Swimmer's Ear

What it is

Swimmer's ear — otitis externa — is an infection of the outer ear canal, the passage between the opening of the ear and the eardrum. It develops when water remains in the canal after swimming, creating a warm, moist environment in which bacteria that are normally present can multiply.

It is different from a middle ear infection, which sits behind the eardrum and is usually associated with colds rather than with swimming. That distinction matters because the treatments differ, and it is one reason a painful ear should be looked at by a clinician rather than guessed at.

Anything that breaks the skin inside the canal makes it more likely — which is why scratching with a finger or a cotton swab is a specific risk factor rather than a general caution.

Symptoms

• •Itching inside the ear canal, often the first sign.
• •Pain, which characteristically gets worse when the outer ear is pulled or pressed.
• •Redness and swelling of the ear canal.
• •Fluid or pus draining from the ear.
• •Muffled hearing, or a feeling of fullness.

We are not a medical source and this page is not medical advice. The CDC's own page on swimmer's ear is the right source to read. See a clinician if an ear is painful, draining, or if hearing is affected — and promptly for a child, who cannot always describe what they are feeling. Swimmer's ear is normally treated with prescription ear drops, which means it needs a diagnosis.

Prevention: what the CDC recommends

1. 1.Keep ears as dry as possible. Use a bathing cap or ear plugs if you are prone to it.
2. 2.Dry your ears thoroughly after swimming. Tilt the head to each side to let water run out, and dry the outer ear gently with a towel.
3. 3.Do not put anything in the ear canal. No cotton swabs, no fingers, no other objects — they push water in and scratch the canal lining, which is what the bacteria need.
4. 4.Do not try to remove earwax yourself. Earwax is protective; removing it makes infection more likely, not less.
5. 5.Ask a clinician about using drying drops after swimming if you get swimmer's ear repeatedly — and note that these should not be used by anyone with a perforated eardrum, ear tubes, or ear drainage.

Do swim caps or ear plugs help?

Ear plugs, yes. A swim cap, barely. A cap covers the outer ear but does not seal the ear canal, so water finds its way in around the edge. This is a widespread and understandable assumption and it does not hold.

Pre-molded silicone ear plugs seal the canal and substantially reduce how much water gets in. Child sizes exist and genuinely fit smaller canals. A cap worn over plugs is a good combination, because the cap helps hold them in place — and a low-profile plug is worth choosing so the cap edge does not lever it out.

If pre-molded plugs do not seal — some canals are simply unusual — an audiologist can make custom-molded plugs. Full comparison in swim cap vs ear plugs.

Who gets it and why lakes matter

Children are affected more often than adults, in part because their ear canals are narrower and drain less readily. Anyone who swims frequently is at higher risk simply through repeated exposure, and people who use ear plugs, hearing aids or cotton swabs regularly are at higher risk because all three can scratch the canal.

Lake and river water is relevant here: untreated water carries a wider range of bacteria than a properly chlorinated pool, which is one reason drying ears after open-water swimming is worth being deliberate about. The CDC's guidance on swimming in oceans, lakes and rivers is worth reading alongside this.

Outer ear versus middle ear, and why it matters

These get confused constantly and they are different conditions with different causes and treatments.

The practical use of that table: pain that gets noticeably worse when the outer ear is pulled or pressed points toward the outer canal, and a child who has a cold and an earache but no tenderness on the outer ear is more likely to have the other thing. Either way it is a clinician's call, not ours — we include this because families are often told "ear infection" and reasonably assume swimming caused it.

Who is most at risk

• •Children, whose ear canals are narrower and drain less readily than an adult's.
• •Frequent swimmers, simply through repeated exposure.
• •Anyone who uses cotton swabs, which both push water in and scratch the canal lining.
• •Hearing aid and ear plug users, where the device itself can abrade the canal — which is an argument for well-fitting plugs rather than against plugs.
• •People with narrow canals or a lot of earwax, where water is slower to escape.
• •Anyone with eczema or a skin condition affecting the ear, where the skin barrier is already compromised.

Ear plugs: types, and getting them to seal

Pre-molded silicone plugs are the standard: a shaped plug with a short stem, washable, reusable, and available in child sizes that genuinely fit smaller canals. They are where to start.

Moldable putty plugs are rolled and pressed into the canal opening. They seal well on awkwardly shaped canals and they are less comfortable for long swims, and they are not reusable indefinitely.

Custom-molded plugs are made by an audiologist from an impression of the ear. They are the answer when nothing off the shelf seals, and they are what we would look at for anyone with a genuine history rather than an occasional problem.

Whichever type: seat the plug in the canal opening, not resting in the bowl of the outer ear, and check it after pulling a cap on. Plugs muffle sound noticeably, which is worth thinking about around boats and busy water. And if there is any history of a perforated eardrum, ear tubes or ear surgery, ask a clinician before using plugs or drying drops at all.

A simple routine that works

1. 1.As soon as you are out, tilt the head to one side and hold it for a few seconds. Repeat on the other side.
2. 2.Towel the outer ear — the visible part only. Nothing goes in.
3. 3.For a child who is prone to it, consider pre-molded plugs next time, and a cap over them.
4. 4.Watch for itching over the next day or two, which is usually the first sign, and see a clinician if it develops into pain.

What we recommend

Make head-tilt-and-towel a habit rather than a response to a problem — it takes ten seconds per child and it is the whole of routine prevention. For a child with a history of ear infections, add properly fitted pre-molded plugs, and talk to your clinician about whether drying drops are appropriate.

Gear-wise, plugs are the tool and a cap is a useful accessory to them: our picks are in swim cap vs ear plugs and best kids' swim caps.