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EspañolSwimmer's ear symptoms: What are the early signs of swimmer's ear?
Overview: What does swimmer's ear feel like?
Swimmer’s ear is the swelling of the outer ear canal and sometimes the outer ear itself. Despite its name, swimmer’s ear is not just a problem reserved for swimmers. It can happen to anyone. Doctors call the condition “otitis externa,” or swelling of the outer ear and ear canal. The most common cause of swimmer’s ear is a bacterial infection. However, it can also be due to a fungal infection, an allergic reaction, eczema, or psoriasis. The most common experience of swimmer’s ear is pain. Swimmer’s ear hurts. Sometimes the pain is excruciating. Pulling or pushing on the ear worsens the pain. This is because the tissues beneath the ear canal's thin layer of skin are extremely sensitive. Though it’s the most obvious symptom, ear pain isn’t the only common symptom. The ear canal gets red and swollen. There’s often a discharge from the ear. The swelling can be so bad that it partly or completely closes the ear canal so that the ear will feel “full.” Bad swelling can make it hard to hear through the affected ear.
Key takeaways:
Swimmer's ear is a common health condition that can affect anyone, regardless of age, sex, race, or ethnicity. However, it is more common in children and young adults.
Early signs of swimmer's ear include itching and ear discomfort.
Serious symptoms of swimmer's ear, such as fever, malaise, blood leaking from the ear, or bad-smelling discharge, may require immediate medical attention.
Swimmer's ear is caused by bacterial infections, fungal infections, or skin conditions. You may be at risk for developing swimmer's ear symptoms if you swim regularly, the most common cause, or use cotton swabs in the ears, the other leading cause of otitis externa. Other risk factors include humid environments, high temperatures, foreign objects (such as earphones, earplugs, or hearing aids), ear wax buildup, narrow ear canals, hairy ear canals, trauma, radiation therapy, chemotherapy, and a weakened immune system.
Swimmer's ear usually requires a medical diagnosis.
Swimmer's ear generally requires treatment, but most cases will resolve without treatment. Swimmer's ear symptoms typically resolve within a few days of treatment.
Treatment of swimmer's ear may include topical antibiotic ear drops, pain relievers, topical steroid ear drops, or oral antibiotics in the most severe cases. Read more about swimmer's ear treatments here.
Untreated swimmer's ear could result in complications, such as chronic external ear infections, recurrent infections, or the spread of the infection to other parts of the ear or head.
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What are the early signs of swimmer's ear?
Otitis media (middle ear infection) develops very quickly, so there isn’t much time between the early symptoms of swimmer’s ear and a fully florid infection. The most common early signs of swimmer’s ear include:
Itching
Ear pain
Ear redness
Other swimmer's ear symptoms
Swimmer’s ear typically presents with symptoms, such as:
Ear pain
Worsening ear pain when pulling on the ear, chewing, or putting pressure on the outer part of the ear canal
Discharge from the ear
Redness on the skin of the ear canal and maybe the outer ear
Swelling in the ear canal
“Fullness” in the ear
Decreased hearing in the affected ear
Swollen lymph nodes
Ear discharge is one of the most common symptoms of otitis externa and can vary widely in color and consistency.
Complicated swimmer’s ear occurs when the infection spreads to other parts of the ear or head. Symptoms may include:
Fever
Malaise (feeling sick)
Bad-smelling discharge
Bloody discharge
RELATED: What to do for an earache
Swimmer's ear vs. ear infection symptoms
Swimmer’s ear involves the ear canal and sometimes the outer ear. The ear canal runs from the opening in the outer ear to the eardrum. The middle and inner ear are on the other side of the eardrum. The inner ear and middle ear infections are more serious. These infections often affect the rest of the body and can cause serious symptoms and complications. Both middle ear and inner ear infections are treated with oral antibiotics rather than topical antibiotics.
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RELATED: Ear infection symptoms: what are the early signs of an ear infection?
Types of swimmer's ear: How can I tell which one I have?
Healthcare professionals distinguish between two types of swimmer’s ear:
Acute otitis externa is a sudden case of swimmer’s ear that resolves within a few days to a few weeks.
Chronic otitis externa is a swimmer’s ear that continues for three months or longer or recurs regularly for over three months. Chronic or recurrent swimmer’s ear is often due to skin conditions, such as contact dermatitis or eczema.
Healthcare providers also make distinctions based on the severity of the condition:
Mild otitis externa has mild symptoms, such as itching, discomfort, and some swelling and redness in the ear canal
Moderate otitis externa involves swelling severe enough to block the ear canal partly
Severe otitis externa is marked by the complete closure of the ear canal, severe pain, and swollen lymph nodes
When to see a doctor for swimmer's ear symptoms
Although swimmer’s ear usually resolves without treatment, talk to a healthcare provider. There is a risk of complications if it’s left untreated. It’s also possible that the infection is deeper in the ear.
If an outer ear infection includes symptoms such as fever, feeling sick, or bad-smelling discharge, see a doctor as soon as possible. These body-wide symptoms indicate that the infection has spread to other parts of the head.
