Swimmer's Ear: What It Is, How to Treat It, and How to Prevent It

What Is Swimmer's Ear?

Swimmer's ear — otitis externa — is an infection of the outer ear canal: the passage between the outer ear and the eardrum. It's distinct from a middle ear infection (otitis media), which affects the space behind the eardrum. The distinction matters because the two conditions have different causes, different symptoms, and different treatments.

The most common cause is bacterial infection, most frequently Pseudomonas aeruginosa or Staphylococcus aureus. Water exposure is the primary risk factor — trapped water in the ear canal raises the pH and creates a warm, moist environment that bacteria thrive in. The name "swimmer's ear" reflects this, though the condition can occur in anyone whose ear canal is regularly exposed to moisture, including people who shower frequently or live in humid climates.

Fungal otitis externa — caused by Aspergillus or Candida species — is less common but worth knowing about. It tends to cause more intense itching than bacterial infection and may produce a characteristic dark or white discharge. It's more common in people who have used antibiotic ear drops repeatedly, as these can disrupt the normal bacterial flora and allow fungi to proliferate.

Recognising Swimmer's Ear

The hallmark symptom of otitis externa is pain that worsens when the outer ear is pulled or pressed. This is the key distinguishing feature from middle ear infection — if pulling your ear makes the pain worse, the problem is in the outer canal. If pulling the ear makes no difference to the pain, it's more likely to be a middle ear problem.

The condition typically progresses through three stages. In the early stage, there's itching and mild discomfort, with some redness of the canal. In the moderate stage, pain becomes more significant, the canal swells, and there may be clear or slightly cloudy discharge. In the advanced stage, the pain is severe, the canal may be completely blocked by swelling, and there may be fever and swelling of the lymph nodes around the ear.

Most people seek treatment in the early to moderate stage, which is appropriate — early treatment is more effective and prevents progression. If you're experiencing significant pain, swelling, or discharge, see your GP rather than waiting to see if it resolves.

Treatment

Otitis externa is treated with topical antibiotic or antibiotic/steroid combination ear drops, prescribed by a GP. The steroid component reduces inflammation and swelling, while the antibiotic addresses the infection. NICE guidelines recommend topical treatment as first-line for uncomplicated otitis externa — oral antibiotics are not needed in most cases.

For the drops to work, they need to reach the infected tissue. If the canal is significantly swollen, a wick (a small piece of expandable material) may be inserted to hold the canal open and allow the drops to penetrate. This is usually done by a GP or ENT specialist.

During treatment, keep water out of the ear. Use a cotton ball lightly coated in petroleum jelly as an earplug during showering, and avoid swimming until the infection has fully resolved — typically seven to ten days. Continuing to swim during treatment significantly delays recovery.

Pain relief with paracetamol or ibuprofen is appropriate while waiting for the drops to take effect. Avoid inserting anything into the ear canal — including cotton buds — as this will worsen the infection and delay healing.

Prevention for Regular Swimmers

The most effective preventive measure is ensuring the ear canal is thoroughly dry after swimming. After getting out of the water, tilt your head to each side and gently pull the outer ear in different directions to help water drain. A hairdryer on the lowest heat setting, held at arm's length, can help dry the canal — but don't hold it close or use high heat.

Well-fitted earplugs reduce water entry significantly. Custom-moulded earplugs, available from audiologists, provide a better seal than over-the-counter options and are more comfortable for regular use. They're worth the investment if you swim several times a week.

Acidifying ear drops — typically a dilute acetic acid solution — can be used after swimming to restore the normal acidic pH of the ear canal, which inhibits bacterial growth. These are available over the counter and are a useful preventive measure for people who are prone to recurrent otitis externa.

Avoid swimming in water of questionable quality. Open water — rivers, lakes, the sea — carries higher bacterial loads than well-maintained pools. If you swim in open water regularly, the preventive measures above become particularly important.

Swimmer's Ear and Earwax

The relationship between earwax and swimmer's ear is worth understanding. Earwax is protective — its acidic pH inhibits bacterial growth, and its waxy consistency repels water. People who clean their ears aggressively and remove too much wax are actually at higher risk of swimmer's ear, because they've removed the ear's natural antimicrobial barrier.

Conversely, wax impaction can create a pocket of moisture behind the wax plug that becomes infected. If you have symptoms of wax impaction and then develop swimmer's ear, the wax may need to be removed after the infection has resolved — but not during active infection.

For more on protecting your ears during swimming season, our ear care guide covers the practical steps that reduce both wax buildup and infection risk.