Swimmer's ear (otitis externa): symptoms and treatment by video

Swimmer's ear affects the ear canal, outside the eardrum. Water that stays in the ear, especially contaminated water, lets bacteria grow in the canal. Scratching or putting objects in the ear, cleaning earwax with cotton swabs, and skin conditions such as eczema or psoriasis also raise the risk.

In Puerto Rico people swim year-round, at beaches such as Isla Verde and Condado and in hotel and condo pools, so swimmer's ear is common among residents and visitors alike.

It is not the same as otitis media, an infection behind the eardrum that is common in children and often comes with a cold. Swimmer's ear hurts when you move the outer ear and usually starts after swimming. For ear pain in young kids, see ear pain in children.

Here is how the video visit works:

Symptoms usually start in the affected ear after swimming or bathing:

• Ear pain that gets worse when you pull or touch the outer ear
• Itching inside the ear canal
• Yellow, yellow-green, pus-like or foul-smelling drainage
• Hearing loss or a blocked feeling in the ear

The usual treatment is antibiotic ear drops, for as long as the doctor directs. Drops with a corticosteroid may be added to reduce swelling, along with pain relievers. If the infection spreads, antibiotics by mouth may be needed. The doctor chooses the treatment based on your evaluation.

Keep the ear dry while it heals. If the drainage does not improve with treatment, the doctor re-evaluates you and, if a test is needed, gives you a lab order for a lab near you.

Otitis externa (swimmer's ear) is inflammation or infection of the outer ear and ear canal: the pain gets worse when you pull on the outer ear, there may be drainage, and it usually follows swimming or using cotton swabs. Otitis media is an infection of the middle ear, behind the eardrum; it often starts shortly after a cold and brings pain, fever, a feeling of fullness and reduced hearing.

Sudden yellow or green drainage from the ear can mean the eardrum has ruptured: get checked soon. More about middle ear infections in ear pain in adults.

To lower your risk of swimmer's ear:

• Dry your ears well after swimming: tilt your head to each side and dry the outer ear with a towel.
• Use earplugs when swimming if you get swimmer's ear often.
• Do not scratch your ear or put objects in it, including cotton swabs.
• Check the National Weather Service San Juan beach forecast before you go; it includes rip current risk and the UV index.

In older adults and people with type 2 diabetes, the infection can spread to the bone around the ear (malignant otitis externa), which needs hospital treatment. For your safety, if you have diabetes and your ear pain is very severe or getting worse fast, go to the emergency room.

For your safety, go to the emergency room or call 911 if you have any of these signs. See also when to go to the ER.

• High fever with ear pain
• Swelling, redness or pain behind the ear
• Sudden hearing loss or weakness on one side of the face
• Diabetes or a weakened immune system with very severe ear pain