Chronic Swimmer's Ear

Medically reviewed by Karen Gill, MD on November 20, 2017Written by Anna Giorgi

What is chronic swimmer’s ear?

Chronic swimmer’s ear is when the outer ear and ear canal become infected, swollen, or irritated, on a long-term or recurring basis. Water trapped in your ear after swimming often causes this condition. The ear’s structure and the water left in the ear after swimming combine to create a damp, dark space where bacteria and fungi can thrive and cause infection.

Swimmer’s ear occurs fairly often in children and teenagers, especially those who swim regularly. Cases are typically acute (not chronic) and respond to treatment in one to two weeks. Chronic swimmer’s ear occurs when the condition isn’t resolved easily or when it recurs multiple times.

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

What are the 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 you don’t have enough earwax in your ear. Without the protection of adequate earwax, bacteria can enter your ear and cause an infection.

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

  • allowing too much water to get into your ears
  • overcleaning the ear canal with cotton swabs
  • allowing cosmetic chemicals from products such as hairspray to enter your ear, causing 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

What are the risk factors for chronic swimmer’s ear?

Chronic swimmer’s ear is most common in children. Children typically have narrow ear canals, which trap water more easily.

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

  • swimming frequently, particularly in public pools
  • 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 such as psoriasis, eczema, or seborrhea

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

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

What are the symptoms of chronic swimmer’s ear?

Chronic swimmer’s ear begins with the symptoms of an acute case of swimmer’s ear. 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
  • 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, as multiple sequential episodes
  • the symptoms persist for more than three months

What are the complications associated with 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 and 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

How is chronic swimmer’s ear diagnosed?

A doctor can usually diagnose chronic swimmer’s ear during an office visit. They will use an otoscope, a lighted instrument that allows them to examine inside the ears. Your doctor will look for the following symptoms of chronic swimmer’s ear:

  • red, swollen, or tender ear and ear canal
  • flakes of scaly, shedding skin in the ear canal
  • blockage of the affected area that may require clearing

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

Your doctor may also take a sample of ear discharge or debris for laboratory analysis. This allows them to determine the organism causing the recurring infection.

What is the treatment for chronic swimmer’s ear?

Before you begin treatment, your doctor may need to clear any discharge or debris in the ear. This procedure uses 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 to cure a bacterial 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.

Treatments with antibiotic eardrops typically last for 10 to 14 days. It’s important to finish the course of eardrops, even if the pain and symptoms subside before the end of the course.

Other treatments for chronic swimmer’s ear 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 to relieve pain or discomfort

Your treatment may be modified to include oral antibiotics, especially if eardrops haven’t helped. Your doctor may also prescribe pain relievers to relieve pain that has increased in severity or has lasted a long time.

High doses of IV antibiotics treat cases of chronic swimmer’s ear with malignant otitis externa, especially in older adults or people with diabetes.

During your treatment, you will get the best results if you do not:

  • swim
  • fly
  • get the inside of your ears wet while bathing
  • put anything in your ears, including headphones and ear plugs, until your symptoms subside

How can I prevent chronic swimmer’s ear?

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

  • Don’t remove earwax.
  • Don’t put anything in your ears, including cotton swabs, fingers, liquids, or sprays.
  • Consider wearing earplugs if you swim often. Sometimes ear plugs can make swimmer’s ear worse. Ask your doctor if you should use ear plugs if you are prone to swimmer’s ear.
  • Thoroughly dry your ears with a towel or a hair dryer on a low setting after swimming or showering. Be gentle and only dry the outer ear when drying with a towel.
  • Turn your head from side to side to help water flow out when your ears get wet.
  • Shield your ears or put cotton balls in them before applying hair dyes or spraying hairsprays or perfumes.
  • Use preventive eardrops made from 1 part rubbing alcohol and 1 part white vinegar before and after swimming.
  • Don’t swim in places where there may be a high bacterial content.
  • Don’t stop any treatment for swimmer’s ear sooner than your doctor recommends.

What is the long-term outlook?

Treatment for chronic swimmer’s ear is usually successful. However, depending on the severity of your infection, your treatment may take some time. You may also need to repeat treatment.

It’s important to follow your doctor’s instructions and take all medication, especially oral antibiotics or antibiotic eardrops, for the prescribed period. Your infection isn’t cured simply because your symptoms disappear.

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