Swimmer’s ear, or acute otitis externa, is a painful infection in the skin of the outer ear canal.

What causes swimmer’s ear?

When moisture gets trapped in the ear canal, bacterial or fungal organisms can proliferate.

Swimmer’s ear commonly occurs in children and teenagers, and also those with eczema, highly sensitive or allergic skin, excessive earwax, and those who wear hearing aids or earbuds. Risk factors that may contribute to swimmer’s ear include:

  • Impacted earwax
  • Small ear canals
  • Swimming in lakes and rivers
  • Use of ear plugs, earbuds or hearing aids
  • Eczema (allergic dermatitis) of the ear canal
  • Small scratches from cotton swabs or bobby pins
  • Chemical irritants such as hair sprays or dyes

What are the signs and symptoms?

The cardinal symptom of swimmer’s ear is intense itching or pain that worsens when you tug on your earlobe. Your doctor may see redness, swelling or drainage from your ear canal. If the canal is severely swollen or full of wax, you may experience pressure or hearing loss. Diabetics, the elderly and those with weakened immune systems are at greater risk for such complications.

You should seek immediate medical attention for any of the following:

  • Fever
  • Drainage
  • Severe pain
  • Tender to touch
  • Decreased hearing
  • Visible redness of the ear
  • Swelling around the ear

How is otitis externa treated?

Otitis externa is generally treated with antimicrobial drops placed directly into the ear canal.  Systemic or oral antibiotics are rarely necessary. Many brands of ear drops contain a steroid to decrease pain and swelling. Ear drops containing the antibiotic ciprofloxacin or ofloxacin are generally the safest. A popular brand containing neomycin and polymyxin is effective, but it also causes frequent allergic responses and can damage your hearing if you have a hole in your eardrum. When you instill ear drops, lay on your side with the affected ear up for 15 minutes to allow the medication to penetrate. Massage the ear to get the air bubbles out. It may be helpful to have a companion place the drops in your ear for you.

Swimmer’s ear is one of the few common illnesses for which immediate referral to a specialist is strongly recommended. The ENT specialist has a microscope and tiny tools to gently clean the wax and infected debris out of your ear canal. Thorough cleaning removes germs and allows prescription ear drops to absorb directly into the skin. The ENT specialist can also determine if the eardrum is intact or perforated, and can submit a culture to look for unusual or resistant organisms.  If the canal is swollen shut, the otolaryngologist may place a small sponge in the canal to wick the medication. This will need to be removed in 2-3 days.

Preventing Swimmer’s Ear

  • Don’t put anything smaller than your elbow in your ear
  • Avoid ear plugs that retain moisture or push wax deeper into the ear canal
  • Dry your ears with a towel or hair dryer immediately after swimming or bathing
  • Use alcohol drops mixed with boric acid or vinegar after swimming to remove excess moisture, kill germs and restore a healthy pH to the skin (don’t use with a damaged eardrum!)
  • Schedule periodic ear cleaning with your ENT provider if you have excessive earwax, itchy or flaky ears

More information on how to safely clean your ears

© 2020 Richmond ENT.  Mike Armstrong MD, Michaela Bailey, Bill Wilkes MD