Ear Infections in Swimmers Prevention, Treatment & When to See an ENT

Anyone who swims regularly has probably dealt with it at some point. That uncomfortable feeling after a session in the pool, a slight fullness in the ear, maybe some itching, and then the next morning, pain that makes it clear something isn’t right. For some people it happens occasionally. For others particularly regular swimmers or those who spend a lot of time in the water, it becomes a recurring problem that starts affecting how often they can actually swim.

Swimmer’s ear, as it’s commonly called, is one of the more frequent ENT complaints seen in people who spend time in pools, lakes, or the sea. It’s very treatable. It’s largely preventable. And understanding what’s actually happening in the ear canal when water gets in and why some people are more prone to it than others, changes how the problem gets managed.

What Is Swimmer’s Ear?

The medical term is otitis externa, an infection of the outer ear canal, the passage that runs from the outer ear to the eardrum. It’s distinct from a middle ear infection, which is behind the eardrum and is the kind more commonly seen in young children with colds.

The ear canal is a warm, slightly moist environment lined with delicate skin. Under normal conditions, it has a natural defence system, the skin produces cerumen (ear wax) that has mild antibacterial and antifungal properties, and the slightly acidic environment of the canal makes it difficult for bacteria and fungi to take hold.

Water disrupts this balance. When water sits in the ear canal after swimming, it softens the skin lining, dilutes and washes away the protective wax, and raises the pH of the canal, making it less acidic and more hospitable to bacterial or fungal growth. If bacteria from pool water, sea water, or a lake get into that softened, less-defended environment, an infection develops.

The most common bacteria responsible are Pseudomonas aeruginosa and Staphylococcus aureus both of which thrive in wet environments and are frequently found in pool water despite chlorination.

Why Do Some Swimmers Get It More Than Others?

This is a question regular swimmers often ask, why does one person in a group swim session come away with an ear infection while everyone else is fine?

Several factors influence susceptibility:

Ear canal shape – a narrower or more curved ear canal traps water more easily and makes drainage slower after swimming. This is anatomical and not something that can be changed, but it does explain why some people are consistently more prone regardless of how careful they are.

Ear wax production – people who naturally produce less wax have less of the protective barrier that keeps the canal’s environment stable. Those who regularly clean their ear canals with cotton buds — removing the wax that’s supposed to be there have the same problem.

Skin conditions – eczema, psoriasis, or seborrhoeic dermatitis affecting the ear canal skin create a less intact barrier, making infection easier to establish.

Frequency and duration of swimming – more time in the water means more cumulative exposure. Competitive swimmers, water polo players, and those who swim daily are at significantly higher risk than casual swimmers.

Water quality – pool water that’s not optimally chlorinated, sea water, and lake or river water all carry higher bacterial loads than a well-maintained pool. Warmer water also supports more bacterial growth.

Hearing aids and earplug use – regular use of hearing aids or earphones that sit in the canal can trap moisture and slightly abrade the canal skin, increasing susceptibility.

Previous ear surgery or a perforated eardrum – these change the anatomy and defence mechanisms of the ear in ways that increase infection risk, and also mean that water in the ear carries a higher risk of reaching the middle ear.

Recognising Swimmer’s Ear The Symptoms

Otitis externa has a fairly distinctive symptom pattern that differentiates it from middle ear infections:

Itching inside the ear canal – often the first symptom, appearing before pain develops. The canal feels irritated and uncomfortable.

Pain that worsens when the outer ear is touched or pulled – this is one of the more telling signs. Pressing on the tragus, the small flap of cartilage at the entrance to the ear canal or pulling the outer ear causes a significant increase in pain. Middle ear infections don’t typically do this.

A feeling of fullness or blockage – the ear feels plugged, similar to the feeling of water being stuck in the ear but persisting even after any water should have drained.

Discharge from the ear – watery, then increasingly thick or purulent as the infection progresses. May have an odour.

Reduced hearing – if the canal becomes swollen enough or fills with debris and discharge, hearing on that side becomes muffled.

Redness and swelling – visible at the entrance to the ear canal, sometimes extending to the outer ear in more severe cases.

In mild cases, symptoms are limited to itching and mild discomfort. In moderate to severe cases, pain can be significant, enough to make chewing or jaw movement uncomfortable, because of the proximity of the ear canal to the jaw joint.

What Makes It Worse

A few things consistently make otitis externa more severe or slower to heal:

Continuing to swim – the most common reason infections don’t resolve. Getting the ear wet again before the infection has cleared reintroduces water to an already compromised canal.

Putting objects in the ear – cotton buds, fingers, or anything else inserted to try to clean or dry the ear. These further damage the canal lining and push debris deeper.

Using ear drops that aren’t prescribed for this condition – certain drops are not appropriate for ear canal infections, and using the wrong thing delays treatment.

Delay in treatment – what starts as mild otitis externa can progress to moderate or severe if left untreated. In people with diabetes or those who are immunocompromised, a severe form called malignant or necrotising otitis externa can develop, where the infection spreads to the cartilage and bone of the skull base. This is a serious complication that needs aggressive treatment, which is why diabetes and ear infections is a combination that should always be assessed promptly.

Treatment What Actually Works

Mild Cases

For mild otitis externa primarily itching and minimal discomfort, a few measures can be tried:

Acetic acid ear drops – a dilute acidic solution that helps restore the normal pH of the ear canal and has mild antibacterial properties. Available over the counter and often effective for very early or mild cases.

Keeping the ear dry – this is non-negotiable. No swimming until resolved. Showering with a cotton ball lightly coated in petroleum jelly placed at the entrance to the ear canal to prevent water entry. Not submerging the ear.

