What Is Swimmer's Ear?

If you've ever experienced an ear infection, you know how uncomfortable and painful it can be. Swimmer's ear is a specific type of bacterial infection that causes discomfort and pain in and around the outer ear canal, per the Centers for Disease Control and Prevention (CDC). It typically starts mild, with moderate itching and redness, and then can become tender and inflamed, potentially harming your hearing ability, per StatPearls.

Despite its name, you don't have to spend time at a beach or pool to pick up swimmer's ear. This condition can happen after you shower, bathe, or clean your ears with cotton swabs. Swimmer's ear is most often seen in children, but adults are at risk as well, per the CDC.

About 10% of all people experience swimmer's ear in their lifetime, with a peak likelihood of the infection around ages 7–14, per StatPearls. Having swimmer's ear once significantly increases your risk of having it again, per a June 2015 review published in the journal BMJ Clinical Evidence.

Here's how to know if you have swimmer's ear, what you can do to ease the swelling and aching, and how you can prevent it from happening again.

Causes

Swimmer's ear, also known by its medical name otitis externa, usually occurs after water gets trapped inside the ear. This allows bacteria (and in some cases, a fungus) in your ear canal to multiply, leading to an infection near the ear's opening, explained Ileana Showalter, MD, an ENT-otolaryngologist at Mercy Medical Center in Baltimore.

True to the condition's name, swimming or just splashing around in water is a significant cause. But swimmer's ear can also arise from any situation where your ear traps a small amount of water, like after a shower, bath, or time in a hot tub. You may even get it from sweating or being in a high-humidity location, per the National Eczema Society (NES). Stress and hearing aid use are both risk factors, per StatPearls.

Sometimes swimmer's ear develops not from trapped water but from a cut or scrape inside the ear canal. Overly aggressive cleaning with cotton swabs tends to cause it—if the swab scratches the skin inside the ear, bacteria can thrive and trigger an infection. People with excessive ear wax or the chronic skin condition eczema, which causes itching and redness, are also more likely to develop swimmer's ear, per the June 2015 review.

Symptoms

Swimmer's ear usually starts with mild itching, redness, and swelling. As the infection progresses, the area becomes inflamed and painful, said Derek Lam, MD, ENT-otolaryngologist at Oregon Health and Science University. The symptoms typically start within a few days of swimming, per the CDC.

The pain can be severe. It's typically worse than a middle-ear infection triggered by a cold. That's because many nerves link the base of the brain through the ear canal, the jaw, and down to the diaphragm, explained M. Jennifer Derebery, MD, clinical professor of otolaryngology at USC School of Medicine in Los Angeles. "Pain in one area of the nerve may refer to another area," Dr. Derebery said. "That is why it is common to have jaw pain with swimmer's ear as well."

Another way to tell if it's swimmer's ear or a middle-ear infection is to wiggle the outer ear, per the CDC. If you don't feel pain, you probably don't have swimmer's ear—tugging or putting pressure on the ear would worsen the pain.

If left untreated, swimmer's ear symptoms can intensify. You might notice discharge or fluid leaking out of your ear. Swollen lymph nodes (structures in the body's immune system) around the neck and a fever can also occur. In extreme cases, the skin can swell up and close over the ear, leading to muffled hearing. Luckily, any hearing loss you experience will disappear once the infection is treated.

How To Treat Swimmer's Ear

If the discomfort doesn't stop after a few days or becomes more severe over a short period, see a healthcare provider. "If you leave the infection unattended, the pain can get excruciating," Dr. Showalter said. "In fact, it's one of the most severe pains we see in our specialty."

Some home treatment options might ease your pain if symptoms hit over the weekend or you cannot immediately see a healthcare provider. Dr. Showalter advised taking an over-the-counter pain reliever like Advil (ibuprofen) or Tylenol.

However, as soon as you can, get some face time with your primary care provider, Dr. Lam said, or head to an urgent care facility. Your healthcare provider will examine the ear and perhaps take a fluid sample. You'll likely go home with antibiotic ear drops if it's swimmer's ear. Once you start the treatment, you can expect symptoms to clear up in about six days, per StatPearls.

If Symptoms Don't Go Away

Typically, you will see an improvement in pain within 48–72 hours after you start using the antibiotic ear drops. If that's not the case, see a healthcare provider, per StatPearls.

Sometimes the antibiotic ear drops don't work because swimmer's ear has caused a buildup of debris or fluid in the ear canal, and the drops can't get through. "An ear that hasn't been cleaned will not respond to the treatment, so you have to get rid of the gunk so that the medicine can work," Dr. Showalter said. Your healthcare provider will clear the outer ear canal using a vacuum-type apparatus that sucks out debris. Then the antibiotics can do their job.

Another reason the infection might persist is that it's not caused by bacteria. While most swimmer's ear cases are bacterial in origin, a subset of patients develop a fungal infection, which requires different treatment, Dr. Showalter said. That type of infection looks the same as fungus growing in bread, and it's often not easy to see because it can be obscured by wax.

If your symptoms linger and antibiotic drops don't affect you, ask your healthcare provider if it might be a fungal infection. You're more likely to have fungal growth after prolonged antibiotic use, so let your healthcare provider know if you've recently completed a round of antibiotic treatment, per the June 2015 review.

Fungus grows slowly, so the hallmark of this kind of infection is that it doesn't get better. "You might find that your ear has been itching for months; and you've used several types of drops and it persists," Dr. Showalter said. "That would be highly suspicious," Dr. Showalter noted, of a fungal infection.

How To Prevent Swimmer's Ear

You don't need to give up swimming or limit yourself to bodies of chemically treated water. While it seems logical to assume that a murky lake or river might promote an infection more than a crystal-clear pool, that's not necessarily the case, Dr. Lam said. The wetness trapped inside the ear, not the type of water you're in, causes the infection.

To prevent water from getting caught in your ear canal, consider wearing earplugs when you go for a dip, and make sure you dry your ears thoroughly after time in a pool or following a shower. Dabbing a few drops of rubbing alcohol or white vinegar inside each ear can help dry them faster. A short blast of warm air from a hair dryer gets them dry quickly too.

If you suspect vigorous ear cleaning led to your infection, lay off the cotton swabs and clean your ears with a washcloth. "Generally, we advise people to avoid cotton swabs because everyone's ears are different, and there are some subset of people who will have trouble because the wax tends to be dry or the canal is small—so they are pushing the wax [further inside]," Dr. Showalter said.

That said, Dr. Showalter was okay with people cleaning with swabs within reason—for example, by being very gentle and sticking to the outer ear. If you use them to go deeper into the ear canal, you might end up pushing the tip of the swab inside. That packs the wax, so it builds up, or removes too much wax, so dirt and debris (and bacteria) can enter. Both set up the ideal conditions for swimmer's ear—which you want to avoid.