What is swimmer's ear?
Swimmer's ear, or otitis externa, is inflammation or infection of the outer ear canal — the passage that runs from the opening of the ear to the eardrum. It is a different condition from a middle ear infection (otitis media), which affects the space behind the eardrum and is more common in young children. Swimmer's ear affects the canal itself, and its most noticeable feature is usually pain, especially when the ear is touched or pulled.
It gets its common name because it often develops after water gets trapped in the ear canal — for example after swimming — creating a warm, moist environment where bacteria or fungi can grow. But it is not limited to swimmers: anything that damages or irritates the skin of the ear canal, such as scratching, cotton buds, or skin conditions like eczema, can allow infection to take hold. It is usually straightforward to treat but can be quite painful.
Symptoms of swimmer's ear
Swimmer's ear symptoms centre on the affected ear and often come on over a day or two. A very characteristic feature is pain when the outer ear is tugged or the little flap in front of the ear is pressed. Common symptoms include:
- •Ear pain, which can be severe and worsens when the ear is touched or pulled
- •Itchiness in the ear canal
- •A feeling of fullness or blockage in the ear
- •Discharge from the ear, which may be clear then become thicker or pus-like
- •Reduced or muffled hearing if the canal swells or blocks
- •Redness and swelling of the ear canal or outer ear
- •Tenderness of the outer ear and sometimes the area around it
Swimmer's ear versus a middle ear infection
Because both cause ear pain, swimmer's ear (otitis externa) is sometimes confused with a middle ear infection (otitis media), but they are distinct and treated differently. Swimmer's ear affects the outer ear canal, and a very telling sign is that the pain is worse when the outer ear is pulled or the flap in front of the ear is pressed. It often follows water exposure or ear irritation, and there may be itching and discharge from the canal.
A middle ear infection, by contrast, affects the space behind the eardrum, is most common in young children, and typically follows a cold or throat infection rather than swimming. Its pain is not usually made worse by tugging the outer ear. This distinction matters because treatment differs — swimmer's ear is usually treated with medicated ear drops applied directly into the canal, while middle ear infections often settle on their own or are treated differently. A doctor can tell them apart by examining the ear.
How is swimmer's ear treated?
Swimmer's ear is usually treated with medicated ear drops prescribed by a doctor, which may contain an antibiotic to treat infection, a steroid to reduce inflammation and swelling, or an antifungal if a fungal infection is the cause. These drops are applied directly into the ear canal and are usually effective within a few days to a week. It is important to use them as directed and to complete the course. Pain relief such as paracetamol or ibuprofen helps with discomfort.
During treatment, it is important to keep the affected ear dry — avoid swimming and try to keep water out while washing your hair, for example by using a cotton ball coated in petroleum jelly as a plug. If the ear canal is very swollen, a doctor may occasionally insert a small sponge or wick to help the drops reach deep into the canal. Most cases clear up well with treatment, though it is important to see a doctor rather than self-treating, as the right type of drops depends on the cause.
Preventing swimmer's ear
Because trapped moisture and a damaged ear canal are the main triggers, prevention focuses on keeping the ears dry and undisturbed. After swimming or bathing, tilt the head to each side to let water drain out, and gently dry the outer ear with a towel. Some people find using a hairdryer on a low, cool setting held a little away from the ear helps dry the canal. Swimmers prone to the condition can use well-fitting earplugs or a swimming cap.
Just as importantly, avoid inserting cotton buds, fingers or other objects into the ear canal, as these scratch and damage the protective skin and remove the wax that helps keep the canal healthy — both of which make infection more likely. If you are prone to swimmer's ear, a doctor or pharmacist can advise on acidifying or drying ear drops that can be used after swimming to help prevent it. Managing skin conditions like eczema in the ear also helps.
When swimmer's ear needs prompt attention
Most swimmer's ear is straightforward, but some situations need prompt or more careful medical attention. You should see a doctor if the pain is severe, if there is significant swelling or discharge, or if symptoms do not improve within a few days of starting treatment. A fever, spreading redness or swelling around the ear, or pain that is worsening despite treatment should also be reviewed, as occasionally the infection can be more serious or spread.
People with diabetes or a weakened immune system should be particularly careful, as they can rarely develop a more serious form of the infection that spreads to the surrounding tissue and bone, which needs urgent specialist treatment. For most healthy people, though, swimmer's ear responds well to ear drops and self-care, and being aware of these warning signs simply ensures the uncommon serious cases get the prompt attention they need.