Written with Mr Steve Frampton, Consultant ENT Surgeon at Dr Helen Medical.
Swimming is one of the pleasures of summer, whether that means lengths at the local pool, a day at the beach or plenty of splashing on holiday. It can, however, be followed by an uncomfortable problem: an ear that feels blocked, itchy, sore and then painful.
Sometimes water is simply trapped close to the ear drum and the sensation settles as the ear dries. In other cases, if the delicate ear canal skin is irritated and broken, bacteria within the moisture can infect the outer ear canal skin and deeper tissues causing an infection known as otitis externa, commonly called ‘swimmer’s ear’.
It is helpful to understand what swimmer’s ear is, what you can safely do at home when it starts, and when you should seek further help.
Can I get water out of my ear safely?
If the ear simply feels wet or blocked after swimming and there is no pain, discharge, known eardrum perforation or recent ear surgery, try these gentle measures:
- Tilt your head so the affected ear faces down and allow gravity to help.
- Gently pull the outer ear in different directions to help straighten the canal.
- Dry only the outside of the ear with a soft towel.
- Allow the ear to dry naturally.
- Prevent further water from entering the ear.
- Do not force water from the ear and do not insert cotton buds, tissues, fingers or the corner of a towel into the canal. These can push wax and water deeper, damage the skin and increase the risk of infection.
Why does my ear feel uncomfortable after simple swimming?
Ear discomfort after swimming can have several possible causes. These include:
– Water temporarily trapped in the ear canal, which can create a full, muffled or sloshing sensation.
– Water held behind a build-up of earwax, making the ear feel blocked and reducing hearing.
– Irritation or infection of the outer ear canal, known as swimmer’s ear or otitis externa.
– A middle ear problem (often a viral infection after a common cold) that may stretch the ear drum and cause sensitization of the nerves running on the ear drum which become sensitized to the feeling of water in the ear.
– A pre-existing ear drum perforation (hole in the eardrum) allows water to pass through to the more sensitive ear structures of the middle ear which can lead to discomfort, and sometimes infection or dizziness.
– Pressure waves down the ear canal can additionally, if significant, cause damage to the ear drum or the structures of the delicate inner ear.
Because these causes need different treatment, significant, recurring, or non-resolving discomfort or other symptoms should not be managed on guesswork alone. An examination allows us to look at the ear canal and drum and identify whether the problem is water, wax, inflammation, infection or something else.
What is swimmer’s ear?
Swimmer’s ear is inflammation of the external ear canal, the passage between the outer ear and the eardrum. The medical name is otitis externa.
The ear canal has its own protective environment. Earwax is not simply dirt: it helps repel water, traps debris and supports the natural defences of the canal. Repeated exposure to water can soften the skin and this layer can be damaged by itching with a finger or cotton bud, or even rubbing from in-ear headphone buds or hearing aid moulds. Bacteria (or occasionally fungi) favouring the damp and warm conditions, can then penetrate the deeper tissues around the ear canal, causing swelling and pain.
Despite the name, you do not have to be a regular swimmer to develop it. Otitis externa may also follow bathing, showering, humid weather or any activity that leaves moisture sitting in the ear canal. Additionally, those with a tendency to broken skin in or around the ear canal, eg eczema or psoriasis, have an increased tendency to this occurring.
What are the symptoms of progression to swimmer’s ear?
Swimmer’s ear often begins with a blocked feeling with mild irritation or itching and then becomes increasingly blocked and painful.
Symptoms can include:
– Pain inside the ear, which may become quite severe.
– Tenderness when the outer ear is gently moved or when pressing the small flap in front of the ear canal (tragus).
– Pain on chewing or moving the jaw
– Muffled hearing
– Redness and swelling of the outer ear or swelling of the cheek or face
– Watery, yellow or unpleasant-smelling discharge.
– Buzzing or ringing in the affected ear.
– Pain that is increasing, marked tenderness, discharge or worsening hearing makes inflammation or infection more likely and is a good reason to seek advice.
How is acute swimmer’s ear treated?
Treatment depends on what the examination shows. A clinician will usually look into the ear with an otoscope or microscope to assess the canal and eardrum.
Sometimes wax / infected material may need to be removed to allow full examination of the ear and can help remove some of the infection, allowing access for treatments to improve the health of the ear.
Treatment may include:
– Advice on pain relief, such as paracetamol or ibuprofen when suitable for the individual.
– Keeping the ear dry while the canal heals.
– Medicated ear drops, which may contain an antibiotic, antifungal treatment, steroid, antiseptic or pain relieving medication depending on the situation.
– A small temporary ear wick if swelling has narrowed the canal and drops cannot enter properly by gravity.
Further investigation if symptoms are, unusually severe or not responding as expected.
Tablets are not needed for most uncomplicated cases because treatment applied directly to the ear canal is usually most effective. Tablet antibiotics may be considered if infection has spread into tissues surrounding the canal or there are other clinical concerns. Occasionally, admission to hospital is required for antibiotics to be delivered directly into a vein or for further investigation if the infection is severe or not responding to normal treatment.
