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Steps To Heal Otitis Externa (Swimmer's Ear)
Prescriptions ear drops are the mainstay of treatment
FangXiaNuo / Getty Images
Medically reviewed by John Carew, MD
Otitis externa, also known as swimmer's ear, is an infection of the outer ear canal that causes pain along with swelling, redness, itching, ear drainage, and decreased hearing.
Prescription ear drops are the mainstay of otitis externa treatment, some of which contain acidifying or drying agents. Bacterial and fungal otitis externa can be effectively treated with antibiotic or antifungal ear drops. Steroid ear drops can help ease itchiness and inflammation.
FangXiaNuo / Getty Images
This article explains how to heal swimmer's ear, including preferred treatment options and self-care tips. It also explains when it is time to see an ear, nose, and throat (ENT) specialist if complications arise that might permanently damage your hearing.
Related: Anatomy of the Ear: What You Should Know
Otitis Externa: A Common Outer Ear InfectionOtitis externa is a common ear infection that accounts for nearly 500,000 healthcare provider office or emergency room visits yearly. An estimated 10% of people will get otitis externa at some point in their life.
Otitis externa is called swimmer's ear because repeated exposure to water can make the ear canal vulnerable to inflammation. Inflammation, in turn, can disrupt the integrity of the skin in the ear and allow bacteria and fungus easier entry into underlying tissues.
This condition can affect all age groups. However, children who spend a lot of time in the water are at greatest risk, particularly during the summer months when swimming is common.
Symptoms of otitis externa often develop rapidly, usually within a span of 48 hours, and may include:
Ear pain (made worse by touching the ear canal, tugging the ear, or chewing)
Itchiness
Redness and swelling
A feeling of ear fullness
Swollen lymph nodes in the neck
Ear drainage with crusting
Muffled hearing
Fever
Jaw pain on the affected side
Otitis externa is most often caused by bacteria and less frequently by fungi. Swimming in contaminated water is a common way to get swimmer's ear. But you can also get it if water becomes trapped in the ear while showering or sweating, especially in humid climates.
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Other risk factors include:
Ear wax buildup
Having hairy ear canals
Using unclean hearing aids or earbuds
Wearing earplugs
Putting things into your ear (like cotton swabs or fingers)
Related: What It Means When Your Ear is Draining
Will Otitis Externa Heal Without Treatment?Unlike otitis media (middle-ear infection), which sometimes heals on its own, otitis externa generally won't go away without treatment. While milder cases may clear without medications, it can take weeks—and a lot of aggravation and discomfort—to get there.
Swimmer's ear is generally not serious, but a prolonged or severe infection can injure the ear canal and make it vulnerable to repeated infections (known as chronic otitis externa). Repeated infections, in turn, can cause the ear canal to narrow, potentially affecting hearing.
By treating otitis externa early with prescription ear drops, you can avoid complications and usually resolve the infection within a week or less.
When to Seek Otitis Externa TreatmentGiven the benefits of early treatment, it is important to see a healthcare provider if you even have mild symptoms of otitis externa. Early treatment almost invariably leads to better outcomes.
The diagnosis is relatively straightforward, and the treatment can readily be dispensed by a general practitioner. More complicated cases may require an ENT specialist known as an otolaryngologist.
The diagnosis of swimmer's ear involves a visual examination of the ear canal using a lighted scope called an otoscope. A swab of your ear canal may be cultured in the lab to determine if the cause is bacterial or fungal. This helps ensure that the correct treatment is dispensed.
A thorough diagnosis by a healthcare provider is important because otitis externa can mimic other conditions like eczema, psoriasis, and contact dermatitis that require different treatments.
Note to ParentsOtitis externa is not only common in children but also more likely to cause complications if left untreated. The spread of infection to the middle ear can lead to otitis media with effusion (OME), a potentially serious condition that can cause temporary or permanent hearing loss.
In infants and young children, even temporary hearing loss can lead to delays in speech development and social skills development.
