Otitis Externa: How to Treat Swimmer’s Ear
What is swimmer’s ear?
Otitis externa (or “swimmer’s ear”) is an infection of the outer ear canal—the tube that runs from the outer portion of the ear to the eardrum. The infection causes inflammation and pain in the ear canal.
It’s most common in children, but can happen to adults as well. Most of the time, it’s caused by a bacterial infection. You can expect to recover within a week with proper treatment.
Most common symptoms
Many patients are surprised that they “just” have an ear infection based on the amount of pain. There are multiple nerves that serve to the ear and eardrum, so a small amount of infection and inflammation in this area can cause a large amount of pain. —Dr. David Lee
The most common symptom of otitis externa is ear pain or itching that gets worse by pulling on the outer ear. There may be redness inside the ear.
You may feel like your ear is blocked and have trouble hearing. Sometimes, fluid leaks out of the ear canal. Some people develop a low-grade fever.
- Ear pain
- Ear itching
- Redness in the ear canal
- Temporary hearing loss
- Sensation of ear fullness
- Fluid draining out of the ear
What is the main cause of otitis externa?
The external ear canal gets moist easily, making it a good breeding ground for bacteria and fungus to grow. It is typically caused by bacteria, and less commonly, by fungus or a virus. The infection leads to inflammation, which causes the pain.
Treating swimmer’s ear
For busy swim seasons, like the summer, keep a small bottle with half vinegar and half rubbing alcohol in your swim bag. A couple drops in everyone’s ears after you're done swimming for the day can help prevent swimmer’s ear! —Dr. Lee
If needed, your doctor will clean any debris (such as dead skin) out of the ear.
For mild cases, you can use an over-the-counter or prescription ear drop. In most mild cases, a drop that combines steroids and an acidic chemical can clear it up.
For moderate cases of bacterial infection, an antibiotic drop may be added. If your ear canal is swollen, you may also need an ear wick (a piece of cotton that helps ear drops get into the entire ear canal).
For severe infections (or if your ear canal is very swollen), you may also need oral antibiotics.
If your doctor believes it’s a fungus infection, they will prescribe antifungal medication.
While recovering from otitis externa, keep your ears dry, even when showering. An easy way to keep the ears dry when showering is using a small cotton ball in your ear canal, and covering it with vaseline. Avoid using earbuds and hearing aids (if possible). Do not swim until your symptoms have completely improved, and you have talked to your doctor.
- Chronic irritation of the ear canal: This damages the skin inside the ear and makes it easier for bacteria to infect it. You can irritate your ear by repeatedly inserting things into it (like cotton swabs and fingers) and using devices that go in deep (like hearing aids and earbuds).
- Children: They are more likely to stick and leave objects in their ears, which can cause irritation and lead to infection.
- Frequent swimming: Bacteria like moist conditions.
- Skin conditions, including allergic skin reactions, psoriasis, and eczema.
- Anything that weakens your immune system due to a medical condition, such as diabetes or HIV.
- Exposure to radiation treatment.
Does otitis externa go away by itself?
My rule is “nothing in your ear that is smaller than your elbow.” Cotton swabs can cause microtrauma to the skin of the ear canal and predispose to further ear infections. The ear is a self-cleaning organ, and a small amount of wax is normal and healthy—it can prevent infections! —Dr. Lee
An ear infection doesn’t usually go away without treatment, and may get worse. If you think that you have otitis externa, call your doctor.
Call your doctor immediately or go to the ER if you have:
- Severe ear pain
- Pain or swelling around your ear
- Facial numbness
- Facial weakness
- Any mental status changes, like confusion, headaches, or blurry vision.
Otitis externa in children
Young children with ear pain will often pull on or frequently touch the affected ear. This can clue you in on a possible infection.
If your child has a fever, do not give them aspirin. Very young children should not be given NSAIDs (like ibuprofen) without talking to a doctor. You may give your child acetaminophen, following the package instructions.
Make sure to take the full course of medication as prescribed to help prevent the infection from returning. Your symptoms will most likely improve within 1 or 2 days of starting treatment, and completely go away within a week. Contact your doctor if your symptoms are getting worse, or if they don’t improve within 3 days of starting treatment.
- Avoid sticking anything like your finger or cotton swabs into your ear.
- Limit use of devices like earbuds.
- Allow ears to fully dry after going in water.
Daniel DuPont is from Wayne, Pennsylvania. He is a member of the Emergncy Residency class of 2022 Perelman School of Medicine at the University of Pennsylvania.