Can microsuction help a blocked or painful ear?
Removal, under direct vision, of material blocking the ear canal (using magnifying eyewear or a microscope and a variety of blunt instruments or a tiny hoover – microsuction) can be very helpful when water or discharge is trapped behind wax, or when infection is preventing treatment from reaching all the way down the ear canal to the ear drum.
A very inflamed canal may however be sensitive and sometimes only a limited amount of microsuction is tolerated at an initial consultation. Further follow up appointment(s) may be required to provide further clearance after the antibiotics have been in use.
Should I carry on swimming?
If you have ear pain, discharge or confirmed otitis externa, it is best to stop swimming until the ear has been assessed and treated. Keep shampoo, soap and water out of the affected ear when showering / bathing as well. A small ball of cotton wool to fill the outer canal opening coated with petroleum jelly on its outer surface can be placed at the entrance to the ear during a shower and can help to keep spray / steam (in which infection thrives) out of the ear. You will be advised on long term water exposure depending on your individual situation.
How can I prevent swimmer’s ear?
If you or your child is prone to ear problems after swimming, the following steps may reduce recurrences:
– Let the ears drain and dry naturally after swimming.
– Avoid the use of cotton buds or other objects to clean or dry the ear canal.
– Consider a well-fitting swimming cap, water-excluding headband or suitable swimming earplugs to keep water out of the ears when swimming.
– Make sure reusable earplugs are clean and dry before use (and consider disposable).
– Avoid scratching itchy ears, as broken skin makes infection more likely.
– Seek advice if earwax repeatedly traps water or if eczema affects the ear canal.
– Do not over-clean the ears. Healthy earwax has an important protective role.
– If earplugs themselves cause irritation, or you have a history of eardrum perforation, grommets or ear surgery, we can provide advice on management.
When should I seek medical advice for ear pain after swimming?
Arrange a clinical assessment if:
– Discomfort is significant, worsening, or does not improve within a few hours of leaving the water.
– There is discharge, bleeding or an unpleasant smell from the ear.
– The ear canal or outer ear looks swollen or red.
– Hearing has changed or the ear remains blocked.
– Symptoms keep returning after swimming.
– You think an earplug, cotton bud tip or another object may be stuck in the ear.
– There was pain after diving, a sudden pressure change or a possible eardrum injury.
– Your child is very young or you are unsure where the pain is coming from.
Seek urgent medical advice through an urgent GP service or NHS 111 if you or your child feels generally unwell, has a high temperature, swelling around the ear, new dizziness or vomiting, sudden or marked hearing loss, or severe pain.
People with diabetes or a weakened immune system should seek prompt assessment for ear pain or discharge. Rarely, an outer ear infection can spread into deeper tissues and bone.
A specialist view can save a lot of trial and error.
A sore ear can turn a much-anticipated holiday or school break into a miserable few days. The reassuring point is that most cases of swimmer’s ear respond well once the cause has been identified and the right treatment reaches the ear canal.
My advice is simple: let wet ears dry gently, avoid scratching and keep cotton buds out of the ear canal and do not ignore blockage and discomfort that is increasing or accompanied by discharge.
Concerned about ear pain after swimming?
If you or your child has a painful, blocked or discharging ear after swimming, Mr Steve Frampton can provide a specialist ENT assessment and treatment at Dr Helen Medical in Ringwood including ear microscopy and microsuction where clinically appropriate.
Book a private ENT appointment by calling 01202 022956 or booking online.
Frequently asked questions
How long does swimmer’s ear last?
With appropriate treatment, symptoms often begin to improve within a few days. Complete the prescribed course and keep the ear dry. If pain is not improving, symptoms worsen or the ear remains blocked, arrange a review.
Is swimmer’s ear contagious?
Otitis externa is not usually passed from one person to another. It develops because the environment or skin of the ear canal has become irritated and then infected. It can however spread between the ears on susceptible individuals so try to avoid contamination of the unaffected ear by the infected one (typically by children via fingers).
Can children get swimmer’s ear?
Yes. Children can develop otitis externa, thought typically this is older school age children rather than babies and toddlers. Ear pain in children can also come from the middle ear, so an examination is useful to help ascertain the cause and provide appropriate treatment.
Why does my hearing sound muffled after swimming?
Water may be sitting in the canal or trapped behind earwax. Swelling and discharge from otitis externa can also temporarily reduce hearing. Sudden or significant hearing loss without a clear associated history of water exposure should be assessed urgently by a medical professional (within 48hrs) rather than assumed to be trapped water as treatment for some causes of acute hearing loss are time critical.
Can I fly with swimmer’s ear?
Outer ear inflammation does not usually create the same pressure problem as a middle ear condition, but a painful or swollen ear may still make travelling uncomfortable. If symptoms are severe, there is discharge, or you are unsure whether the eardrum or middle ear is involved, seek medical advice before flying.
Book a private ENT appointment by calling 01202 022956 or booking online.