Related: Common and Uncommon Causes of Ear Pain
Effective Otitis Externa TreatmentsPrescription ear drops are the mainstay of treatment for otitis externa. Oral painkillers are occasionally prescribed to help ease the pain.
The treatment may also involve the cleaning of the ear canal or the use of a tool called an ear wick to deliver medications into a blocked ear canal.
Types of Ear DropsDepending on the type and severity of infection involved, one or more ear drops may be prescribed. Each has a different mechanism of action that can either kill the underlying germ or make the environment of the ear hostile to the germ.
Ear drops commonly prescribed for swimmer's ear include:
Drying ear drops: Bacteria and fungi thrive in moist environments. These ear drops mainly contain isopropyl alcohol, which dries the ear canal and impedes the germ's growth.
Acidifying ear drops: These ear drops typically contain acetic acid, which is hostile to most bacteria and fungi. On the downside, the drops can cause stinging if tissues are inflamed.
Antibiotic ear drops: Ciprofloxacin ear drops are effective for bacterial infections. Ofloxacin, polymyxin B, and neomycin may also be used.
Antifungal ear drops: Clotrimazole, fluconazole, and miconazole ear drops may be prescribed to treat fungal ear infections.
Corticosteroid (steroid) ear drops: Hydrocortisone and dexamethasone can help ease inflammation and pain and are often the ingredients found in combination antibiotic ear drops.
Oral antibiotics taken by mouth are not used to treat otitis externa. On their own, they are insufficient to curb a bacterial infection and may only increase the risk of antibiotic resistance. The only exception is when the infection has spread outside of the ear canal.
Related: How to Use Ear Drops Correctly
Oral PainkillersEar pain is very rarely severe with otitis externa. Pain can make it difficult to sleep, work, or function. Oral painkillers, both over-the-counter and prescription, can often provide short-term relief.
Some of the more common options include:
Related: How to Manage Ear Pain Safely
Other ProceduresBefore ear drops can be used, the ear canal may need to be cleaned. This procedure, known as aural toileting, is performed by a healthcare provider (and never by yourself or a nonmedical professional).
The process usually involves:
Manually clearing the ear of any debris (like large pieces of wax)
Irrigating the ear canal with sterile fluids from a bulb syringe
Suctioning the ear canal with gentle vacuum pressure
If the ear canal cannot be adequately cleaned or is very swollen, a device called an otowick may be used. This spongy wick is inserted into the canal and expands when drops are applied, securing it in place. The wick can be left for several days, allowing the drops to travel deep into the ear canal when applied.
Related: Natural Remedies for Swimmer's Ear
Following Otitis Externa Antibiotic PrescriptionOtitis externa is more often than not caused by a bacterial infection and, with proper treatment, can heal within three to 10 days.
According to guidelines issued by the American Academy of Otolaryngology, the following antibiotic therapies can be used:
Ciprofloxacin with hydrocortisone: Three drops to the affected ear twice daily
Polymyxin B, neomycin, and hydrocortisone: Three to four drops to the affected ear four times daily
Ofloxacin: Five drops to the affected ear twice daily
The drops need to be administered without missing a dose. Be sure to space the doses as evenly as possible (every eight hours for ciprofloxacin, every six to eight hours for polymyxin B/neomycin, and roughly every five hours for ofloxacin).
The treatment can be extended up to 10 days, with up to 95% of people experiencing complete clearance within seven to 10 days.
How to Pay for TreatmentThe cost of treating any ear infection can often exceed $300. While insurance may cover some of the expenses, you may still be left with co-pay or coinsurance costs.
To reduce out-of-pocket costs, see if combination ear drops (which are generally more expensive) can be substituted with individual ear drops (which are generally less expensive).
You can also compare drug prices and get coupons on consumer websites like GoodRx or find low-cost drugs (like ofloxacin ear drops) from online retailers like Mark Cuban's CostPlus.
