Health Library Ear Canal Problems (Swimmer's Ear)From Healthwise

Swimmer's ear (otitis externa) is an 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.

Swimmer's ear is more likely if you have a very narrow or hairy ear canal, live in a warm, humid climate, have impacted earwax, or have had a head injury that also injured your ear.

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.

Review the Check Your Symptoms section to determine if and when you need to see a doctor.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Symptoms of an ear infection: Go to the topic Ear Problems and Injuries, Age 12 and Older or Ear Problems and Injuries, Age 11 and Younger.
• Symptoms of earwax buildup: Go to the topic Earwax.

	Yes	Do you think you have an ear canal infection?
When to See a Doctor See significance of an ear canal infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Is your ear canal swollen and painful? Yes Do you have fluid that looks like pus or that is white, yellow, or bloody draining from your ear? Yes Do you know or think you have a fever? Yes Is the outside of your ear red or swollen? Yes Is the skin around or behind your ear red or swollen more than 0.5 in. (1.3 cm)? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have mild ear pain and itching that is worse after 3 days of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had any ear problems for 2 weeks or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have hearing loss or dizziness?
When to See a Doctor See significance of hearing loss or dizziness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had a sudden hearing loss? Yes Have you had dizziness or vertigo that makes it hard to stand or walk? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you have mild hearing loss or vertigo that has not gotten better after 2 to 3 days of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have the following symptom?

• An object or insect in your ear: Go to the topic Objects in the Ear.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

You may be able to relieve your ear canal problem.

• If you are quite sure that you do not have a ruptured eardrum:
  • 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.
  • Avoid getting any more water in your ear until the irritation clears up. Cotton coated with petroleum jelly can be used as an earplug. 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.
• 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 of inserting 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.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate the symptoms if any of the following occur during home treatment:

• Ear pain and itching persist or get worse after 3 days of 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.
• Drainage from the ear that does not appear to be earwax develops.
• Drainage from the ear that smells bad develops.
• Fever develops.
• Dizziness or unsteadiness develops.
• Ear discomfort lasts for longer than 3 days.
• Symptoms become more severe or frequent.

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.

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?

• Ear Infections
• Ear Problems and Injuries, Age 11 and Younger
• Ear Problems and Injuries, Age 12 and Older
• Earwax
• Hearing Loss
• Objects in the Ear

Author:	Jan Nissl, RN, BS	Last Updated: February 13, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Donald R. Mintz, MD - Otolaryngology
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