Swimmer's Ear (Otitis Externa): What You Need to Know

With Austin's warm climate and abundance of pools, lakes, and water activities, swimmer's ear is a condition our team sees frequently, especially during the summer months. While the name suggests it only affects swimmers, this uncomfortable ear canal infection can happen to anyone. At Capital ENT & Sinus Center, we help patients of all ages find relief from swimmer's ear and work to prevent recurring episodes.

What Is Swimmer's Ear?

Swimmer's ear, known medically as otitis externa, is an infection of the outer ear canal, the tube that runs from the outer ear to the eardrum. Unlike middle ear infections (otitis media), which often develop behind the eardrum and are common in young children, swimmer's ear affects the external portion of the ear and can occur at any age.

The ear canal's natural environment includes a thin layer of earwax and slightly acidic conditions that help protect against infection. When this protective barrier is disrupted (often by excess moisture or minor trauma), bacteria or fungi may have an opportunity to grow, potentially leading to infection and inflammation.

Common Causes and Risk Factors

While swimming is a well-known trigger, several factors may contribute to developing otitis externa:

• Excess moisture: Water that remains in the ear canal after swimming, bathing, or humid weather can create an environment where bacteria may thrive
• Minor ear canal injuries: Using cotton swabs, fingernails, or other objects in the ear can cause small scratches that may allow bacteria to enter
• Skin conditions: Eczema, psoriasis, or other skin conditions affecting the ear canal may increase susceptibility
• Hearing aids or earbuds: Devices worn in the ear can sometimes trap moisture or cause irritation
• Narrow ear canals: Some individuals have ear canal anatomy that may make drainage more difficult

It's worth noting that earwax serves a protective function. Aggressive cleaning that removes too much earwax may actually increase the risk of developing swimmer's ear.

Recognizing the Symptoms

Swimmer's ear often begins with mild symptoms that can progress if left untreated. Common signs may include:

• Itching in the ear canal, often an early symptom
• Redness inside the ear
• Discomfort or pain that may worsen when touching the outer ear or pulling on the earlobe
• Drainage of clear, odorless fluid initially, which may become more noticeable over time
• A feeling of fullness or blockage in the ear
• Muffled hearing or temporary hearing loss
• More intense pain that may radiate to the face, neck, or side of the head in advanced cases

In more severe situations, patients may experience increased pain, more significant drainage, fever, or swelling of the lymph nodes around the ear. These symptoms suggest the infection may need prompt medical attention.

When Should You See a Specialist?

Swimmer's ear is treated with prescription ear drops, and pain relief matters too, according to the AAO-HNS clinical practice guideline. See a provider promptly, and see an ENT specialist if you experience:

• Pain that is severe or worsening despite initial treatment
• Symptoms that have not improved within 48 to 72 hours of starting ear drops
• Significant drainage from the ear
• Fever accompanying ear symptoms
• Hearing changes that concern you
• Recurring episodes of swimmer's ear
• Diabetes or a weakened immune system, as these conditions may increase the risk of complications

Our board-certified ENTs can examine the ear canal directly, determine whether otitis externa or another condition is causing your symptoms, and recommend an appropriate treatment approach. In some cases, what seems like swimmer's ear may actually be related to other ear conditions, making accurate diagnosis important.

Prevention Tips

Taking a few precautions can often help reduce the likelihood of developing swimmer's ear:

• Dry ears thoroughly after swimming or bathing by tilting the head to each side
• Consider using a hair dryer on the lowest setting, held at arm's length, to gently dry the ear canal
• Avoid inserting objects into the ear canal, including cotton swabs
• Protect ears when swimming with earplugs designed for water activities
• Ask about preventive drops; some patients use a mixture of rubbing alcohol and white vinegar after swimming, though it's best to check with a healthcare provider first. Do not use these drops if you have ear tubes, a hole in the eardrum, or an active infection, since the guideline calls for different management when the eardrum is not intact

If you use hearing aids, earbuds, or other devices regularly, cleaning them as recommended and allowing your ears time to air out may also be helpful.

What to Expect During Your Visit

When you visit Capital ENT & Sinus Center for ear concerns, our physicians will examine your ear canal and eardrum using specialized instruments. This evaluation helps determine whether swimmer's ear is present and how extensive the infection may be. Based on the findings, our team can discuss treatment options, which often include prescription ear drops designed to address the infection and reduce inflammation, the first-line treatment recommended in the AAO-HNS clinical practice guideline.

In cases where the ear canal is significantly swollen, a small wick may be placed to help medication reach the affected area. Antibiotic pills are usually not needed unless the infection has spread beyond the ear canal. Our specialists will provide guidance on how to use any prescribed treatments effectively and what to expect during recovery.

Sources

• American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS): "Swimmer's Ear (Otitis Externa)," ENThealth.org
• Rosenfeld RM, et al. Clinical practice guideline: acute otitis externa. Otolaryngology–Head and Neck Surgery. 2014. PubMed