Chronic Swimmer's Ear

Written by Anna Giorgi | Published on July 20, 2012
Medically Reviewed by George Krucik, MD

What Is Chronic Swimmer’s Ear?

Chronic swimmer’s ear is an ear condition in which the outer ear and ear canal become infected, swollen, or irritated. The disorder often results from having water trapped in your ear after swimming. The ear’s structure and the water left in the ear after swimming combine to create an ideal damp, dark space in which bacteria and fungi can thrive and cause infection.

Swimmer’s ear occurs fairly often in children and teenagers. Cases are typically acute (not chronic) and respond to treatment within one to two weeks. Chronic swimmer’s ear occurs when the condition is not resolved easily or when it recurs multiple times.

The medical term for chronic swimmer’s ear is chronic otitis externa.

Causes of Chronic Swimmer’s Ear

Your earwax, or cerumen, provides a natural barrier against germs entering your ear. Swimmer’s ear can occur when your earwax is reduced or removed. Without the protection of adequate earwax, bacteria can enter your ear and cause an infection.

The following circumstances are common causes of chronic swimmer’s ear:

  • allowing too much water to get into your ears
  • extreme cleaning of the ear canal with cotton swabs
  • allowing cosmetic chemicals from products such as hairspray to enter your ear, which could cause a sensitivity reaction
  • scratching the inside or outside of the ear, causing small breaks in the skin which can trap infection
  • having something stuck in your ear
  • not following through with treatment for acute swimmer’s ear

Risk Factors for Chronic Swimmer’s Ear

Chronic swimmer’s ear is most common in children. Children typically have a narrow ear canal, which allows water to become trapped more easily.

Other circumstances and behaviors that can increase your risk of developing chronic swimmer’s ear include:

  • swimming frequently
  • swimming in areas where there may be excessive bacteria, such as hot tubs or polluted water
  • using headphones, hearing aids, or swim caps that could scratch or injure your ears
  • having skin conditions that typically affect other parts of the body, such as psoriasis, eczema, or seborrhea; these may also affect the ear canal

An acute case of swimmer’s ear may become chronic if:

  • the physical structure of the ear makes treatment difficult
  • the bacterium is a rare strain
  • you have an allergic reaction to antibiotic eardrops
  • the infection is both bacterial and fungal

Symptoms of Chronic Swimmer’s Ear

Chronic swimmer’s ear begins with the symptoms of an acute case of swimmer’s ear. Signs and symptoms include:

  • itching inside the ear or ear canal
  • pain that intensifies when you tug on the outside of the ear or when you chew
  • feeling that the ear is stuffed or blocked
  • a reduced level of hearing
  • fever
  • fluid or pus draining from the ear
  • swollen lymph nodes around the ear

The condition is considered chronic if:

  • the symptoms occur repeatedly, in sequential episodes
  • the symptoms persist for more than three months

Complications of Chronic Swimmer’s Ear

Complications of untreated chronic swimmer’s ear include:

  • hearing loss
  • infection of the surrounding skin
  • cellulitis (an infection that affects the deep tissues of the skin)

Serious complications that affect other parts of the body include:

  • malignant otitis externa (an infection that spreads to the base of your skull, which is more likely to affect older adults and people with diabetes or immune deficiencies)
  • widespread infection (a rare, potentially life-threatening complication that occurs when malignant otitis externa spreads to your brain or other parts of your body)

Diagnosing Chronic Swimmer’s Ear

A physician can usually diagnose chronic swimmer’s ear during an office visit. Using an otoscope—a lighted instrument that allows for examination inside the ear—your physician may find:

  • a red and swollen ear and ear canal
  • redness in the eardrum
  • flakes of scaly shedding skin in the ear canal
  • blockage of the affected area that may require clearing

These are all signs of chronic swimmer’s ear.

To determine why the condition has become chronic, you may be referred to an otolaryngologist (an ear, nose, and throat specialist) who can identify whether the primary site of the infection is the middle ear or the outer ear. An infection in the middle ear requires a different type of treatment.

Your physician may also take a sample of ear discharge or debris for laboratory analysis. This way, he or she can determine the specific bacteria that are causing the recurring infection.

Treatment for Chronic Swimmer’s Ear

Before you begin treatment, your physician may need to clear away any discharge or debris that has collected in the ear. This procedure is done using suction or an ear curette, which has a scoop on the end.

For most cases of chronic swimmer’s ear, treatment will begin with antibiotic eardrops intended to cure the infection. If your ear is very swollen, your doctor may have to insert a cotton or gauze wick (tube) into your ear to allow the eardrops to travel into the ear canal.

Antibiotic eardrops are typically used for 10 to 14 days. It is important to finish the complete course of eardrops, even if the pain and symptoms subside before the end of the course.

Additional treatments for chronic swimmer’s ear may include:

  • corticosteroids to lessen inflammation
  • vinegar eardrops to help restore your ear’s normal bacterial balance
  • antifungal eardrops for infections caused by fungi
  • acetaminophen or ibuprofen for relief of pain or other discomfort

Your treatment may be modified to include oral antibiotics, especially if eardrops haven’t succeeded in the past. You may also be given prescription pain relievers to relieve pain that has increased in severity or has lasted a long time.

Cases of chronic swimmer’s ear with malignant otitis externa are treated with high doses of intravenous (IV) antibiotics, especially in elderly or diabetic patients.

During your treatment, you will achieve the best results if you:

  • avoid swimming
  • avoid flying
  • avoid getting the inside of your ears wet while bathing
  • do not put anything in your ears, including headphones, until your symptoms have subsided

Outlook for Chronic Swimmer’s Ear

Treatment for chronic swimmer’s ear is usually successful. However, depending on the severity of your infection, your therapy may take some time and may need to be repeated.

It’s important to follow your physician’s instructions and take all medication, especially oral antibiotics or antibiotic eardrops, for the prescribed period of time. Relief of symptoms does not mean that your infection is cured.

How to Prevent Chronic Swimmer’s Ear

You can reduce your risk of developing chronic swimmer’s ear by following these techniques:

  • Do not remove earwax.
  • Do not put anything in your ears, including cotton swabs, fingers, liquids, or sprays.
  • Consider wearing earplugs if you swim often.
  • After swimming or showering, thoroughly dry your ears with a towel or a hair dryer on a low setting. When drying with a towel, be gentle and only dry the outer ear.
  • When your ears get wet, turn your head from side to side to help water flow out.
  • Shield your ears or put cotton balls in them before applying hair dyes or spraying hairsprays or perfumes.
  • Use preventive eardrops made from one part rubbing alcohol and one part white vinegar before and after swimming.
  • Do not swim in places where there may be a high bacterial content.
  • Do not stop any treatment for swimmer’s ear sooner than your physician recommends.
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