By Hearology® Publishing. Professionally reviewed by Michael Field. Last reviewed on 28.8.26. Next review due on 29.8.27.
That ear that felt a bit off after your holiday swim. The one that itched for a week after a sweaty festival weekend. The vague, muffled tenderness you put down to water getting in and waiting to drain.
Sound familiar?
You may have been experiencing swimmer's ear - clinically known as otitis externa, a common inflammation or infection of the outer ear canal. It affects around 1 in 10 people at some point in their lives, often without them ever knowing what to call it, let alone how to treat it properly.
What causes it, and who is most at risk?
Water is the main culprit, but it's not the only one. Getting water, shampoo or soap into the ear canal can irritate the skin - and damage from cotton buds scratching or poking the ear can cause inflammation and infection. Hot, humid weather also creates the warm, moist conditions that bacteria and fungi thrive in, which is why cases tend to spike over summer.
People with eczema, asthma or allergic rhinitis are at greater risk, as are those with excessive ear wax, which can trap moisture and create an environment ripe for infection. Hearing aid wearers can also be more susceptible, as the dome or mould sits in the ear canal and restricts airflow.
The myth that cotton buds are a reasonable ear-cleaning tool is a highly persistent one. They are not. The ear is self-cleaning; cotton buds can scratch and irritate the canal, and push wax or debris further in, setting the stage for otitis externa. If you're a cotton bud user, now is a good time to stop.
How is it treated?
Otitis externa sometimes gets better without treatment, but it can take several weeks. Most people would rather not wait that long - and there's good reason to act promptly. Treatment is usually straightforward: prescription ear drops tailored to the cause, sometimes alongside steroid drops to reduce inflammation. In some cases, microsuction may be needed to clear discharge and débris from the canal so that drops can work more effectively.
While you're recovering, it's important to keep the affected ear dry by wearing a shower cap when bathing or showering and avoiding swimming until the condition has fully cleared. If you regularly suffer from otitis externa linked to swimming, custom-moulded earplugs from an audiologist can be a worthwhile long-term investment because they create a precise seal against water entry that off-the-shelf plugs simply can't match.
When should you seek help?
If your ear is painful or discharging, or your hearing feels muffled, don't wait it out. Without the right treatment, otitis externa can become chronic and drag on for months. In older adults or those with diabetes or a weakened immune system, it can progress to something far more serious. Necrotising otitis externa is a severe infection that can invade the temporal bone and skull base, causing cranial nerve damage and neurological complications. It is rare, but it is real - and it is largely preventable with prompt action.
As Michael Field, an Audiologist at Hearology® , puts it, "Otitis externa is one of those conditions people try to manage themselves for too long - sometimes making things worse in the process. If your ear is sore, itchy, or discharging, please get it assessed. The sooner we see it, the simpler it is to treat."
References
https://my.clevelandclinic.org/health/diseases/8381-swimmers-ear-otitis-externa - Web page from Cleveland Clinic, a medical site belonging to an international clinic, covering the symptoms, causes, diagnosis and treatment of otitis externa
https://www.hopkinsmedicine.org/health/conditions-and-diseases/otitis-externa - Web page from Johns Hopkins Medicine covering the causes, symptoms, diagnosis and treatment of otitis externa, including the role of trapped water, bacteria and fungi - and how to prevent it
https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/otitis-externa/ - Web page from NHS Inform covering the symptoms, causes and treatment of otitis externa, including self-care advice and when to seek medical help
https://www.guysandstthomas.nhs.uk/health-information/otitis-externa - Web page from Guy's and St Thomas' NHS Foundation Trust covering the causes, symptoms and treatment of otitis externa, including prescribed eardrops, pain relief and tips for prevention
https://pmc.ncbi.nlm.nih.gov/articles/PMC10593509/ - Study published in the International Archives of Otorhinolaryngology presenting a retrospective cohort study of 34 patients with necrotising otitis externa
