Swimmer’s Ear: Causes, Treatment and Prevention

If you enjoy spending time in the water during the summer months, you may have experienced swimmer’s ear. This often-painful condition can cause symptoms such as itching, redness, muffled hearing, or a “plugged up” feeling in your ear. While common and usually treatable, swimmer’s ear can become more serious without proper care.  

Though children are more prone to getting swimmer’s ear, it can affect people of any age. Symptoms can resemble other health concerns, so the right diagnosis and treatment will help resolve the condition and prevent complications. 

What Is Swimmer’s Ear?

Swimmer’s ear (otitis externa) is an infection of the ear canal. The ear canal is the passage that carries sounds from the outside of the body to the eardrum (tympanic membrane). 

Water can get trapped in the ear canal when you swim, making the canal more susceptible to germs and allowing bacteria and fungi to grow. It can also wash away earwax, which acts as a natural guard against infection. Swimmer’s ear is more likely to occur when the ear canal’s natural protection is disrupted. 

Although it is often associated with swimming, swimmer’s ear can develop any time moisture or irritation affects the ear canal. 

What Causes Swimmer’s Ear?

Bacterial infection is the most common cause of swimmer’s ear, according to Usama Shahbaz, MD, a family practice physician at Methodist Family Medicine Clinic in Oak Ridge.

“When you get a bacterial infection related to otits externa, it usually occurs because there was a breakage in the ear’s skin, which allows bacteria to enter and thrive,” Dr. Shahbaz says. He notes that allergies and other skin disorders can also lead to otitis externa.

Other causes of swimmer’s ear include:

• Germs in hot tubs or unclean pool water
• Being in warm, humid or damp places
• Cleaning or scratching your ear canal using your fingers, cotton swabs or other objects
• Having a cut or injury in the skin of your ear canal
• Having a foreign object in the ear canal
• Too much (or too little) earwax
• Dry skin in the ear canal, eczema or other inflammatory skin conditions
• Using earphones, ear buds or hearing aids
• Spending long periods of time in the water, especially in the summer months

Swimmer’s Ear vs. Ear Infection 

Swimmer’s ear is often confused with a middle ear infection (otitis media), but they are different conditions that affect different parts of the ear and may require different treatment. 

Swimmer’s ear (otitis externa): 

• Affects the outer ear canal 
• Pain often worsens when the ear is touched or pulled 
• Itching is common 
• May include visible redness, swelling, or drainage 
• Often linked to water exposure or irritation 

Middle ear infection (otitis media): 

• Occurs behind the eardrum, often after a cold or respiratory infection 
• Pain is deeper and not usually affected by touching the outer ear 
• May include fever, pressure, or fullness in the ear 
• Common in young children 
• Hearing may feel muffled due to fluid buildup 

If you are unsure which condition you or your child may have, a medical provider can examine the ear and recommend the appropriate treatment. 

Swimmer’s Ear Symptoms

Symptoms of swimmer’s ear may include:

• Redness or itching inside the ear
• Ear/earlobe pain that may spread to your head, neck, or side of the face
• Swollen glands in the upper neck or around the ear, or a swollen ear canal
• Pus or drainage that may have a bad smell
• Muffled hearing or hearing loss, or a “plugged-up” sensation in the ear
• Fever

How to Safely Remove Water From the Ears

Dr. Shahbaz says the safest way to remove water from the ears is to lean toward or lie on the side of the affected ear for a couple of minutes.

“Ear canals are slanted, and this helps the water come out more easily,” he explains “With younger children who are still developing, the ear canal is straight, which can be a challenge. But with some patience, leaning or lying on the affected side will help expel the water.”

To dry your ears after showering, tilt your head to each side to help drain water from your ears. With the ear facing down, pull your earlobe in different directions. Gently dry your ears with the edge of a towel.

“Do not use cotton-tipped swabs,” Dr. Shahbaz emphasizes. “These can lodge earwax toward the eardrum, which can lead to difficulty hearing. They can even cause an accidental eardrum rupture. And small pieces of cotton left over in the ear canal can lay a foundation for infection.”

Preventing Swimmer’s Ear 

To help prevent swimmer’s ear, Dr Shahbaz suggests these steps: 

• Avoid over-cleansing the ears. “Your earwax is a natural protector against bacteria. It also protects the inner lining of the ear – the skin. If this first-line protection is lost and the skin breaks open, you risk an infection. Earwax also helps keep an acidic environment – your ears will love you for it!” 
• Keep your ears as dry as you can. “Excessive water exposure can lead to the breakdown of the ear’s natural skin barrier.” Dr. Shahbaz says. He recommends avoiding submerging your head in water unless necessary. 
• Use caution with devices that can trap moisture in the ear. Ear buds and hearing aids can foster bacteria growth. If you enjoy hearing music while you’re in the pool, use a water-safe external sound source. “I would ditch the swimmer’s headphones and use a portable battery-powered speaker,” Dr. Shahbaz says. 
• Don’t scratch or pick your ears, or clean your ear canal with cotton swabs, your fingers, or other objects. “This can lead to further damage of the lining of the ear or introduce germs from your hands,” says Dr. Shahbaz. 

Consider using well-fitted earplugs when swimming if you are prone to swimmer’s ear, and dry your ears thoroughly afterward. 

When to Seek Medical Help

“Pain in or around the ear, itchiness, discharge or hearing loss are the most common symptoms to look out for,” Dr Shahbaz says. “If your child is tugging their ears, this can be a sign that they should be seen by a medical professional. Watch out for fevers as well.”

How is Swimmer’s Ear Treated?

A medical provider can examine the ear with a lighted instrument called an otoscope, and may take a sample of any discharge. Treatment will depend on symptoms, age, and severity of the condition, and may include:

• Prescription ear drops to reduce swelling or to kill bacteria or fungus
• Pain medication
• Keeping the ear dry as directed by your doctor

With correct treatment, swimmer’s ear often clears up in about 7–10 days. Most people begin to feel relief within a few days of starting treatment. Left untreated, it may cause other problems such as hearing loss, recurrent infection or infection that spreads beyond the ear. In rare cases, untreated infections can become severe, particularly in older adults or those with chronic health conditions. 

Your Partner in Care

Stay “in the swim” this summer! If you need help finding a primary care physician or other medical provider to help with hot-weather health concerns, visit our find a doctor webpage.