Most people will be diagnosed and treated by a family physician, but a specialist in ear, nose, and throat disease, called an otolaryngologist, may be needed. The diagnosis is usually straightforward. The clinician will ask about the symptoms and look at the ear and ear canal. The visual appearance of the ear and ear canal is usually all a clinician needs to make a diagnosis. However, if there’s a serious problem, the clinician will perform a complete head and neck exam. If outer ear infections happen repeatedly, the clinician may swab the inner ear and send it to a laboratory to identify the pathogen responsible.
Complications of swimmer's ear
While most cases of swimmer’s ear resolve without treatment or complications, some develop into more serious problems. In particular, the infection can spread to other parts of the head. Complications of swimmer’s ear include:
Chronic infection of the ear
Temporary hearing loss
Eardrum infections
Infection of skin tissues in the face (cellulitis)
Infection of the temporal bone (osteomyelitis)
Necrotizing otitis externa (or malignant otitis externa), a life-threatening infection of the temporal bone and other tissues in the head
How to treat swimmer's ear symptoms
Bacterial infections are behind most cases of swimmer’s ear, so the most common treatment is antibiotic ear drops, or ear drops that combine a topical antibiotic with a corticosteroid to reduce swelling. The clinician usually starts treatment by cleaning the ear with water or suction. Antibiotic treatment typically lasts seven to 10 days.
Less commonly, the infection may be caused by a fungal infection (fungal otitis externa). If a fungal infection has been confirmed by a culture, it will be treated with ear drops containing an antifungal medicine.
Sometimes, people may need oral antibiotics because the infection has spread or they have weakened immune systems. However, many physicians prescribe oral antibiotics because they don’t expect people to be able to use ear drops successfully.
Healthcare professionals will treat mild to moderate ear pain with over-the-counter acetaminophen or NSAIDs, such as ibuprofen. They may prescribe a short course of opioid combination analgesics, such as a combination of an opioid with acetaminophen, for severe pain.
RELATED: Swimmer’s ear treatments and medications |
Signs swimmer's ear is getting better
If swimmer’s ear is due to a bacterial infection, symptoms should gradually improve with antibiotic treatment. Most cases get better without treatment, but there is a chronic infection risk if untreated.
With antibiotic treatment, 65% to 90% of swimmer’s ear cases will be cured in seven to 10 days. Symptoms will usually clear up in a few days, but it is important to continue taking the antibiotics for the entire prescribed duration in order to eradicate the infection. If symptoms don’t improve after three days of antibiotics, see a doctor for a follow-up visit.
Most importantly, use the ear drops properly
It’s hard to take ear drops. Most people do it incorrectly. One study found that only 40% of people prescribed ear drops use them correctly. Ear drops are also unpleasant, so many people don’t bother taking all of the medicine that they should. Follow these tips to ensure successful treatment:
Have someone else administer the drops if possible
Lie down with the affected ear facing up toward the ceiling
Pull down on the earlobe to straighten the ear canal
Run the medicine down the side of the ear canal
When done, stay in the same position for three to five minutes
Do not put anything in the ear canal
Avoid submerging the head in water or taking showers during the entire course of treatment. Using cotton balls in the ears may help to keep water out if bathing is necessary.
RELATED: 20 home remedies for ear infections
FAQs about swimmer's ear symptoms
What does the beginning of swimmer’s ear feel like?
Swimmer’s ear typically starts with itching and discomfort in the ear canal. The disease progresses rapidly, however. People may be in serious pain fairly soon after symptoms start.
Will swimmer's ear go away by itself?
Swimmer’s ear typically resolves on its own. However, this isn’t always true. Some bacterial infections may be stubborn or spread to other parts of the ear, the head, or the face. Fungal infections may not resolve without treatment. Allergic reactions or eczematous otitis externa may require a medical diagnosis before the condition can be effectively managed.
Is peroxide good for swimmer's ear?
Some people advise using hydrogen peroxide to treat or prevent swimmer’s ear. While it does kill bacteria,, it also harms human cells, so healthcare professionals do not advise putting it in the ear canal. Remember that the skin in the back two-thirds of the ear canal is very thin and easily injured. Be careful of what you put in there.
Are there ways to prevent swimmer’s ear?
Since water remaining in the ear canal for an extended amount of time can cause swimmer's ear, it’s essential to dry the ears after prolonged water exposure. One way to do this is to rid the ear of water by pulling each earlobe in different directions with the ear facing down. Another method is using a cold setting on a hair dryer to dry the ears. A snug-fitting swim cap can also keep ears dry while swimming or bathing.
What’s next? Additional resources for people with swimmer's ear symptoms
Test and diagnostics
Otitis externa, StatPearls (2023)
Otitis externa: a practical guide to treatment and prevention, American Family Physician (2001)
Treatments
Acute otitis externa: an update, American Family Physician (2012)
Ear drops, Cleveland Clinic (2023)
Ear eczema, National Eczema Society (2023)
Otitis externa, StatPearls (2023)
Swimmer’s ear treatments and medications, SingleCare (2020)
Scientific studies and clinical trials
Accuracy of patient self-medication with topical ear drops, Journal of Laryngology and Otology (2000)
Cotton-tip applicators as a leading cause of otitis externa, International Journal of Pediatric Otorhinolaryngology (2004)
More information on related health conditions
Ear infection symptoms: what are the early signs of an ear infection?, SingleCare (2023)
Ear infection treatments and medications, SingleCare (2023)
Inner ear infections: what are the early signs of an inner ear infection?, SingleCare (2023)