What is swimmer’s ear?
The outer ear canal is lined with thin skin protected by a slightly acidic layer of earwax. Prolonged moisture, scratching or injury breaks this barrier, letting bacteria (often Pseudomonas or Staphylococcus) or fungi multiply, causing otitis externa. It is called swimmer’s ear because it is common after swimming, but it can occur in anyone, including people who never swim. It differs from a middle ear infection (otitis media), which sits behind the eardrum. See clogged ears and earwax blockage.
Symptoms
- Ear pain, often severe, worse on pulling the ear or pressing the tragus, and when chewing.
- Itching in the ear canal, often an early sign.
- Redness and swelling of the canal, sometimes narrowing it.
- Fluid or discharge: clear, then pus-like or smelly.
- Feeling of fullness and muffled hearing.
- Tender lymph nodes near the ear or neck.
- Fever in more severe cases.
- It usually affects one ear, but can affect both.
Causes and risk factors
- Water trapped in the ear from swimming, showering or humid climates.
- Cotton buds, fingers, keys or other objects that scratch the canal.
- Earwax removal, particularly with sharp tools, or removing protective wax by over-cleaning.
- Hearing aids, earbuds and earplugs that trap moisture or irritate.
- Skin conditions: eczema, dermatitis, psoriasis.
- Narrow ear canals or lots of ear hair or exostoses (surfers’ ear).
- Contaminated water, hot tubs or lakes.
- Diabetes and weakened immunity, which increase risk of severe infection.
Treatment
- Ear drops: antibiotic drops (such as ciprofloxacin, ofloxacin or neomycin-based) often with a steroid, for 7–10 days; antifungal drops if a fungus is involved.
- Cleaning (aural toilet) by a doctor using suction or a small wick when the canal is blocked by debris or swelling.
- Wick: a small sponge placed in the canal to carry drops when swollen.
- Pain relief: paracetamol or ibuprofen; a warm (not hot) compress on the ear can ease pain.
- Oral antibiotics only for severe infection, spread beyond the canal, fever, or in people at high risk.
- Keep the ear dry during treatment: cover with a cotton ball and petroleum jelly when showering and avoid swimming for 7–10 days or as advised.
- Use drops exactly as prescribed: lie on your side for 3–5 minutes after instilling them.
Home care and what to avoid
- Do not insert cotton buds, fingers or any object in the ear.
- Do not use hydrogen peroxide, alcohol or home remedies in a painful ear without advice, particularly if the eardrum may be perforated.
- Do not remove earwax or irrigate the ear if you have pain, discharge or a known perforation.
- Keep the ear dry while it heals.
- Avoid earplugs, hearing aids and earphones until healed, or clean them well.
- Take pain relief as needed.
- See can you swim with an ear infection for return-to-water advice and cómo sacar agua del oído (Spanish).
How long does it last?
With proper treatment, pain typically starts to improve within 48–72 hours and most cases clear in 7–10 days. Swelling and hearing may take a little longer to return to normal. If there is no improvement after 3 days of drops, if symptoms worsen, or if the problem recurs, a doctor should re-examine the ear because of wrong diagnosis, resistant organisms, fungal infection, allergy to drops or an underlying skin problem.
Prevention
- Dry your ears gently after swimming or showering: tilt the head, pull the earlobe, and use a towel on the outer ear; a hairdryer on low and cool setting at a distance can help.
- Use earplugs or a swim cap for frequent swimmers.
- Avoid cotton buds and do not over-clean wax.
- Preventive drying drops (acetic acid or alcohol-based) may help frequent sufferers, if the eardrum is intact and your doctor agrees.
- Treat eczema and dermatitis.
- Clean hearing aids and earbuds regularly.
- Avoid swimming in polluted water or hot tubs that are poorly maintained.
Swimmer’s ear versus other ear problems
- Middle ear infection: pain deeper in the ear, often with a cold, fever and muffled hearing; pulling the ear does not hurt more. See ear fullness.
- Eustachian tube dysfunction: pressure and popping without pain on touch. See Eustachian tube dysfunction.
- Earwax blockage: fullness and reduced hearing, usually painless.
- Fungal otitis externa: intense itching, black or grey spots, after antibiotics or humid conditions.
- Jaw or dental problems: ear pain referred from the jaw. See ear pain when swallowing.
When to see a doctor
- Ear pain with discharge, fever or hearing loss.
- Severe or worsening pain, swelling or redness around the ear.
- Diabetes, weakened immunity or previous ear surgery.
- Ear grommets or a known perforated eardrum.
- No improvement after 48–72 hours of treatment.
- Recurring episodes.
- Facial weakness, severe headache or dizziness: urgent.
Three common situations
A swimmer with an itchy, painful ear after a holiday: likely swimmer’s ear; see a doctor for drops and keep the ear dry.
An older adult with diabetes and severe ear pain at night: needs prompt assessment for necrotising otitis externa.
A child with ear pain, a cold and fever, but no pain on tugging the ear: more likely a middle-ear infection.
Key points to remember
Swimmer’s ear is a common infection of the outer ear canal, treated with ear drops and keeping the ear dry. Avoid cotton buds, dry the ears after swimming and see a doctor for severe pain, discharge or risk factors. Our ENT team can clean and treat the ear.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about swimmer’s ear
These answers are general information and do not replace an examination or individual medical advice.
What are the first signs of swimmer’s ear?
Itching in the ear canal, followed by pain, redness and fullness.
How is swimmer’s ear treated?
Usually with prescription antibiotic or antibiotic-steroid ear drops for 7–10 days and keeping the ear dry.
Can swimmer’s ear go away on its own?
Mild cases may, but most need treatment to resolve fully.
Is swimmer’s ear contagious?
No, it is not spread person to person.
How long should I avoid swimming?
About 7–10 days or until your doctor says it is healed.
How do I prevent swimmer’s ear?
Dry your ears after water exposure, avoid cotton buds and use earplugs if you swim often.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.