Diagnosis

Doctors can usually diagnose swimmer's ear during an office visit. If your infection is at an advanced stage or persists, you may need further evaluation.

Initial testing

Your doctor will likely diagnose swimmer's ear based on symptoms you report, questions he or she asks, and an office examination. You probably won't need a lab test at your first visit. Your doctor's initial evaluation will usually include:

  • Examination of your ear canal with a lighted instrument (otoscope). Your ear canal may appear red, swollen and scaly. Flakes of skin and other debris may be present in the ear canal.
  • Visualization of your eardrum (tympanic membrane) to be sure it isn't torn or damaged. If the view of your eardrum is blocked, your doctor will clear your ear canal with a small suction device or an instrument with a tiny loop or scoop on the end (ear curette).

Further testing

Depending on the initial assessment, symptom severity or the stage of your swimmer's ear, your doctor may recommend additional evaluation.

  • If your eardrum is damaged or torn, your doctor will likely refer you to an ear, nose and throat specialist (ENT). The specialist will examine the condition of your middle ear to determine if that's the primary site of infection. This examination is important because some treatments intended for an infection in the outer ear canal aren't appropriate for treating the middle ear.
  • If your infection doesn't respond to treatment, your doctor may take a sample of discharge or debris from your ear at a later appointment and send it to a lab to identify the exact microorganism causing your infection.

Treatment

The goal of treatment is to stop the infection and allow your ear canal to heal.

Cleaning

Cleaning your outer ear canal is necessary to help eardrops flow to all infected areas. Your doctor will use a suction device or ear curette to clean away any discharge, clumps of earwax, flaky skin and other debris.

Medications for infection

For most cases of swimmer's ear, your doctor will prescribe eardrops that have some combination of the following ingredients, depending on the type and seriousness of your infection:

  • Acidic solution to help restore your ear's normal antibacterial environment
  • Steroid to reduce inflammation
  • Antibiotic to fight bacteria
  • Antifungal medication to fight an infection caused by a fungus

Ask your doctor about the best method for taking your eardrops. Some ideas that may help you use eardrops include the following:

  • Reduce the discomfort of cool drops by holding the bottle in your hand for a few minutes to bring the temperature of the drops closer to body temperature.
  • Lie on your side with your infected ear up for a few minutes to help medication travel through the full length of your ear canal.
  • If possible, have someone help you put the drops in your ear.

If your ear canal is completely blocked by swelling, inflammation or excess discharge, your doctor may insert a wick made of cotton or gauze to promote drainage and help draw medication into your ear canal.

If your infection is more advanced or doesn't respond to treatment with eardrops, your doctor may prescribe oral antibiotics.

Medications for pain

Your doctor may recommend easing the discomfort of swimmer's ear with over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others) or acetaminophen (Tylenol, others).

If your pain is severe or your swimmer's ear is at a more advanced stage, your doctor may prescribe a stronger medication for pain relief.

Helping your treatment work

During treatment, the following steps will help keep your ears dry and avoid further irritation:

  • Don't swim or scuba dive.
  • Avoid flying.
  • Don't wear an earplug, hearing aid or headphones before pain or discharge has stopped.
  • Avoid getting water in your ear canal when bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a bath.

Preparing for your appointment

Here are some suggestions to help you get ready for your appointment and understand what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. When you make your appointment, ask if you need to fast for bloodwork or if there's anything else you need to do to prepare for diagnostic tests.
  • Write down all the symptoms you're experiencing and when they started. Include any that may seem unrelated to problems with your ears.
  • Make a list of all your medications, including any over-the-counter drugs and vitamins or supplements you're taking.
  • Write down any known allergies, such as skin reactions or drug allergies.

If you're experiencing any signs or symptoms of swimmer's ear, some basic questions to ask your doctor include:

  • What is likely causing problems with my ear?
  • What is the best treatment?
  • When should I expect improvement?
  • Are there treatment side effects I should watch for? Should I notify you if they occur?
  • Do I need to make a follow-up appointment?
  • If I have swimmer's ear, how can I keep from getting it again?
  • Do you have brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask any other questions you have.

What to expect from your doctor

Your doctor is likely to ask you some of the following questions:

  • When did you first notice your symptoms?
  • Have your symptoms gotten worse?
  • Have you been swimming lately?
  • Do you swim often?
  • Where do you swim?
  • Have you ever had swimmer's ear before?
  • Do you have allergies or chronic skin conditions?
  • Do you use cotton swabs or other objects to clean your ears?
  • Do you use headphones or any other ear devices?
  • Have you had any other recent ear examinations or procedures?
May 05, 2016
References
  1. Goguen LA. External otitis: Pathogenesis, clinical features and diagnosis. http://www.uptodate.com/home. Accessed Feb. 3, 2016.
  2. Goguen LA. External otitis: Treatment. http://www.uptodate.com/home. Accessed Feb. 3, 2016.
  3. Lalwani AK. Diving medicine. In: Current Diagnosis & Treatment in Otolaryngology--Head & Neck Surgery. 3rd ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com. Accessed Feb. 3, 2016.
  4. Swimmer's ear: Otitis externa. Centers for Disease Control and Prevention. http://www.cdc.gov/healthywater/swimming/rwi/illnesses/swimmers-ear.html. Accessed Feb. 3, 2016.
  5. Papadakis MA, et al., eds. Ear, nose, & throat disorders. In: Current Medical Diagnosis & Treatment 2016. 55th ed. New York, N.Y.: The McGraw-Hill Companies; 2016. http://www.accessmedicine.com. Accessed Feb. 3, 2016.
  6. Rosenfeld RM, et al. Clinical practice guideline: Acute otitis external. In: Otolaryngology—Head and Neck Surgery. 2014;150:S1.
  7. Swimmer's ear. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/swimmers-ear. Accessed Feb. 3, 2016.