What You Need to Know About Swimmer's Ear

You’ve heard of swimmer’s ear, but what exactly is it, and what should you do if you get it?

Swimmer’s ear is an infection of the outer portion of the ear, which includes the ear canal, says Matthew Kashima, chair of otolaryngology and head and neck surgery at Johns Hopkins Medicine’s Bayview Medical Center in Baltimore.

It’s a bit of a misnomer, because swimming isn’t always involved. But otitis externa, as the condition is also called, is linked often enough to water exposure that the name “swimmer’s ear” has stuck, Kashima says.

If you’ve never had swimmer’s ear before, be glad. “It can be painful, and oftentimes, your ear can feel clogged or stopped up, you might have some discharge with some blood or pus in it, and if you pull on the outside of the ear, it’ll hurt,” he says.

Should you experience any of these symptoms in one or both ears, it’s best to see a doctor, be it your primary care doctor, an urgent care one, or an ear, nose, and throat specialist, Kashima says.

“Swimmer’s ear can resolve on its own, but it will get better faster with treatment,” he says. Plus, swimmer’s ear symptoms can mean other things instead, including an infection of the middle ear or temporomandibular joint syndrome (“lock jaw”), so it’s just best to get it checked out as soon as possible.

Different Types of Swimmer’s Ear

Swimmer’s ear comes in a few different forms: infectious, inflammatory, and chemical.

The infectious type is caused by bacteria—or occasionally a virus—that gets in the ear canal, grows, and causes local inflammation, swelling, and pain. The bacteria or virus might be from whatever water you’ve been swimming in, or it could already be on the skin of your outer ear.

“We have bacteria all over our skin,” Kashima says. “You can have bacteria already growing in your ear, feeding off of dry skin and other debris in the ear, and when water gets in the ear canal, it provides moisture for the bacteria to grow.”

The inflammatory type starts with dry or irritated skin in the ear canal—often eczema or psoriasis. When skin sloughs off in the ear, it can cause itching and irritation, Kashima says. The irritation allows bacteria already on the skin to get below the skin’s surface, causing an infection.

Similarly, the chemical type is caused by an allergic or irritant reaction of the skin to a chemical (often in a perfume or cosmetic), which causes the skin of the ear canal to become inflamed. This can allow bacteria on the skin to develop into a secondary infection, Kashima says.

If your ear is itchy, Kashima advises not using cotton swabs to scratch it. That can cause irritation—or more irritation—making infection all the more likely to happen.

Treatment for Swimmer’s Ear

If there’s an infection, swimmer’s ear is typically treated with an antibiotic ear drop. If the infection has been caused by inflammation, then Kashima usually prescribes an anti-inflammatory ear drop, cream, or oil preparation—sometimes with a steroid—as well. If there’s no actual infection, just irritation, then anti-inflammatory ear drops will usually be enough. Nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen can help with the pain, Kashima adds, and if there’s any debris in the ear, he’ll clean that out to make the drops more effective.

Occasionally, swimmer’s ear may be the result of a fungal infection, and that’s treated with anti-fungal ointment and several visits to the doctor for careful ear cleaning, he adds.

After applying the drops, don’t stuff your ear with a cotton ball, Kashima says. Keep your head tilted with the affected ear up for about two minutes to allow the drops to be in contact with the affected area, then realign your head and let the drops run back out on their own. That will dry out your ear and remove any debris.

Preventing Swimmer’s Ear

“Don’t stick anything in your ear,” Kashima says. “The only thing you should stick in your ear is your elbow,” he jokes, “so if you live by that rule, you’ll do pretty well.”

Kashima makes one exception to that rule: Rubbing alcohol drops, used regularly after swimming, help dry the ears out quickly, and a dry ear is less likely to develop swimmer’s ear than a wet one. “If you let that water stay in for days and days, then something might fester,” he says.

After he swims, he’ll put a few drops of rubbing alcohol into each ear with a cotton pad. As the alcohol dries up, the water drips out.

Charles McPeak, co-founder and coach of the Los Angeles–based SilverPeak Performance, follows this practice as well: “After every swim, I put a couple drops of rubbing alcohol in each ear. I haven’t had an ear infection in 30-plus years.”

Another trick Kashima shares is to run a hair dryer on a low fan setting and at arm’s length away from your ear to dry each ear out. “This has been the best advice from my doctor for preventing swimmer's ear,” says Lance Ogren, a Level 4 USMS coach of Palmetto Masters in Mount Pleasant, S.C. 

There are several remedies available over the counter, such as Swim-EAR or TYR’s Clear Ear Drying Aid, or you can make your own ear drops at home.

Passing Time on Land

“Keeping the ear dry will help it get better more quickly,” says Kashima, who recommends his patients with swimmer’s ear stay out of the water for one to two weeks.

That can be frustrating for the dedicated Masters swimmer who likes to stick to a regular swimming routine. But coaches are familiar with the condition, and they know what’s needed to get healthy as soon as possible.

“Take a couple days off and let the medicine get to work,” Ogren says. “Your body wasn’t able to fight off the infection in the first place, so give it a chance, and you’ll be back in the water in no time.” You won’t lose fitness in just a week, he says.

“After a couple of days off, begin a stretching routine or some light yoga, but don’t go for the hot, 100-degree, super-intense sessions,” he says. “Then maybe move on to some core work.”

For swimmers recovering from swimmer’s ear, McPeak recommends yoga four times a week: “Yoga goes hand in hand with swimming because it’s also a form of resistance training with a low impact on the body. Plus, we all know what flexibility and being relaxed can do for swimmers.”

So, should your ear suddenly become painful, don’t panic—just get it checked out as soon as possible. If you have to stay out of the water for a week or two, don’t worry. Do some yoga, rest up, allow your ear to recover, and enjoy the brief change of pace to your exercise routine. You’ll be back in the water before you know it.