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Bacterial & Viral Infections

Swimmer’s Ear (External Otitis)

The pool party had been awesome. Ryan and his friends had eaten pizza, listened to music, and, of course, spent lots of time in the water. But the aftermath of the party wasn’t as great. Two nights later, Ryan woke with a sharp pain in his ear — it really hurt! He remembered having ear infections when he was a little kid, but this didn’t feel the same somehow. His outer ear felt so sore to the touch that he couldn’t even stand to rest his head on his pillow. He wondered if it had something to do with the water that had been stuck in his ear after swimming.

Ryan was right — he had an infection of the ear canal commonly known as swimmer’s ear. Keep reading for tips and tricks on keeping swimmer’s ear at bay.

What Is External Otitis?

The medical terms for swimmer’s ear are external otitis or otitis externa. Swimmer’s ear is an infection of the ear canal (the tubular opening that carries sounds from the outside of the body to the eardrum) that can be caused by many different types of bacteria or fungi. It usually develops in ears that are exposed to moisture.

People who get external otitis often have been diving or swimming for long periods of time. This can bring infectious bacteria directly into the ear canal. External otitis occurs most often during the summer months — when more people are participating in water activities.

People who don’t swim can also develop external otitis by scratching their ear canals when they try to clean their ears. This is especially true if they use cotton-tipped applicators or dangerously sharp small objects, like hair clips or bobby pins. Sometimes, in a person with a middle ear infection (otitis media), pus collected in the middle ear can drain into the ear canal through a hole in the eardrum and cause otitis externa to develop.

What Are the Signs and Symptoms of External Otitis?

The primary symptom of external otitis is severe ear pain that gets worse when the pinna, or outside part of the ear, is pulled or pressed on. Sometimes there is itching in the ear canal before the pain begins. The outer ear may become reddened or swollen, and lymph nodes around the ear may become enlarged and tender. There also may be a greenish-yellow discharge of pus from the ear opening. It can be hard to hear in the affected ear if pus or swelling of the canal begins to block passage of sound into the ear. A slight fever may accompany external otitis.

There is no set time that it takes external otitis to develop, but the ear pain often follows an episode of swimming or water immersion and develops gradually over several days.

Can I Prevent External Otitis?

You may be able to prevent external otitis by using acid alcohol drops after you’ve finished swimming for the day. (You shouldn’t use these drops if you have ear tubes or a hole in your eardrum.) It’s also a good idea to dry your ears thoroughly with a clean towel after swimming, bathing, or showering.

Keep all objects out of your ear canals — including cotton-tipped applicators — unless your doctor has told you it’s OK to use them.

How Long Does It Last?

If it’s treated with prescription ear drops, external otitis is usually cured within 7 to 10 days. The pain should lessen within a few days of treatment.

External otitis is not contagious, so you don’t have to limit your contact with friends as long as you’re feeling well enough to socialize.

Should I Call My Doctor?

You should call your doctor if you have any of the following:

  • pain in an ear with or without fever
  • persistent itching of the ear or in the ear canal
  • loss of hearing or decreased hearing in one or both ears
  • discharge from an ear, especially if it’s thick, discolored, bloody, or bad-smelling

These are all signs that you may have external otitis.

How Is External Otitis Treated?

If you think you have external otitis, you should see your doctor. This is the fastest way to relieve the ear pain and to prevent the spread of infection.

Your doctor’s treatment for external otitis will depend on how severe the pain and the infection are. For most all outer ear infections, your doctor may prescribe ear drops containing antibiotics or maybe mixed with corticosteroids. These will help fight the infection and reduce swelling of the ear canal. For full treatment, ear drops are usually given several times a day for 7 to 10 days.

If the opening into your ear is narrowed by swelling, your doctor may clean your ear and insert a wick into your ear canal to help carry ear drops into the ear more effectively. If you have a severe infection, he or she may give you antibiotics to take by mouth as well. Your doctor may take a culture of the discharge from your ear to help identify what type of germ is causing the infection.

What Can I Do to Make Myself Feel Better?

Place a warm cotton cloth or heating pad against your ear to help relieve the pain. You may also take acetaminophen or ibuprofen.

At home, follow your doctor’s directions for using ear drops and take all oral antibiotics as prescribed (don’t stop taking these even if you feel better; it’s important to take the full course of any antibiotics your doctor prescribes). To avoid contaminating the infected ear, your doctor will probably tell you to keep your head out of water for several days or weeks — even while showering or shampooing! This can be tough, but your doctor can give you suggestions on how to do this, such as using a shower cap or cotton earplugs coated with petroleum jelly (removed after the shower is finished).

If your ear pain is not relieved by over-the-counter pain medications, your doctor may order a stronger prescription pain reliever. You’ll use this only for a short time — until the ear drops and antibiotics begin to work.

Reviewed by: Steven P. Cook, MD
Date reviewed: August 2012