Swimmer’s Ear: Sudden Ear Pain That Needs a Doctor’s Visit

Ear pain can feel scary, especially when it starts suddenly at night. One moment you feel fine, and a few hours later your ear hurts so much that it is hard to sleep, chew, or touch the side of your face.

One common reason is swimmer’s ear, also called otitis externa. This is an infection or inflammation of the ear canal, the narrow passage between the outside of the ear and the eardrum.

Swimmer’s ear is usually not a true emergency, but it should not be ignored. If you have ear pain at night and there is no pus or fluid draining from the ear, no fever, no severe dizziness, no swelling around the ear, no facial weakness, and the pain is not extreme, you may be able to take an over-the-counter pain reliever such as ibuprofen or acetaminophen, following the label instructions, and visit urgent care or a doctor the next morning.

Do not skip the visit just because the pain feels better in the morning. Pain can come and go, but the infection may still be there. A clinician needs to look inside the ear, check the ear canal and eardrum, and decide whether prescription ear drops are needed.

What Is Swimmer’s Ear?

Swimmer’s ear is an infection of the outer ear canal. It often happens when moisture stays trapped in the ear after swimming, showering, or sweating. A warm, wet ear canal makes it easier for bacteria, and sometimes fungi, to grow.

Despite the name, you do not have to be a swimmer to get it. Swimmer’s ear can happen after a pool day, a beach trip, a shower, or even after aggressive ear cleaning.

The ear normally protects itself with earwax. Earwax is not “dirt.” It helps trap debris, protects the skin of the ear canal, and makes the environment less friendly to germs. When the canal stays wet or gets scratched by cotton swabs, earbuds, fingernails, or ear-cleaning tools, that protective barrier can break down.

That is when infection becomes more likely.

What Swimmer’s Ear Feels Like

Swimmer’s ear often starts with a strange feeling rather than obvious pain. You may notice itching, pressure, or a blocked sensation, like water is still stuck in the ear.

Then the pain may build quickly. People often describe it as:

• pain inside the ear canal
• sharp pain when touching or pulling the outer ear
• pain when pressing the small flap in front of the ear canal
• pain that gets worse when chewing, talking, or moving the jaw
• a full or clogged feeling in the ear
• muffled hearing
• itching deep in the ear
• drainage or wetness from the ear
• tenderness around the ear
• a bad smell from ear discharge in some cases

A key clue is pain when the outer ear is touched or gently pulled.

Can You Treat Swimmer’s Ear at Home?

You should not try to fully treat swimmer’s ear at home without an exam.

The reason is simple: ear pain can come from different problems. It may be swimmer’s ear, a middle ear infection, wax impaction, injury to the ear canal, a ruptured eardrum, or another condition. Treatment depends on what the clinician sees.

Do not put random drops, alcohol, vinegar, peroxide, essential oils, or home remedies into a painful ear unless a clinician has told you it is safe for your situation. Some drops are not safe if the eardrum is damaged, if you have ear tubes, or if there is another ear condition.

Over-the-counter pain medicine may help you get through the night, but it does not cure the infection.

How Doctors Treat Swimmer’s Ear

Treatment usually focuses on clearing the infection, reducing inflammation, and helping the ear canal heal.

A Doctor or Urgent Care Clinician May

• examine the ear with an otoscope
• check whether the ear canal is swollen, red, blocked, or draining
• make sure the eardrum looks intact
• gently clean debris from the ear canal if needed
• prescribe medicated ear drops
• recommend pain relief while the drops begin working

Prescription ear drops are the main treatment for most cases. They may contain an antibiotic, an antifungal medication, a steroid to reduce swelling, or a combination, depending on what the doctor finds.

Oral antibiotics are not usually the first choice for uncomplicated swimmer’s ear. Clinical guidelines note that topical treatment is usually preferred, while oral antibiotics have limited usefulness unless the infection is more advanced, has spread beyond the ear canal, or the patient has risk factors such as immune compromise.

Sometimes the ear canal is so swollen that drops cannot get in well. In that case, a clinician may place a small wick in the ear canal to help the medication reach the infected area.

What Happens If Swimmer’s Ear Is Not Treated?

Untreated swimmer’s ear can become more painful and harder to treat. The canal may swell more, drainage may increase, and hearing can become more muffled because the canal is blocked.

In some cases, the infection can spread to nearby skin and soft tissue. This is more concerning in people with diabetes, older adults, and anyone with a weakened immune system.

Most people recover well with proper treatment, but delaying care can mean more pain, a longer recovery, and a higher chance of complications.

Who Gets Swimmer’s Ear More Often?

Swimmer’s ear is more common in people who have frequent moisture or irritation in the ear canal.

Risk Factors Include

• swimming, especially often or in untreated water
• trapped water after bathing or showering
• narrow ear canals
• frequent use of cotton swabs or ear-cleaning tools
• scratches or irritation inside the ear canal
• earbuds, hearing aids, or devices that trap moisture
• eczema, psoriasis, or sensitive skin in the ear canal
• allergies to hair products, cosmetics, earrings, or ear devices
• excess earwax or blockage
• diabetes or a weakened immune system

Children can be more prone to swimmer’s ear because their ear canals are smaller and water can get trapped more easily.

How to Lower Your Risk

You cannot prevent every ear infection, but you can reduce the risk.

After swimming or showering, gently dry the outer ear with a towel. Tilt your head to help water drain. You can gently pull the earlobe in different directions to help open the canal.

Avoid cotton swabs inside the ear canal. They can scratch the skin, push wax deeper, and make infection more likely.

Use swim earplugs or custom swim molds if you get swimmer’s ear often. CDC recommends keeping ears as dry as possible and using a bathing cap, ear plugs, or custom-fitted swim molds while swimming.

A hair dryer on the lowest, coolest setting may help dry the outer ear area, but keep it at a safe distance and do not blow hot air into the ear.

When to Schedule a Visit

Schedule a visit if you have ear pain, itching, drainage, muffled hearing, or pain when touching the outer ear. These symptoms are common with swimmer’s ear and need an exam.

You should be seen sooner if the pain is severe, symptoms are getting worse, you have fever, fluid or pus is coming from the ear, your hearing changes, or you have diabetes or a weakened immune system.

If you are in the Buckhead area and think you may have swimmer’s ear or another ear infection, schedule a consultation with our Buckhead clinic. We can examine your ear, identify the likely cause of your pain, and recommend the right treatment so the infection does not keep getting worse.