Deep Dive: Swimmer’s Ear

Dr Sarah Law shares her insights on swimmer’s ear, a common ear infection that afflicts outdoor and pool swimmers

At least 10% of swimmers will experience an ear infection at least once in their lifetime and some may suffer from surfer’s ear. Both are disruptive issues and can keep you out of the water, affect your hearing and cause pain or discomfort. We speak to NHS ENT Specialist Registrar Dr Sarah Law to learn more about our ears.

What is swimmer’s ear and what is surfer’s ear, and is there a difference?

Swimmer’s ear is also known as otitis externa, which is a bacterial or fungal infection of the outer ear canal (the tube between the outer ear and eardrum). This is caused by trapped water, which creates a moist environment that helps infections to grow. Surfer’s ear or exostosis occurs when repeated exposure to cold water and wind stimulates new abnormal bone growth in the ear canal, which narrows the ear canal – this is a common condition in surfers, but as more people swim in cold water, more people are at risk.

What are the most common symptoms of swimmer’s and surfer’s ear?

You can experience earache when touching or pulling the outer ear, itching, swelling, ear discharge, and/or sudden muffled hearing due to a build-up of discharge in outer ear infections. In middle ear infections where the infection is behind the eardrum, you may additionally experience fever or a feeling of fullness or blockage. If you start to experience gradual hearing loss, water trapping and increased frequency ear infections due to narrowed ear canals, you may have Surfer’s ear.

What is the best way to treat these conditions?

Swimmer’s ear: Prescription topical ear spray or drops (antibiotic + steroid), pain relievers, and keeping the ear dry.

Surfer’s ear: No cure other than surgery (if severe). Avoiding cold water exposure and using ear plugs can help prevent worsening of the condition.

Will I need antibiotics, or can it heal on its own?

Swimmer’s ear often requires antibiotic ear drops, but mild cases may heal by itself. There is no need for antibiotic ear drops for Surfer’s ear unless an infection develops.

How long does it usually take to recover?

Swimmer’s ear usually improves within 7–10 days with treatment. Surfer’s ear is a chronic condition that worsens over time without intervention.

Can I take pain relievers to help with discomfort?

Yes, taking paracetamol with or without ibuprofen can help with discomfort during ear infections.

Should I avoid water while my ear is healing?

Definitely. I often emphasise to my patients the need to keep your ear dry while you are treating the ear infection. You can use cotton wool in your ears with Vaseline on top as a water seal when you have a shower, then throw away the cotton wool afterwards. Avoid swimming until the ear infection has completely resolved and avoid using ear plugs in one ear that can transfer to the other ear or reintroduce infected ear plugs/hearing aids back into the affected ear which can cause repeated infections. Avoid scratching your ear canal as this can damage the surface. When it gets wet, infections can also enter this way.

How can I prevent swimmer’s ear from happening again?

To prevent swimmer’s ear, I would advise wearing ear plugs when swimming with a swimming cap. You can also try Earol Swim which plugs the ears with olive oil to prevent water trapping. To prevent yourself scratching your ear canal at night when you are asleep which injures the lining of the ear canal, you can wear gloves.

Are there ear drops or other products that can help?

For recurring infections, you can try Otinova ear spray over the counter which relieves itching, it contains aluminium which also dries the ear and is antiseptic. I’d advise to contact your GP who can prescribe antibiotic ear drops/spray for you after examination of the ear to confirm the diagnosis. In severe or refractory infections, your GP may refer you to the ENT team in hospital for micro suctioning and further treatment.

Is it safe to use cotton swabs to clean my ears?

There is a phrase “don’t put anything smaller than your elbow into your ear!” Inserting small objects including cotton swabs can push earwax deeper, cause injury to the surface of the ear canal, or create a hole in the eardrum. If you want to clean the outer pinna (anywhere outside of the ear canal opening) with cotton wool, that is fine.

What should I do if I feel water trapped in my ear after swimming?

Tilt your head and gently pull the earlobe, lie on the affected side to let the water out. You can also use a hairdryer on a low setting to dry out the ear.

What happens if swimmer’s ear is left untreated?

If swimmer’s ear is left untreated, the ear canal may swell and narrow temporarily due to inflammation, which can cause severe pain. If the infection is not properly treated, this can cause a superimposed fungal infection which would require a longer course of antifungal ear drops. The infection can also spread deeper to the eardrum and other nearby structures. In the older population, in diabetics and in immunocompromised patients, chronic ear infections can lead to infection spreading to the bones of the skull called necrotising otitis externa requiring prolonged intravenous antibiotic treatment.

Can swimmer’s ear lead to long-term hearing problems or other issues?

This is rare, but chronic infections can lead to scarring and narrowing of the ear canal which can affect hearing. If the eardrum has ruptured, it may be temporary hearing loss, or permanent if the hole doesn’t close. Necrotising otitis externa could affect the inner ear and damage the hearing nerve when infection spreads to the skull, but this is only in the most severe cases.

Tried and tested

Earol Swim £10.50, boots.com

Delivers a metered dose of a unique blend of Olive Oil & Tea Tree Oil into the outer ear finely coating the auditory canal creating a water resistant barrier.

Swim-eze £8.99, innova2020.com

Dries water in the ears. Fast-acting and non-medicated, it removes the trapped water in the ear immediately, leaving the ear clean, water-free and dry.

EarHub £4.99 (3 Pairs), ear-hub.com

Soft silicone, mouldable and reusable silicone earplugs containing aloe vera which inhibits the growth of certain bacteria. Can be used in and out of the water.