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Ear Canal Problems (Swimmer's Ear)

Topic Overview

Picture of the anatomy of the ear

Swimmer's ear (otitis externa) is a painful inflammation and infection of the ear canal. It occurs when the protective film that covers the ear canal (lipid layer) is removed. This causes the ear canal to look red and swollen. The ear canal may be narrower than normal and is tender when the outside of the ear is gently pulled up and back.

Swimmer's ear may develop when water, sand, dirt, or other debris gets into the ear canal. Since it often occurs when excess water enters the ear canal, a common name for this inflammation is "swimmer's ear." If you have had swimmer's ear in the past, you are more likely to get it again.

A rare but serious infection called malignant external otitis can develop if bacteria invade the bones inside the ear canal and spread to the base of the skull. Not many people get this infection—it is mainly seen in older adults who also have diabetes, people who have HIV, and children who have impaired immune systems—but it can be fatal. Symptoms include ear pain with sudden facial paralysis, hoarseness, and throat pain. Antibiotics are used to treat this infection.

Other causes of inflammation or infection of the ear canal include:

  • Allergies.
  • Bony overgrowths in the ear canal called exostoses.
  • Bubble baths, soaps, and shampoos.
  • Cleaning the ear canal harshly or with a sharp object.
  • Headphones inserted into the ear.
  • Scratching the ear canal with a cotton swab, bobby pin, fingernail, or other sharp object.
  • Skin problems, such as eczema, psoriasis, or seborrhea.
  • Sweating.

You are more likely to get swimmer's ear if:

  • You have a very narrow or hairy ear canal.
  • You have earwax stuck in the ear canal (impacted) because you commonly use cotton swabs that may push the ear wax deeper into the ear canal.

Symptoms can include itching, pain, and a feeling of fullness in the ear. Your ear canal may be swollen. You may have moderate to severe pain, drainage, or hearing loss. Unlike a middle ear infection (acute otitis media), the pain is worse when you chew, press on the "tag" in front of the ear, or wiggle your earlobe.

You may be able to prevent swimmer's ear. Symptoms often get better or go away with home treatment.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have a problem with the ear canal?
This includes problems like fluid in the ear after swimming.
Yes
Ear canal problem
No
Ear canal problem
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Yes
Symptoms of inner ear infection
No
Symptoms of inner ear infection
Have you had an injury to your ear in the past week?
The ear can be injured by a direct hit, a very loud noise (like a gunshot or firecracker), or an object being pushed into the ear.
Yes
Recent ear injury
No
Recent ear injury
Yes
Symptoms of ear canal infection
No
Symptoms of ear canal infection
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Do you have diabetes?
Yes
Diabetes
No
Diabetes
Do you have a health problem or take medicine that weakens your immune system?
What weakens the immune system in an adult or older child may be different than in a young child or baby.
Yes
Disease or medicine that causes immune system problems
No
Disease or medicine that causes immune system problems
Do you have any new hearing loss?
Yes
New hearing loss
No
New hearing loss
Was the hearing loss sudden and complete?
Yes
Sudden and complete hearing loss
No
Sudden and complete hearing loss
Do you have vertigo?
Yes
Vertigo
No
Vertigo
Is the vertigo making it hard to stand or walk?
Yes
Hard to stand or walk
No
Hard to stand or walk
Have you had vertigo for more than a week?
Yes
Vertigo for more than 1 week
No
Vertigo for more than 1 week
Have you had any ear symptoms for more than a week?
Yes
Ear symptoms for more than 1 week
No
Ear symptoms for more than 1 week

Symptoms of an inner ear infection may include:

  • Pain deep in the ear. (External ear infections may itch or hurt in the outer part of the ear, but not deep in the ear.)
  • Fever.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:

  • Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
  • Steroid medicines, which are used to treat a variety of conditions.
  • Medicines taken after organ transplant.
  • Chemotherapy and radiation therapy for cancer.
  • Not having a spleen.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and you may have trouble standing, walking, or keeping your balance.

Ear Problems and Injuries, Age 12 and Older
Ear Problems and Injuries, Age 11 and Younger

Symptoms of an infection in the ear canal (swimmer's ear) may include:

  • Pain, especially when you touch your ear, wiggle your earlobe, or chew.
  • Redness or swelling in the ear canal.
  • Drainage from the ear.