Avoiding anything in the ear canal – no cotton buds, no earphones, no hearing aids in the affected ear until healed.

Moderate to Severe Cases

These need medical treatment and shouldn’t be managed at home beyond keeping the ear dry and taking appropriate pain relief.

Antibiotic ear drops – the mainstay of treatment. Typically containing a fluoroquinolone antibiotic, sometimes combined with a corticosteroid to reduce swelling and inflammation. Drops need to be placed correctly to reach the affected area, lying on the side with the affected ear up, instilling the drops, and staying still for a few minutes allows the medication to reach the canal lining properly.

Ear wick – when the canal is significantly swollen, drops can’t penetrate far enough to be effective. An ENT will insert a small wick, a compressed sponge material into the canal. The wick expands with the drops, drawing medication deeper into the swollen canal and holding it in contact with the lining. It’s removed once the swelling has reduced enough for drops to reach adequately on their own.

Oral antibiotics – not usually needed for uncomplicated otitis externa, as the drops provide direct, concentrated treatment to the site. Oral antibiotics are added when infection has spread beyond the canal, when there’s significant fever or systemic illness, or in immunocompromised patients.

Microsuction and cleaning – removing debris, discharge, and accumulated skin material from the canal allows drops to work more effectively and speeds resolution. This is done by an ENT under direct vision.

Pain management – regular paracetamol and ibuprofen for pain control during the treatment period. Keeping the ear dry and avoiding manipulation of the outer ear reduces pain significantly.

Prevention How to Actually Avoid It

For regular swimmers, prevention is considerably more useful than repeated treatment. A few measures genuinely help:

Dry the ears after every swim – tilt the head to each side to allow water to drain. Gently drying the outer ear with a soft towel is fine. A hairdryer on the lowest heat setting, held at a distance, can help evaporate water from the canal, but heat should be gentle, not direct or close.

Acetic acid or alcohol-acetic acid drops after swimming – a few drops in each ear after every swim session restores the canal’s acidic environment and speeds drying. This is one of the most effective preventive measures for those prone to swimmer’s ear. Several over-the-counter preparations are available, or a doctor can recommend one. Not appropriate if there’s a known perforated eardrum or grommets in place.

Ear plugs – custom-moulded or well-fitted silicone ear plugs prevent water from entering the canal during swimming. They need to fit properly, poorly fitting plugs don’t seal effectively and can themselves trap water. For people with a history of recurrent otitis externa or a perforated eardrum, well-fitted ear plugs are particularly important.

Don’t over-clean the ears – the wax is there for a reason. Removing it with cotton buds strips away the protective layer and leaves the canal more vulnerable to infection. Leave the wax alone, the ear’s self-cleaning mechanism handles it in most people.

Choose pools carefully – well-maintained, properly chlorinated pools carry significantly lower infection risk than poorly maintained ones, natural water bodies, or warm recreational pools. If a pool has visible signs of poor maintenance or if multiple people in the same group keep getting ear infections, the water quality is worth questioning.

Treat any underlying skin condition – eczema or psoriasis affecting the ear canal should be managed properly, as chronically inflamed skin is far more susceptible to infection from water exposure.

For children in swimming lessons – keeping sessions shorter during periods of high infection risk, drying ears promptly after lessons, and checking regularly for early signs of irritation helps catch problems before they develop into full infections.

When Should You See an ENT?

Most mild cases of swimmer’s ear can be started with acetic acid drops and keeping the ear dry. But see an ENT if:

• Pain is moderate to severe and not settling within a day or two
• There’s significant discharge from the ear
• Hearing has reduced on the affected side
• The outer ear or surrounding skin looks red or swollen
• Symptoms aren’t improving after two to three days of home measures
• There’s a fever alongside ear pain
• The person has diabetes or is immunocompromised, these cases need assessment from the outset rather than home treatment
• There’s a known perforated eardrum or grommets in place, water in the ear in these situations needs prompt assessment
• Ear infections keep coming back despite preventive measures, recurrent otitis externa usually has an underlying reason that needs to be identified

For competitive swimmers or those whose training schedule means they can’t afford extended time out of the pool, an early ENT review rather than waiting to see if it settles is usually the more practical approach. Getting the right treatment started quickly, including an ear wick if needed resolves the infection faster and gets them back in the water sooner.

A Note on Fungal Ear Infections

Not all swimmer’s ear is bacterial. A significant proportion, particularly in warm, humid climates like Chennai is caused by fungal organisms, most commonly Aspergillus or Candida species. Fungal otitis externa tends to produce more intense itching than bacterial infection, sometimes with less pain. The discharge looks different often described as having a fluffy or granular appearance.

Fungal ear infections don’t respond to standard antibiotic ear drops, they need antifungal treatment. This is one reason why ear infections that are treated with antibiotic drops but don’t resolve should be assessed by an ENT rather than just continuing the same treatment. A simple examination under a microscope or with an otoscope usually makes the distinction clear.

Final Thoughts

Swimmer’s ear is common, uncomfortable, and highly preventable. For most swimmers, a combination of proper drying technique, acetic acid drops after swimming, and leaving the ear canal alone between swims is enough to keep it at bay.

When it does develop, early treatment with the right drops and keeping the ear dry, resolves most cases within a week to ten days. The mistake that prolongs it is continuing to swim or hoping it’ll clear without treatment.

For those who keep getting it despite preventive measures, an ENT assessment helps identify whether there’s an underlying structural or skin factor driving the susceptibility, and what can be done about it.

Our ENT specialist manages ear infections in swimmers of all ages, from straightforward cases needing the right drops to recurrent infections needing a closer look at what’s driving them. If swimmer’s ear has been keeping you or your child out of the pool more than it should, come in for an assessment.