Swimmer’s ear

Swimmer’s ear is an infection in the outer ear canal. The outer ear canal runs from the eardrum to the outside the head. Swimmer’s ear is often brought on by water that stays in the ear. The moisture helps bacteria grow.

Putting fingers, cotton swabs or other objects in the ears can damage the thin layer of skin lining the ear canal. This also can lead to swimmer’s ear.

Swimmer’s ear also is called otitis externa. Ear drops usually can treat swimmer’s ear. Treating swimmer’s ear quickly can help prevent complications and more-serious infections.

Swimmer’s ear symptoms are usually mild at first. But they can get worse if the infection isn’t treated or spreads. Doctors often classify swimmer’s ear as mild, moderate and advanced.

Mild symptoms

• Itching in the ear canal.
• Slight redness inside the ear, which might be hard to see on Black or brown skin.
• Mild discomfort that’s made worse by pulling on the outer ear, called the pinna or auricle, or pushing on the little bump in front of the ear, called the tragus.
• Fluid coming from the ear.

Moderate symptoms

• Worse itching.
• Increasing pain.
• Feeling of fullness inside the ear and a partial blocking of the ear canal by swelling, fluid and debris.
• Decreased or muffled hearing.

Advanced symptoms

• Severe pain that might radiate to the face, neck or side of the head.
• Completely blocked ear canal.
• Redness or swelling of the outer ear. Redness might be hard to see on Black or brown skin.
• Swelling in the small round or bean-shaped clusters of cells, called lymph nodes, in the neck.
• Fever.

Make an appointment to get medical help for even mild symptoms of swimmer’s ear.

Get urgent medical help or go to an emergency room for:

• Severe pain.
• Fever.

Swimmer’s ear is an infection that’s usually caused by bacteria. It’s less common for a fungus or virus to cause swimmer’s ear.

The ear’s natural defenses

The outer ear canals have built-in ways of staying clean and free of infection:

• A thin film lines the ear canal, which helps keep water out and bacteria from growing. Earwax, also called cerumen, is a buildup of this waxy film, dead skin cells and other debris that travels to the opening of the ear canal to keep it clean.
• The outer ear, mainly around the opening of the ear canal, helps keep things from going into the ear.

How the infection occurs

Having swimmer’s ear means the ear’s natural defenses have not worked well. The conditions that often play a role in infection include:

• Moisture in the ear canal that makes an ideal place for bacteria to grow.
• Contact with contaminated water.
• Damage to the skin of the ear canal, which can be an entry point for bacteria.

The following can increase the risk of swimmer’s ear:

• Water in the ear canal. This can be from heavy sweating, ongoing humid weather or water left in the ear after swimming.
• Contact with bacteria in water.
• Cleaning the ear canal with cotton swabs, hairpins or fingernails. This can lead to scratches or sores.
• Ear devices, such as earbuds or hearing aids. These can cause tiny breaks in the skin.
• Eczema or other itchy skin conditions.

Swimmer’s ear usually isn’t serious if treated quickly. But complications that can happen include:

• Short-term hearing loss. Hearing might be muffled. It usually gets better after the infection clears.
• Long-term infection, called chronic otitis externa. This involves symptoms of outer ear infection that last for more than three months. Chronic infections are more common if treatment is hard. Treatment can be hard when there is a rare strain of bacteria, an allergic skin reaction, an allergic reaction to antibiotic ear drops, a skin condition such as dermatitis or psoriasis, or a combined bacterial and fungal infection.
• Deep tissue infection, called cellulitis. Rarely, swimmer’s ear can spread deeper into the skin.
• Bone and cartilage damage, called early skull base osteomyelitis. This is a rare complication of swimmer’s ear. It happens if the infection spreads to the firm tissue of the outer ear, called cartilage, and bones of the lower part of the skull. This causes severe pain that gets worse. Being older or having diabetes or a weakened immune system raises the risk of this complication.
• Infection that goes beyond the ear. If advanced skull base osteomyelitis happens because of swimmer’s ear, the infection can spread and affect other parts of the body. These can include the brain or nearby nerves. This rare complication can be fatal.

Follow these tips to avoid swimmer’s ear:

• Keep ears dry. After swimming or bathing, tip your head from side to side with the ear on each side facing down. This helps water drain from the ear canal.

  Dry only the outer ear by wiping it gently with a soft towel. You also can safely dry the outer ear canal with a blow dryer. Use the lowest setting and hold it at least 1 foot (about 0.3 meters) away from the ear.

• At-home treatment to prevent swimmer’s ear. If you know you don’t have a punctured eardrum, you can make ear drops by mixing 1 part white vinegar to 1 part rubbing alcohol. Using this mixture helps the ear dry and prevents the growth of bacteria and fungi.

  Before and after swimming, pour 1 teaspoon (about 5 milliliters) of the mixture into each ear. Let it drain back out.

