Swimmer's ear

Overview

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, creating a moist environment that aids the growth of bacteria.

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. Usually you can treat swimmer's ear with eardrops. Prompt treatment can help prevent complications and more-serious infections.

Symptoms

Swimmer's ear symptoms are usually mild at first, but they can worsen 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" in front of your ear (tragus)
• Some drainage of clear, odorless fluid

Moderate progression

• More-intense itching
• Increasing pain
• More-extensive redness in your ear
• Excessive fluid drainage
• Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
• Decreased or muffled hearing

Advanced progression

• Severe pain that might 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
• Fever

When to see a doctor

Contact your doctor if you have even mild signs or symptoms of swimmer's ear.

Call your doctor immediately or visit the emergency room if you have:

• Severe pain
• Fever

Causes

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.

Your ear's natural defenses

Your outer ear canals have natural defenses that help keep them clean and prevent infection. Protective features include:

• A thin, water-repellent, slightly acidic film lines the ear canal and discourages bacterial growth. Earwax (cerumen) is an accumulation 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, particularly around the opening of the ear canal, helps prevent foreign bodies from entering.

How the infection occurs

If you have swimmer's ear, your natural defenses have been overwhelmed. The conditions that often play a role in infection include:

• Moisture in the ear canal that creates an ideal environment for bacterial growth
• Exposure to contaminated water
• Damage to the sensitive skin of the ear canal that creates an opening for infection

Risk factors

Factors that can increase the risk of swimmer's ear include:

• Excess moisture in your ear canal from heavy perspiration, prolonged humid weather or water remaining in the ear after swimming
• Exposure to high bacteria levels in contaminated water
• Cleaning the ear canal with cotton swabs, hairpins or fingernails, which can cause scratches or abrasions
• Ear devices, such as earbuds or hearing aids, which can cause tiny breaks in the skin

Complications

Swimmer's ear usually isn't serious if treated promptly, but complications can occur.

• Temporary hearing loss. You might have muffled hearing that usually gets better after the infection clears.
• 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, a skin condition such as dermatitis or psoriasis, or a combination of a bacterial and a fungal infection.
• Deep tissue infection (cellulitis). Rarely, swimmer's ear can spread into deep layers and connective tissues of the skin.
• Bone and cartilage damage (early skull base osteomyelitis). This is a rare complication of swimmer's ear that occurs as the infection spreads to the 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.
• More-widespread infection. If swimmer's ear develops into advanced skull base osteomyelitis, the infection can spread and affect other parts of your body, such as the brain or nearby nerves. This rare complication can be life-threatening.

Prevention

Follow these tips to avoid swimmer's ear:

• Keep your ears dry. After swimming or bathing, tip your head to the side to help water drain from your ear canal. Dry only your outer ear, wiping it gently with a soft towel. You can safely dry your outer ear canal with a blow-dryer if you put it on the lowest setting and hold it at least a foot (about 0.3 meters) away from the ear.
• At-home preventive treatment. If you know you don't have a punctured eardrum, you can use homemade preventive eardrops of 1 part white vinegar to 1 part rubbing alcohol. This solution promotes drying and helps prevent the growth of bacteria and fungi. Before and after swimming, pour 1 teaspoon (about 5 milliliters) of the solution into each ear and let it drain back out. Similar over-the-counter solutions might be available at your drugstore.
• Swim wisely. Don't swim in lakes or rivers on days when warnings of high bacteria counts are posted.
• Protect your ears while swimming. Wear earplugs or a swimming cap while swimming to keep your ears dry.
• Protect your ears from irritants. Put cotton balls in your ears while applying products such as hair sprays and hair dyes.
• Use caution after an ear infection or surgery. If you've recently had an ear infection or ear surgery, talk to your doctor before swimming.
• Avoid putting foreign objects in your ear. Never attempt to scratch an itch or dig out 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 break the skin.

What to do about earwax

Earwax usually moves to the opening of the ear canal, where you can gently wash it away with a damp cloth. It's best to leave it alone and let earwax do its job.

If you have an excess of earwax or it's blocking your ear canal, you can do two things rather than digging it out. See your doctor or use an at-home cleaning method. Follow these steps for safe at-home cleaning:

• Soften the wax. Use an eyedropper to apply 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 gently squirt warm water into your ear canal. Tilt your head and pull your outer ear up and back to straighten your ear canal. When finished irrigating, 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 blow-dryer.

Diagnosis

Doctors can usually diagnose swimmer's ear during an office visit. If your infection is advanced or persists, you might need further evaluation.

Initial testing

Your doctor will likely diagnose swimmer's ear based on symptoms you report, questions he or she asks, and an office examination. You probably won't need a lab test at your first visit. Your doctor's initial evaluation will usually include:

• Examining your ear canal with a lighted instrument (otoscope). Your ear canal might appear red, swollen and scaly. There might be skin flakes or other debris in the ear canal.
• Looking at your eardrum (tympanic membrane) to be sure it isn't torn or damaged. If the view of your eardrum is blocked, your doctor will clear your ear canal with a small suction device or an instrument with a tiny loop or scoop on the end.

Further testing

Depending on the initial assessment, symptom severity or the stage of your swimmer's ear, your doctor might recommend additional evaluation, including sending a sample of fluid from your ear to test for bacteria or fungus.

In addition:

• If your eardrum is damaged or torn, your doctor will likely refer you to an ear, nose and throat specialist (ENT). The specialist will examine the condition of your middle ear to determine if that's the primary site of infection. This examination is important because some treatments intended for an infection in the outer ear canal aren't appropriate for treating the middle ear.
• If your infection doesn't respond to treatment, your doctor might take a sample of discharge or debris from your ear at a later appointment and send it to a lab to identify the microorganism causing your infection.

Treatment

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

Cleaning

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 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 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.
• To put drops in a child's or adult's ear, pull the ear up and back.

If your ear canal is completely blocked by swelling, inflammation or excess discharge, your doctor might 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 might prescribe oral antibiotics.

Medications for pain

Your doctor might recommend easing the discomfort of swimmer's ear with over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others).

If your pain is severe or your swimmer's ear is more advanced, your doctor might prescribe a stronger medication for pain relief.

Helping your treatment work

During treatment, do the following to help keep your ears dry and avoid further irritation:

• Don't swim or go scuba diving.
• Don't wear an earplug, a hearing aid or earbuds before pain or discharge has stopped.
• Avoid getting 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.

Preparing for your appointment

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 drug allergies
• Questions to ask your doctor

Some basic questions to ask your doctor about swimmer's ear 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 keep from getting it again?
• Do you have brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor 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 examinations or procedures?