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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.
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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
Exactly How To Clean Your Nasty Little Earbuds
Ear infections can cause pain, itchiness, and discharge in and around your ears. Some people may experience fatigue, fever, or trouble hearing. A buildup of wax, which can also occur from frequent headphone use, can lead to muffled hearing, ringing in your ears, or a feeling of inner-ear pressure, says Dr. Portnuff.
All this is to say: It's worth cleaning your earbuds and you should do so at least once a week, Dr. Portnuff recommends. If you have any irritated skin in or around your ear (like if you have a cut or, IDK, you picked a zit), it's a good idea to clean them after each use, he adds: If the right germs are on your earbuds, an open wound can invite them in and increase your chances of developing an infection. Here's how to do it:
First, remove the physical gunk.
Step one is to get any earwax or other crud, like dust and dirt, off your buds. Remember: The stickier they are, the more germs they'll pick up from your environment, so it's best to get rid of wax first. (Besides, this is the grossest part, might as well get it over with).
Per Apple's AirPod cleaning guide, you shouldn't use a sharp object like tweezers or a nail file to clear out the grime, as you could damage the mesh speakers. Instead, use a dry, soft-bristled brush like a toothbrush to sweep away any visible debris—you can also try an earbud-specific cleaning tool like this one from Etsy, which SELF's editor in chief, Rachel Miller, has been loving.
Then, wipe them off with alcohol.
Once your buds are wax- and dirt-free, rub them down with a 70% isopropyl alcohol wipe or a 75% ethyl alcohol wipe. Evidence shows these towelettes are extremely effective at killing off most viruses, bacteria, and fungi. Just be sure to look for options that are safe for your skin, Dr. Portnuff recommends. Products made with harsh chemicals, such as hospital-grade disinfectants, can leave residue on your earbuds that can cause irritation, especially if you have sensitive skin, he says.
Isopropyl, or rubbing, alcohol (70% or higher) is another great choice, he adds; dab a cotton ball, swab, or piece of cloth in the solution and then wipe down your earbuds. You want to avoid bleach and hydrogen peroxide, though, as they can damage your earbuds. Oh, and never run water over them—many earbuds are water-resistant but that doesn't mean they're waterproof. Dousing them in H2O can forever ruin them.
Don't forget to give the case a good clean too.
Just like with the buds themselves, use a dry bristled brush (or, again, a specialized tool) to remove goop from the inside of your case. Then, yep, use a cloth or swab dampened with rubbing alcohol (or an alcohol wipe) to get rid of any lingering germs. Once you've cleaned everything, just make sure to let the buds and case dry off before using them again to avoid adding extra moisture to your ear.
On that note, you should also always try to put your earbuds back in their case, if they have one, when you're not using them (countertops and desks can be filthy!). And one last warning from Dr. Portnuff: Please, please do not lick your earbuds before using them. Yes, it's a thing, he says, and it transfers all types of germs from your mouth to your ear (and vice versa).
This whole process only takes a minute or two and can potentially save you a trip to urgent care (where Keller ended up, by the way). At the very least, won't it be nice to know that your headphones aren't jam-packed with ear wax and teeny tiny bacteria? That alone makes it worth it to me.
Related:
How To Get Water Out Of Your Ear
Remove excess water from your ears with methods like blow drying, using different types of ear drops, and even adding more water.
Although swimming is often the cause, you can get water trapped in your ear canal from any exposure to water. If this happens, you may feel a tickling sensation in your ear. This feeling may extend to your jawbone or throat. You may also not be able to hear as well or only hear muffled sounds.
Usually, the water drains out on its own. If it doesn't, the trapped moisture may lead to an ear infection. This type of ear infection in the external auditory canal of your outer ear is called swimmer's ear (otitis externa).
It's not hard to get water out of your ear on your own. These 12 tips can help.
If water gets trapped in your ear, you can try several at-home remedies for relief:
1. Jiggle your earlobeThis first method may shake the water out of your ear right away.
Gently tug or jiggle your earlobe while tilting your head downward toward your shoulder.
You can also try shaking your head from side to side while in this position.
2. Make gravity do the workGravity can help the water drain from your ear.
Lie on your side for a few minutes, with your head on a towel, to absorb the water. The water may slowly drain out of your ear.
3. Create a vacuumThis method creates a vacuum that may draw the water out.
The heat from a blow dryer may help evaporate the water inside your ear canal.
If a doctor recommends them, consider eardrops after swimming. Over-the-counter (OTC) eardrops may help soften impacted earwax that may prevent water from exiting the ear. Some formulations may also repel water and reduce the chance of infection.
Options may include:
Do not use these methods if you have any of these conditions:
6. Try more waterThis technique may sound illogical, but it can actually help draw water out of your ear.
Warm steam may also help release water from your ear. Try taking a hot shower or giving yourself a mini sauna with a bowl of hot water.
If at-home remedies aren't working, don't resort to using ear swabs, your finger, or any other object to dig inside of your ear. Doing this may make matters worse by:
A doctor, such as a primary care physician or an otolaryngologist (ENT) may be able to safely remove water or wax from your ear.
These simple tips can help prevent water from getting stuck in your ear in the future.
The following includes frequently asked questions about getting water out of your ear.
Will water come out of my ear naturally?Water typically leaves the ears naturally with the help of gravity. But it doesn't feel like it's working, some home remedies, including eardrops and jiggling your earlobe, may help the water work its way out.
Why can't I get water out of my ear?If you can't get water out of your ear, earwax or other debris may be blocking the way. If this is the case, avoid sticking anything in your ear to clear it, as this can potentially cause an infection. Sterile eardrops may help soften earwax. You may also have an ear infection known as swimmer's ear that may require treatment from a medical professional.
What happens if you have water in your ear for too long?If water stays in your ear, you may develop an ear infection, especially if bacteria was present in the water. This infection is called swimmer's ear and may require treatment from a healthcare professional.
How do you open a blocked ear?If your ear feels blocked due to water or pressure, you may be able to safely open your eustachian tubes and equalize pressure by yawning, swallowing, or applying a warm compress. If this and other remedies do not work, a medical professional may be able to help.
Trapped water usually goes away without treatment. If it bothers you, consider trying one of these home treatments to help relieve your discomfort. But if the water is still trapped after 2 to 3 days or if you show signs of infection, you should call a doctor.
If your ear becomes inflamed or swollen, you may have developed an ear infection. An ear infection can become serious if you don't get treatment for it. It may lead to hearing loss or other complications, such as cartilage and bone damage.
A doctor can prescribe medications to eliminate infection and relieve pain.
Trapped water in your ear may work its way out naturally. Some home remedies, such as jiggling your earlobe or laying on your side so the water drips out, may help it along.
In some cases, water in your ear may lead to an infection that needs medical attention.
Avoid sticking anything, including cotton swabs or your fingers, into your ear. This can introduce bacteria or injury and lead to infection.
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