Swimmer's ear

Symptoms

Swimmer's ear symptoms are usually mild at first. But they can get worse if the infection isn't treated or spreads. Doctors often classify swimmer's ear as mild, moderate and advanced.

Mild symptoms

• Itching in the ear canal.
• Slight redness inside the ear, which might be hard to see on Black or brown skin.
• Mild discomfort that's made worse by pulling on the outer ear, called the pinna or auricle, or pushing on the little bump in front of the ear, called the tragus.
• Fluid coming from the ear.

Moderate symptoms

• Worse itching.
• Increasing pain.
• Feeling of fullness inside the ear and a partial blocking of the ear canal by swelling, fluid and debris.
• Decreased or muffled hearing.

Advanced symptoms

• Severe pain that might radiate to the face, neck or side of the head.
• Completely blocked ear canal.
• Redness or swelling of the outer ear. Redness might be hard to see on Black or brown skin.
• Swelling in the small round or bean-shaped clusters of cells, called lymph nodes, in the neck.
• Fever.

Causes

Swimmer's ear is an infection that's usually caused by bacteria. It's less common for a fungus or virus to cause swimmer's ear.

The ear's natural defenses

The outer ear canals have built-in ways of staying clean and free of infection:

• A thin film lines the ear canal, which helps keep water out and bacteria from growing. Earwax, also called cerumen, is a buildup of this waxy film, dead skin cells and other debris that travels to the opening of the ear canal to keep it clean.
• The outer ear, mainly around the opening of the ear canal, helps keep things from going into the ear.

How the infection occurs

Having swimmer's ear means the ear's natural defenses have not worked well. The conditions that often play a role in infection include:

• Moisture in the ear canal that makes an ideal place for bacteria to grow.
• Contact with contaminated water.
• Damage to the skin of the ear canal, which can be an entry point for bacteria.

Complications

Swimmer's ear usually isn't serious if treated quickly. But complications that can happen include:

• Short-term hearing loss. Hearing might be muffled. It usually gets better after the infection clears.
• Long-term infection, called chronic otitis externa. This involves symptoms of outer ear infection that last for more than three months. Chronic infections are more common if treatment is hard. Treatment can be hard when there is a rare strain of bacteria, an allergic skin reaction, an allergic reaction to antibiotic ear drops, a skin condition such as dermatitis or psoriasis, or a combined bacterial and fungal infection.
• Deep tissue infection, called cellulitis. Rarely, swimmer's ear can spread deeper into the skin.
• Bone and cartilage damage, called early skull base osteomyelitis. This is a rare complication of swimmer's ear. It happens if the infection spreads to the firm tissue of the outer ear, called cartilage, and bones of the lower part of the skull. This causes severe pain that gets worse. Being older or having diabetes or a weakened immune system raises the risk of this complication.
• Infection that goes beyond the ear. If advanced skull base osteomyelitis happens because of swimmer's ear, the infection can spread and affect other parts of the body. These can include the brain or nearby nerves. This rare complication can be fatal.

Diagnosis

A healthcare professional usually can diagnose swimmer's ear during an office visit. An advanced or lasting infection might need more testing.

First steps

Your healthcare professional is likely to diagnose swimmer's ear based on your symptoms, answers to questions and an exam. The exam might include:

• Looking at the ear canal with a lighted tool called an otoscope. The ear canal might appear red, swollen and scaly. Redness might be hard to see on Black or brown skin. There might be skin flakes or other debris in the ear canal.
• Looking at the eardrum, also called the tympanic membrane. This is to be sure it isn't torn or damaged. If the view of the eardrum is blocked, a healthcare professional will clear the ear canal with a small suction device or a tool with a tiny loop or scoop on the end.

Further testing

More testing, if needed, might include sending a sample of fluid from the ear to look for bacteria or a fungus.

Also:

• If the eardrum is damaged or torn, your healthcare professional is likely to refer you to an ear, nose and throat (ENT) specialist. These specialists can use special tools to clean ears with damaged membranes.
• If the infection doesn't get better with treatment, your healthcare professional might take a sample of discharge or debris from your ear and send it to a lab. That's to look for what's causing the infection.

Preparing for your appointment

Here are some suggestions to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they started.
• All medications, vitamins and supplements you take, including doses.
• Your allergies, such as skin reactions or medicine allergies.
• Questions to ask your healthcare professional.

Some basic questions to ask about swimmer's ear include:

• What is likely causing problems with my ear?
• What is the best treatment?
• When should I expect to start getting better?
• Do I need to make a follow-up appointment?
• How can I keep from getting swimmer's ear again?
• Do you have brochures or other printed material I can have? What websites do you recommend?

Be sure to ask all the questions you have about swimmer's ear.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, including:

• Have you been swimming lately?
• Do you swim often?
• Where do you swim?
• Have you ever had swimmer's ear before?
• Do you use cotton swabs or other objects to clean your ears?
• Do you use earbuds or other ear devices?
• Have you had any other recent ear exams or procedures?