Self-Care With Otitis ExternaWhile undergoing treatment for otitis externa, there are five self-care tips that can ensure the best possible outcomes, which are:
Do not use any other ear drops unless your healthcare provider gives you the OK.
Avoid showering until the infection has cleared, instead opting for a bath. Make sure to keep the ear out of the bathwater.
If you have to shower, lightly coat a cotton ball with petroleum jelly to use as an earplug. Keep your ear away from the water stream. Do not use plastic earplugs.
After washing, use a hairdryer set on low to gently dry the ear.
To help ease the pain, place a warm, moist face cloth against the ear. You can do this several times a day for 10 to 15 minutes.
Otitis externa is considered acute if it lasts less than six weeks. If it lasts longer than three months, it is classified as chronic otitis externa.
Chronic otitis externa differs from acute otitis externa in that it is less likely to be caused by an infection and more likely to be caused by an allergy, autoimmune disease, or skin disease like psoriasis or eczema. These conditions often come and go in flares and can affect both ears rather than just one.
With chronic otitis externa, ear pain is uncommon. Instead, there may be itching (sometimes intense) along with muffled hearing in the affected ear. Over time, the persistent inflammation can cause the ear canal to narrow, leading to significant and sometimes irreparable hearing loss.
The treatment of chronic otitis externa is focused on resolving the underlying cause. During flares, corticosteroid ear drops can help ease inflammation and swelling. Antibiotic ear drops may also be used to prevent bacterial infection.
Other possible complications of otitis externa include:
Abscesses: These painful, pus-filled pockets can form in the ear canal as the infection spreads into hair follicles. Severe cases may require antibiotics and the drainage of pus.
Auditory canal stenosis: Severe or repeated infections can scar the walls of the ear canal, causing the ear canal to narrow. The narrowing (stenosis) may affect hearing.
Eardrum perforation: Infections that spread to the middle ear can cause buildup of pus that weakens the eardrum and causes it to rupture (burst). While the eardrum can usually heal itself in a couple of months, surgery may be needed if it doesn't.
Cellulitis: This severe infection occurs when damaged tissues in the ear canal allow bacteria to gain easy access to deeper tissues. Cellulitis can cause pain, fever, and chills and require a seven-day course of antibiotics to clear.
Necrotizing otitis externa: This is a rare but potentially life-threatening spread of the infection from the ear canal to the base of the skull. The treatment involves intravenous antibiotics (delivered to a vein) and possibly surgery.
While uncomplicated cases of otitis externa can be treated by most healthcare providers, those that are resistant to treatment or cause severe symptoms should be seen by an ENT specialist.
Otolaryngologists are typically at the forefront of the latest treatment approaches and are generally better equipped to perform delicate ear procedures like ear cleanings and otowick placement.
To receive certification from the American Board of Otolaryngology (ABO), applicants must complete medical school and an average of five to seven years of postgraduate surgical training.
It is important to see an otolaryngologist if you experience:
As surgical specialists, otolaryngologists are qualified to perform ear surgeries.
Related: 5 Ways to Prevent Swimmer's Ear
SummaryOtitis externa, also known as swimmer's ear, is an infection of the ear canal, most often by bacteria and less commonly by fungi. It can be caused by getting polluted water in your ear while swimming or putting unclean objects in your ear. Children are affected more than adults. Ear pain, itching, drainage, and hearing loss are possible side effects.
The treatment of otitis externa primarily involves prescription ear drops. These include drying, acidifying, antibiotic, antifungal, and steroid ear drops used either alone or in combination. Oral painkillers (very rarely), ear cleaning, and ear wicks may also be included in the treatment plan.
Chronic otitis externa is a persistent condition more often caused by allergies, autoimmune disorders, and skin disease. It is characterized by itching and hearing loss, often in both ears. The treatment is mainly focused on resolving the underlying condition, but steroid and antibiotic ear drops may be used to relieve inflammation and prevent infection.
Read Next: Types of Ear Infection: How to Tell Them Difference
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