Otitis Externa: Swimmer’s Ear Causes and Best Treatment Drops

Swimmer’s ear isn’t just a nuisance after a day at the pool-it’s a real infection that can turn a simple splash into days of pain, swelling, and even hearing loss. Unlike middle ear infections, which happen behind the eardrum, otitis externa attacks the skin lining your outer ear canal-the tube that runs from your eardrum to the outside of your head. It’s common, especially in warm, humid places like Durban, where swimming is part of daily life. About 1 in 10 Americans get it each year, and the numbers are similar in coastal regions worldwide. The good news? Most cases clear up fast with the right drops. The bad news? Many people use the wrong ones-or skip the most important step.

Why Your Ear Gets Infected After Swimming

It’s not the water itself that causes the problem. It’s what happens when water stays trapped in your ear canal. That moisture softens the skin, breaks down its natural defenses, and turns it into a breeding ground for bacteria. Pseudomonas aeruginosa, the most common culprit, thrives in damp environments. You’ll find it in pool water, lakes, even your shower. The same thing happens if you clean your ears with cotton swabs. Rubbing the canal removes protective earwax, which normally keeps the pH acidic (between 5.0 and 5.7) and stops germs from growing. Once that barrier is gone, infection follows.

Some people are more at risk. Kids aged 7 to 12 get it most often-their ear canals are smaller and trap water easier. Adults over 45 are next, especially if they have diabetes. That’s because high blood sugar weakens the immune response in the skin. Men are slightly more likely to get it than women, likely due to more frequent swimming and ear cleaning habits.

How Bad Is It? Recognizing the Stages

Not all swimmer’s ear is the same. The symptoms tell you how serious it is:

• Mild: Itching, slight redness, mild discomfort when tugging the earlobe. About 45% of cases fall here. You might feel like there’s a little pressure, but no pain yet.
• Moderate: More pain, muffled hearing, swelling that starts blocking the canal. This affects 35% of people. You’ll notice it when you chew or move your jaw.
• Severe: Intense pain, swelling that closes the canal completely, swollen lymph nodes, fever above 101°F (38.3°C). This is 20% of cases-and it needs fast treatment. Left untreated, it can spread to the bone, a rare but dangerous condition called malignant otitis externa.

Don’t wait for fever to act. If your ear hurts more than a normal earache, especially after swimming or showering, don’t assume it’ll go away on its own.

What Drops Actually Work? The Science Behind the Options

There are three main types of ear drops used for swimmer’s ear-and not all are created equal.

1. Antibiotic + Steroid Drops (Like Ciprodex)

This is the gold standard for moderate to severe cases. Ciprodex combines ciprofloxacin (an antibiotic) and dexamethasone (a steroid). The antibiotic kills bacteria like Pseudomonas and Staphylococcus. The steroid reduces swelling and pain. Together, they work faster and better than either alone. Clinical trials show 92% of patients are symptom-free in 7 days. On Reddit, users report dramatic pain relief within 24 hours. The downside? Cost. Without insurance, a 10mL bottle runs about $147.50. Generic versions like ofloxacin with dexamethasone cost around $45 and are nearly as effective.

2. Acetic Acid + Hydrocortisone (Like VoSoL HC Otic or Swim-Ear)

This is the go-to for mild cases and prevention. Acetic acid (2%) restores the ear’s natural acidic pH, making it hard for bacteria to survive. Hydrocortisone reduces itching and swelling. Studies show it works in 85% of mild cases. It’s also the best tool for prevention: use a few drops after swimming, and you cut your risk of infection by 65%. Over-the-counter brands like Swim-Ear cost about $15 and have 4.1 out of 5 stars on Amazon. But here’s the catch: it won’t touch a full-blown infection. If you’ve had pain for more than 48 hours, skip this and see a doctor.