• Swim wisely. Don’t swim in lakes or rivers when you see posted warnings of high bacteria counts.
• Protect your ears while swimming. Wear earplugs or a swimming cap while swimming to keep your ears dry.
• Protect your ears from chemicals. Put cotton balls in your ears while using products such as hair sprays and hair dyes.
• Take care after an ear infection or surgery. If you’ve recently had an ear infection or ear surgery, talk to your healthcare professional before swimming.
• Don’t put objects in your ear. Never try to scratch an itch or dig out earwax with items such as a cotton swab, paper clip or hairpin. Using these items can drive debris deeper into the ear canal, disturb the skin inside the ear or break the skin.

What to do about earwax

Earwax usually moves to the opening of the ear canal. There it’s easy to wash away with a damp cloth. It’s best to leave it alone and let earwax do its job.

If you have too much earwax or it’s blocking your ear canal, you can do two things rather than digging it out. See your healthcare professional or use an at-home cleaning method. Follow these steps for safe at-home cleaning:

• Soften the wax. Use an eyedropper to put a few drops of baby oil, mineral oil, glycerin or diluted hydrogen peroxide in your ear canal.
• Use warm water. After a day or two, when the wax is softened, use a rubber-bulb syringe to squirt warm water into your ear canal. Tilt your head and pull your outer ear up and back to straighten your ear canal. Then tip your head to the side to let the water drain out.
• Dry your ear canal. When finished, gently dry your outer ear with a towel or a blow-dryer on a low setting.

A healthcare professional usually can diagnose swimmer’s ear during an office visit. An advanced or lasting infection might need more testing.

First steps

Your healthcare professional is likely to diagnose swimmer’s ear based on your symptoms, answers to questions and an exam. The exam might include:

• Looking at the ear canal with a lighted tool called an otoscope. The ear canal might appear red, swollen and scaly. Redness might be hard to see on Black or brown skin. There might be skin flakes or other debris in the ear canal.
• Looking at the eardrum, also called the tympanic membrane. This is to be sure it isn’t torn or damaged. If the view of the eardrum is blocked, a healthcare professional will clear the ear canal with a small suction device or a tool with a tiny loop or scoop on the end.

Further testing

More testing, if needed, might include sending a sample of fluid from the ear to look for bacteria or a fungus.

Also:

• If the eardrum is damaged or torn, your healthcare professional is likely to refer you to an ear, nose and throat (ENT) specialist. These specialists can use special tools to clean ears with damaged membranes.
• If the infection doesn’t get better with treatment, your healthcare professional might take a sample of discharge or debris from your ear and send it to a lab. That’s to look for what’s causing the infection.

The goal of treatment is to stop the infection and let the ear canal heal.

Cleaning

Cleaning the outer ear canal helps ear drops get to all infected areas. A healthcare professional will use a suction device or ear curet to clean away discharge, clumps of earwax, flaky skin and other debris.

Medicines for infection

Most often, ear drops that have a mix of the following can treat the infection:

• An acidic solution to help restore the ear’s natural defenses.
• A steroid to reduce swelling and irritation, called inflammation.
• An antibiotic to fight bacteria.
• An antifungal medicine to fight infection caused by a fungus.

Ask your healthcare professional about the best way to put in ear drops. Here are some tips that might help:

• Warm the drops by holding the bottle in your hand for a few minutes. This will bring the temperature of the drops closer to body temperature.
• If possible, have someone help you put the drops in your ear.
• Lie on your side with your infected ear up for a few minutes after you put in the drops. This helps the medicine travel through the full length of the ear canal.
• To put drops in someone else’s ear, pull the earlobe down.

For an ear canal that’s blocked, a healthcare professional might put a wick made of cotton or gauze into the ear. This can help the ear drain and help medicines get to the ear canal.

If the infection is more advanced or ear drops don’t clear it up, your healthcare professional might prescribe antibiotics that you take by mouth.

Medicines for pain

Pain relievers that you can get without a prescription might ease the discomfort of swimmer’s ear. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and acetaminophen (Tylenol, others).

Helping the treatment work

During treatment, keep your ears dry to help them heal.

• Don’t swim or go scuba diving.
• Don’t wear an earplug, a hearing aid or earbuds until pain and discharge stop.
• Don’t get water in your ear canal when showering or bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a shower or bath.

Here are some suggestions to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they started.
• All medications, vitamins and supplements you take, including doses.
• Your allergies, such as skin reactions or medicine allergies.
• Questions to ask your healthcare professional.

Some basic questions to ask about swimmer’s ear include:

• What is likely causing problems with my ear?
• What is the best treatment?
• When should I expect to start getting better?
• Do I need to make a follow-up appointment?
• How can I keep from getting swimmer’s ear again?
• Do you have brochures or other printed material I can have? What websites do you recommend?

Be sure to ask all the questions you have about swimmer’s ear.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, including:

• Have you been swimming lately?
• Do you swim often?
• Where do you swim?
• Have you ever had swimmer’s ear before?
• Do you use cotton swabs or other objects to clean your ears?
• Do you use earbuds or other ear devices?
• Have you had any other recent ear exams or procedures?