outer ear slowly and gently with a soft towel or cloth. Tip your head to the side to help water drain from your ear canal. You can dry your ears with a blow-dryer if you put it on the lowest setting and hold it at least a foot (0.3 meter) away from the ear.
- At-home preventive treatment. If you know you don't have a punctured eardrum, you can use a homemade preventive eardrop before and after swimming. A mixture of 1 part white vinegar and 1 part rubbing alcohol may help prevent the growth of bacteria and fungi that can cause swimmer's ear. Pour 1 teaspoon (5 milliliters) of the solution into each ear and let it drain back out. Similar over-the-counter solutions may be available at your drugstore.
- Swim wisely. Avoid swimming in polluted water.
- Avoid putting foreign objects in your ear. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. Using these items can pack material deeper into your ear canal, irritate the thin skin inside your ear or scratch the skin.
- Protect your ears. Avoid substances that may irritate your ears, such as hair sprays and hair dyes. Or put cotton balls in your ears when applying these products.
- Use caution after ear infection or surgery. If you've recently had an ear infection or ear surgery, talk to your doctor before you swim.
Last Updated: 2008-10-16