3. Antifungal Drops (For Fungal Infections)

About 1 in 10 cases of swimmer’s ear are fungal-not bacterial. These are more common in tropical climates and after long-term antibiotic use. Symptoms are similar: itching, discharge, and sometimes a fuzzy feeling in the ear. But antifungal drops like clotrimazole 1% work where antibiotics fail. A 2021 JAMA study found clotrimazole cured 93% of fungal cases, while acetic acid only helped 78%. If your ear itches more than it hurts, and drops aren’t working, fungal infection is likely.

The Most Important Step Most People Skip

You can use the best drops in the world, but if you don’t clean the ear canal first, they won’t work. That’s because earwax, dead skin, and debris form a barrier. Medication can’t reach the infected tissue. The American Academy of Otolaryngology says debridement-gently removing buildup-is the most underused trick in treatment.

Doctors do this with suction or dry cotton swabs under a scope. You can’t do this at home safely. But you can help: before applying drops, wipe the outer ear with a dry cloth. Don’t stick anything inside. If your ear feels blocked, see a clinician. They can insert a tiny wick if the canal is swollen shut. It’s uncomfortable, but it lets drops reach deep in. Patients who skip debridement have 30-40% lower success rates.

What Not to Do

Many people make the same mistakes-and it makes things worse.

• Don’t use cotton swabs. They push wax deeper and scrape the skin, creating entry points for bacteria.
• Don’t use a hairdryer on high heat. You can burn the canal. If you want to dry your ear, use a low setting from a distance.
• Don’t use aminoglycoside drops (like neomycin) if you’re not sure about your eardrum. If you’ve had ear tubes or a perforation, these can cause permanent hearing damage. The FDA warns about this.
• Don’t take oral antibiotics. For uncomplicated swimmer’s ear, pills add no benefit and increase side effects like nausea and diarrhea.

How to Use Drops Correctly

Getting the drops to work isn’t just about what you use-it’s about how you use them. Here’s the right way:

1. Wash your hands.
2. Warm the bottle in your hands for 1-2 minutes. Cold drops can make you dizzy.
3. Lie on your side with the infected ear facing up.
4. Put in the number of drops your doctor prescribed (usually 5).
5. Stay still for 5 minutes. Gently tug your earlobe to help the drops flow in.
6. Wipe away any excess with a clean tissue.
7. Don’t plug your ear with cotton.

Studies show 32% of people skip the 5-minute wait. That cuts effectiveness by 40%. It’s not magic-it’s physics. The drops need time to soak in.

When to See a Doctor

You don’t need to rush to the ER for every earache. But call a doctor if:

• Pain lasts more than 48 hours
• You have a fever above 101°F
• Your hearing gets worse
• There’s pus or bloody discharge
• You have diabetes or a weakened immune system
• OTC drops didn’t help after 3 days

Diabetics are at higher risk for complications. Even mild symptoms need quick attention. If you’re unsure, a video visit with an ENT specialist can give you a diagnosis in minutes. Mayo Clinic’s telemedicine program has 88% accuracy for diagnosing swimmer’s ear remotely.

Prevention: Keep Your Ears Dry

The best treatment is avoiding the infection altogether. Here’s how:

• Use earplugs or a swim cap when swimming.
• After swimming or showering, tilt your head and gently pull your earlobe to drain water.
• Use a few drops of acetic acid solution (like Swim-Ear) as a preventive rinse.
• Avoid inserting anything into your ear canal-not cotton swabs, not fingers, not hairpins.
• If you’re prone to infections, dry your ears with a hairdryer on low, from 12 inches away.

People who use preventive drops after swimming cut their infection risk by two-thirds. That’s the kind of simple habit that keeps you out of the doctor’s office.

Final Thoughts

Swimmer’s ear is common, treatable, and preventable. The key isn’t just picking the right drops-it’s using them right. Clean the ear before applying, lie still for five minutes, and don’t skip the doctor if it doesn’t improve. Most people recover fully in a week with the correct treatment. The real danger isn’t the infection-it’s the delay in getting the right care. Don’t guess. Don’t wait. Know your options, act fast, and keep your ears dry.