Home Treatment

If you have a ruptured eardrum, you will likely need to see your doctor to treat the infection or injury that caused the rupture. A ruptured eardrum usually drains suddenly and leaks fluid that can look like pus, smell bad, or even be bloody.

If you do not have a ruptured eardrum, you may be able to relieve your ear canal problem.

  • Gently rinse the ear using a bulb syringe and warm saline solution or a half-and-half solution of white vinegar and warm water. Make sure the flushing solution is body temperature. Inserting cool or hot fluids in the ear may cause dizziness.
  • If your ear is itchy, try nonprescription swimmer's eardrops, such as Star-Otic or Swim-Ear. Use them before and after swimming or getting your ears wet.
  • To ease ear pain, apply a warm washcloth or a heating pad set on low. There may be some drainage when the heat melts earwax. For more information about earwax removal, see the topic Earwax.
    • Do not use a heating pad when you are in bed. You may fall asleep and burn yourself.
    • Do not use a heating pad on a child.
  • Do not use ear candles. They have no proven benefit in the removal of earwax or other objects in the ear and can cause serious injury.

To insert eardrops

  • First, warm the drops to body temperature by rolling the container in your hands or placing it in a cup of warm water for a few minutes. Inserting cold eardrops can cause pain and dizziness. See a picture showing how to insert eardrops safely.
  • Have the person lie down, ear facing up.
  • Place 2 or 3 drops on the wall of the ear canal so air can escape and drops can get into the ear. Gently wiggling the outer ear will help.
  • You may find it easier to insert eardrops in a small child's ear by holding the child on your lap with his or her legs around your waist and head down on your knees. If possible, remain in this position for 2 to 3 minutes.
Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your fever or pain:

Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • The ear canal, the opening to the ear canal, the external ear, or the skin around the external ear becomes swollen, red, or very painful.
  • Dizziness or unsteadiness develops.
  • Bleeding or discharge from the ear develops.
  • Ear symptoms last longer than 1 week.
  • Symptoms become more severe or frequent.

Prevention

In most cases, it is best to leave your ears alone and let them maintain their own healthy, natural balance.

  • Do not scratch or clean the inside of the ear with cotton swabs, bobby pins, your fingernail, or other objects.
  • Removable earplugs may be used to keep moisture out of the ear canal. But prolonged use of earplugs can make your ears hurt and itch, and the earplugs can push earwax deeper into the canal. If this happens, your ears are more likely to get infected.
  • Keep soap, bubble bath, and shampoo out of the ear canal. Do not let a child lie down in the bathtub with his or her ears underwater. These products can cause itching and irritation.
  • Keep your ears dry.
    • After swimming or showering, shake your head to remove water from the ear canal.
    • Gently dry your ears with the corner of a tissue or towel, or use a blow-dryer on its lowest setting. Hold the dryer several inches (centimeters) from the ear.
    • Put a few drops of rubbing alcohol or rubbing alcohol mixed with an equal amount of white vinegar into the ear after swimming or showering.
    • Wiggle the outside of the ear to let the liquid enter the ear canal, then tilt your head and let it drain out.
    • You can also use nonprescription drops, such as Star-Otic or Swim-Ear, to prevent swimmer's ear.
  • If you use public swimming pools or hot tubs, ask about the chlorine and pH testing of the pool. You are less likely to get swimmer's ear from facilities that maintain good control of their pool testing and treatment.
  • Do not swim in dirty water or locations that have been closed because of pollution.
  • Follow any instructions your doctor has given you to treat skin problems—such as eczema, psoriasis, or seborrhea—that may cause ear canal irritation.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • Have you done anything recently that may have caused your ear canal to become infected, such as cleaning your ears or swimming?
  • Have you had a history of ear itching, pain, or other symptoms? Describe your symptom:
    • When did it start?
    • Do you have problems with the inside or the outside of your ear?
    • Are your symptoms constant, or do they come and go?
    • Does anything make your ear feel better or worse?
  • Did you put anything into your ear before the problem started?
  • Do you have drainage from the ear? What does the drainage look and smell like?
  • Have you had a fever?
  • Are you dizzy or do you feel unsteady?
  • Have you had problems like this before? If so, how was it treated?
  • What home treatment measures have you used? Did they help?
  • What prescription and nonprescription medicine have you tried? Did they help?
  • Do you have any health risks?

Related Information

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Revised January 9, 2012

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