Swimmer's ear (or Otitis Externa) is an infection or inflammation of the outer ear canal, the canal between the eardrum and the outer ear. It can be acute if it develops and departs quickly, or chronic, if symptoms are ongoing or if it keeps reoccurring. 


Its name, swimmer’s ear, refers to the fact that it often occurs as a result of water remaining in the ear after swimming, washing away the protective coating of earwax and creating a moist environment that encourages the growth of bacteria. This condition is most commonly triggered by exposure water in the ear canal, but it can also be caused by mechanical damage due to excessive cleaning, chemical damage such as from hair treatment products, cuts in the skin of the ear canal and other conditions such as eczema.


Symptoms of the condition range from mild to severe and may include:


* Redness and swelling of the skin of the ear canal.  

* Pain – pain may be exacerbated by moving the head or pulling the ear  

* Itchiness.  

* Discharge or increased wax.  

* Foul-smelling yellow or green pus in the ear canal  

* Reduced hearing.  

* Noises inside the ear, such as buzzing or humming.




* Water - dirty water can deliver bacteria to the ear canal. A wet ear canal is also prone to dermatitis. Tiny cracks or splits in the skin can allow bacteria to enter. Swimming can also reduce the amount of wax in the ear canal  

* Mechanical damage - attempts to clean the ears using fingernails, cotton buds or other objects may cut the delicate tissues of the ear canal and lead to infection.  

* Chemical irritation - hairsprays, shampoos and hair dyes may get into the ear canal and irritate the tissues.  

* Skin Conditions - Having a skin condition such as dermatitis or psoraiasis, which leads to broken skin in the area making the ear more prone to infection  

* Middle ear infection (otitis media) - an infection within the middle ear can trigger an infection or inflammation in the ear canal.  

* Diabetes - this condition can make earwax too alkaline, which creates a more hospitable environment for infectious agents.  

* Folliculitis - an infected hair follicle within the ear canal can trigger a generalised infection.  

* Narrow ear canals - some people's ear canals are narrower than usual. This means that water can't drain as effectively.



Some of the possible complications of swimmer's ear include:  

* Chronic otitis externa - infection persists, or else keeps recurring.  

* Narrowing of the ear canal - repeated infections can cause the ear canal to be narrowed by scar tissue. The risk of swimmer's ear is increased if water can't drain out properly. Narrow ear canals may also affect hearing.  

* Facial infection - the infection may escape the ear canal, down small holes in the surrounding cartilage, and lead to painful facial swelling.  

* Malignant otitis externa - the infection may spread to the bones and cartilage of the skull.


Malignant otitis externa is the spread of infection to the bones of the ear canal and lower part of the skull. This may cause structural damage in severe cases. Without treatment, the infection may reach the cranial nerves and the brain. People with reduced immunity or diabetes are at increased risk of this complication. Malignant otitis externa is a medical emergency. If you have swimmer's ear and experience strange symptoms, such as dizziness or muscular weakness in your face, seek immediate medical help.



Swimmer's ear is diagnosed by physical examination. The skin of the ear canal will appear red, scaled and peeling when examined using an otoscope. The eardrum may be inflamed and swollen. Microscopic examination of the discharge in the ear canal will, in most cases, tell the doctor whether the infection is caused by bacteria or fungi. The diagnosis can be confirmed by culturing a swab of pus.

In cases where the eardrum is damaged, referral to an ear, nose and throat specialist may be required. In the case of malignant otitis externa, further tests - including skull x-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scans - are taken. Treatment depends on the degree of bone infection (osteomyelitis), but is generally lengthy and involves prolonged courses of antibiotics. Surgery may also be necessary.


Treatment for swimmer's ear depends on the severity of the infection and the type of infectious agent. The most common treatment is eardrops containing antibiotics prescribed by a doctor, and symptoms of swimmer's ear usually resolve with treatment within two to three days. Treatment may include:


* Thorough cleaning and drainage of the ear canal

* Measures to keep the ear canal dry, such as using earplugs or a shower cap while bathing and alcohol based ear drops (e.g. Ear Clear for Swimmer's Ear, Vosol Ear Drops and Aquaear Solution)

* Painkillers to help ease discomfort

* Heat packs held to the ear

* Anti-fungal preparations

* Antibiotic ear drops

* Steroid-based ear drops or creams

* A wick inserted into the ear canal to deliver medicated drops close to the eardrum

* Oral antibiotics

* Intravenous antibiotics

* Surgery, to treat and drain infected skull bones.



Suggestions to reduce the risk of swimmer's ear include:


* Avoid swimming in contaminated water or dirty public pools.

* Wear earplugs when you swim.

* Dry your ears thoroughly after exposure to water.

* Not lying with your head submerged in the bathtub

* Plug your ears with cotton wool when using hair spray, shampoo or other chemical products.

* Avoid vigorous ear cleaning with cotton buds.

* Avoid poking your fingers in your ears, because fingernails can cut the skin of the ear canal.