Swimmer's ear (otitis externa) is a painful inflammation and infection of the ear canal. It occurs when the protective film that covers the ear canal (lipid layer) is removed. This causes the ear canal to look red and swollen. The ear canal may be narrower than normal and is tender when the outside of the ear is gently pulled up and back.
Swimmer's ear may develop when water, sand, dirt, or other debris gets into the ear canal. Since it often occurs when excess water enters the ear canal, a common name for this inflammation is "swimmer's ear." If you have had swimmer's ear in the past, you are more likely to get it again.
A rare but serious infection called malignant external otitis can develop if bacteria invade the bones inside the ear canal and spread to the base of the skull. Not many people get this infection—it is mainly seen in older adults who also have diabetes, people who have HIV, and children who have impaired immune systems—but it can be fatal. Symptoms include ear pain with sudden facial paralysis, hoarseness, and throat pain. Antibiotics are used to treat this infection.
Other causes of inflammation or infection of the ear canal include:
- Bony overgrowths in the ear canal called exostoses.
- Bubble baths, soaps, and shampoos.
- Cleaning the ear canal harshly or with a sharp object.
- Headphones inserted into the ear.
- Scratching the ear canal with a cotton swab, bobby pin, fingernail, or other sharp object.
- Skin problems, such as eczema, psoriasis, or seborrhea.
You are more likely to get swimmer's ear if:
- You have a very narrow or hairy ear canal.
- You have earwax stuck in the ear canal (impacted) because you commonly use cotton swabs that may push the ear wax deeper into the ear canal.
Symptoms can include itching, pain, and a feeling of fullness in the ear. Your ear canal may be swollen. You may have moderate to severe pain, drainage, or hearing loss. Unlike a middle ear infection (acute otitis media), the pain is worse when you chew, press on the "tag" in front of the ear, or wiggle your earlobe.
You may be able to prevent swimmer's ear. Symptoms often get better or go away with home treatment.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and you may have trouble standing, walking, or keeping your balance.
Symptoms of an infection in the ear canal (swimmer's ear) may include:
- Pain, especially when you touch your ear, wiggle your earlobe, or chew.
- Redness or swelling in the ear canal.
- Drainage from the ear.
Symptoms of an inner ear infection may include:
- Pain deep in the ear. (External ear infections may itch or hurt in the outer part of the ear, but not deep in the ear.)
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Some home treatment can help swimmer's ear. But it is important to see a doctor first. If your doctor says it's okay, you can try the following:
- Gently rinse your ear using a bulb syringe and a mixture of equal parts white vinegar and rubbing alcohol. Make sure the flushing solution is body temperature. Inserting cool or hot fluids in the ear may cause dizziness.
- If your ear is itchy, try non-prescription swimmer's eardrops, such as Auro-Dri. Use them before and after swimming or getting your ears wet. Read and follow all instructions on the label, and learn how to insert eardrops safely.
- To ease ear pain, apply a warm face cloth or a heating pad set on low. There may be some drainage when the heat melts earwax. For more information about earwax removal, see the topic Earwax.
- Do not use a heating pad when you are in bed. You may fall asleep and burn yourself.
- Do not use a heating pad on a child.
- Do not use ear candles. They have no proven benefit in the removal of earwax or other objects in the ear and can cause serious injury.
Try a non-prescription medicine to help treat your fever or pain:
Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Be sure to follow these safety tips when you use a non-prescription medicine:
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- The ear canal, the opening to the ear canal, the external ear, or the skin around the external ear becomes swollen, red, or very painful.
- Dizziness or unsteadiness develops.
- Bleeding or discharge from the ear develops.
- Ear symptoms last longer than 1 week.
- Symptoms become more severe or frequent.
In most cases, it is best to leave your ears alone and let them maintain their own healthy, natural balance.
- Do not scratch or clean the inside of the ear with cotton swabs, bobby pins, your fingernail, or other objects.
- Removable earplugs may be used to keep moisture out of the ear canal. But prolonged use of earplugs can make your ears hurt and itch, and the earplugs can push earwax deeper into the canal. If this happens, your ears are more likely to get infected.
- Keep soap, bubble bath, and shampoo out of the ear canal. Do not let a child lie down in the bathtub with his or her ears underwater. These products can cause itching and irritation.
- Keep your ears dry.
- After swimming or showering, shake your head to remove water from the ear canal.
- Gently dry your ears with the corner of a tissue or towel, or use a blow-dryer on its lowest setting. Hold the dryer several centimetres (inches) from the ear.
- Put a few drops of rubbing alcohol or rubbing alcohol mixed with an equal amount of white vinegar into the ear after swimming or showering.
- Wiggle the outside of the ear to let the liquid enter the ear canal, then tilt your head and let it drain out.
- You can also use non-prescription drops, such as Auro-Dri, to prevent swimmer's ear.
- If you use public swimming pools or hot tubs, ask about the chlorine and pH testing of the pool. You are less likely to get swimmer's ear from facilities that maintain good control of their pool testing and treatment.
- Do not swim in dirty water or locations that have been closed because of pollution.
- Follow any instructions your doctor has given you to treat skin problems—such as eczema, psoriasis, or seborrhea—that may cause ear canal irritation.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- Have you done anything recently that may have caused your ear canal to become infected, such as cleaning your ears or swimming?
- Have you had a history of ear itching, pain, or other symptoms? Describe your symptom:
- When did it start?
- Do you have problems with the inside or the outside of your ear?
- Are your symptoms constant, or do they come and go?
- Does anything make your ear feel better or worse?
- Did you put anything into your ear before the problem started?
- Do you have drainage from the ear? What does the drainage look and smell like?
- Have you had a fever?
- Are you dizzy or do you feel unsteady?
- Have you had problems like this before? If so, how was it treated?
- What home treatment measures have you used? Did they help?
- What prescription and non-prescription medicine have you tried? Did they help?
- Do you have any health risks?
Current as of:
February 26, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
H. Michael O'Connor MD - Emergency Medicine
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