Acute Otitis Externa - Swimmer's Ear

Overview, Causes, & Risk Factors

Swimmer's ear is an inflammation or infection of the tissues of the outer ear and the external ear canal. The ear canal is the narrow tube that extends from the outer ear to the eardrum.

What is going on in the body?

Swimmer's ear is an inflammation or infection of the outer ear and the external canal. The ear canal contains glands that produce oil, sweat, and ear wax. Ear wax helps maintain an acidic environment in the ear canal.

If the ear canal loses its acidity, bacteria can grow more easily. Some people, such as individuals with diabetes, have a less acid environment. A wet environment in the ear canal also makes it a breeding ground for bacteria. Water that is left in the ear after swimming or bathing can promote infection.

What are the causes and risks of the infection?

Conditions that can lead to swimmer's ear include:

benign ear growths in the ear canal that do not allow water to drain out effectively

chronic otitis externa, or chronic irritation of the ear canal

dermatitis due to allergic reactions to hair spray, dyes, or other chemicals

dermatitis due to conditions such as psoriasis and eczema

lower levels of acidity in the ear wax, such as in people with diabetes

using cotton-tipped swabs, which may injure the ear canal or pack the wax tightly

very narrow openings into the ear canal, such as in people with Down syndrome

water left in the ear after bathing or swimming, which is why it is also called swimmer's ear

Most episodes of swimmer's ear are caused by bacteria. Fungal infections may also occur in the ear canal, although they are less painful. These often do not respond as quickly to antibiotics and may require specific antifungal medicines.

Symptoms & Signs

What are the signs and symptoms of the infection?

Swimmer's ear generally causes discolored ear drainage and intense ear pain. Discharge from bacterial infections may be yellow or green. Discharge from a fungal infection might appear as a mixture of dark gray, white, and yellow pus with mold on its surface. Drainage might be foul-smelling.

Sometimes, when a person's ear canal is full of dirt or swollen, his or her hearing is impaired. The outer ear and ear canal are also very tender and painful to the touch. In addition, the person may have a fever.

Sometimes the tissue in front of and below the ear can also become painful, tender, and swollen. This occurs as the infection in the ear canal moves through small holes in the cartilage of the outer ear canal and then into the surrounding soft tissue.

Diagnosis & Tests

How is the infection diagnosed?

Swimmer's ear is diagnosed by examining the outer ear canal. Cultures can be helpful if the infection is not responding to treatments.

Prevention & Expectations

What can be done to prevent the infection?

Since water is the most common cause of swimmer's ear, it is important to get all the water out of the ear canal after bathing or swimming. Some measures to keep water from collecting in the ear canal include:

inserting antiseptic ear drops that can be purchased over the counter into the ear canal after swimming or bathing

inserting oily or lanolin ear drops into the ear canal before swimming or bathing

inserting rubbing alcohol into the ear canal after swimming or bathing

inserting a vinegar and alcohol solution into the ear canal after swimming or bathing

What are the long-term effects of the infection?

If swimmer's ear is not identified and treated effectively, it can cause complications such as:

hearing impairment from scarring or narrowing of the ear canal

infection of soft tissues of the face and neck. This complication is seen especially in people with diabetes and in others with impaired immune systems.

necrotizing external otitis, which is an infection of the bones of the ear canal and skull

What are the risks to others?

Swimmer's ear is not contagious and poses no risk to others.

Treatment & Monitoring

What are the treatments for the infection?

Swimmer's ear is usually treated with ear drops that contain antibiotics and steroids. One common medicine is hydrocortisone/neomycin/polymixin B. It is also very important to have the ear wax removed. If the infection spreads into the soft tissues around the ear, oral antibiotics may be needed. If the ear canal is particularly swollen, a wick may be inserted to draw the ear drops in.

Antifungal medicines will be prescribed for fungal infections. Over-the-counter pain medicines may be used for discomfort.

What are the side effects of the treatments?

Some people have a neomycin skin sensitivity. This can cause a reaction in the ear canal very similar to poison ivy dermatitis. If the person continues to have itching and a lot of swelling of the ear canal, then the neomycin needs to be stopped. Other treatments that do not contain neomycin may be used.

What happens after treatment for the infection?

Successful treatment completely heals the ear canal.

How is the infection monitored?

Any new or worsening symptoms should be reported to the healthcare provider.