Swimmer's Ear and Ear Pain After Swimming: Causes, Self-Care and Prevention

You swim lengths for an hour, step out of the shower and then it starts: a nagging, pressing or stabbing feeling in your ear. Ear pain after swimming is common. Usually it is caused by water that stays in your ear canal, and sometimes that develops into swimmer’s ear: an inflammation of the skin in your ear canal. This article explains how to recognise swimmer’s ear, what other causes there are, what you can do yourself, when to call your GP and how to prevent it from now on.

What is swimmer’s ear?

Swimmer’s ear is an inflammation of the skin in the ear canal. The medical name is otitis externa. The inflammation sits in front of the eardrum, in the part of your ear where earwax is too. Because it often starts after swimming, it is popularly called swimmer’s ear. But you can just as easily get it from showering, earbuds or cotton buds.

Your ear canal is a narrow, slightly curved channel. Once a drop of water is trapped at the back, surface tension stops it from simply running out. The water rinses away the protective earwax and softens the skin. Bacteria that are already there then get their chance.

Causes of swimmer’s ear

• Water in your ear after swimming or showering. This is by far the most common cause.
• Things that close off your ear, such as earbuds or a hearing aid. The skin underneath gets warm and moist. So keep them clean; you can read how in how to clean earplugs.
• Cotton buds and poking around. They damage the skin and push earwax deeper.
• Soap, shampoo, hairspray or perfume that get into your ear and irritate the skin.

If you have a naturally narrow ear canal or sensitive skin, for example because of eczema, moisture gets trapped more easily and symptoms come back more often.

Symptoms: how to recognise swimmer’s ear

Many people first notice a nagging or itchy feeling. Later this can get worse, with:

• pain, especially when you gently pull your outer ear or when you chew
• itching or a burning feeling in your ear
• hearing less well or a blocked ear, because the skin in the ear canal swells
• a red, flaky or swollen ear canal, sometimes with fluid coming from your ear

Is your ear only blocked, without pain or itching? Then it may simply be water or earwax. You can read about the different causes of a muffled ear in blocked ear: causes and what to do.

Other causes of ear pain after swimming

Not every pain after swimming is swimmer’s ear.

Cold water, wind and chlorine

Cold water on your eardrum causes a sharp, short burst of pain that often fades within a few minutes. If you swim outdoors, there is wind as well. In the long run that combination is not harmless: in people who swim or surf in cold open water for years, bone growth can develop in the ear canal, known as surfer’s ear. It develops slowly and narrows the ear canal, so water and bacteria get trapped even more easily. You can read more in preventing surfer’s ear with surf earplugs.

Chlorine plays a part too: it rinses away the protective layer of earwax and dries out the skin in your ear canal. That is why keen indoor swimmers are more likely to have itching and sensitive ears.

Pressure changes when diving

If you dive to the bottom of the deep end, the water pressure on your eardrum increases. Your middle ear has to compensate through the Eustachian tube. If that does not work well, for example because you have a cold, it hurts. Equalising usually helps: pinch your nose and blow gently until you feel a click.

Do not wear swimming earplugs if you dive really deep. Between the plug and your eardrum there is a closed-off layer of air that you cannot equalise. As you go down, the water pressure increases while the pressure in that air layer stays behind, and that pulls on your eardrum. Swimming lengths, ducking under and picking up a coin in shallow water are all fine; keep about one metre as your limit and do not jump in from a height with them.

Grommets, a hole in the eardrum and children

If you have grommets, a hole in your eardrum or have had ear surgery, water can get past the eardrum into your middle ear. That is not a matter of discomfort but of risk. Ask your GP or ENT doctor (ear, nose and throat doctor) what is sensible for you when swimming and showering. Whether you can have custom swimming earplugs made with grommets, you can read in grommets and having earplugs fitted.

Children spend the most time with their heads under water and often have sensitive ears. If your child has ear pain after every swimming lesson, have it checked by your GP first, especially if they have grommets. If there is no medical cause, swimming earplugs are a logical next step.

Getting water out of your ear

Tilt your head towards the wet ear, gently pull your outer ear slightly up and back to straighten the ear canal, and move your jaw as if you are chewing. Often the water then runs out after all. Lying on your side with your ear on a towel also helps. Afterwards, dry the outside of your ear and the entrance of the ear canal well with a towel.

Do not go into your ear with cotton buds, your finger or any other object. You push water and earwax further in and damage the very layer of skin you need to protect. How to keep your ears clean safely is explained in how to clean your ears and remove earwax yourself.

Treating swimmer’s ear yourself

With mild symptoms you can do a lot yourself. The advice below comes from Thuisarts, the Dutch patient website of the Dutch College of General Practitioners. In short: keep the ear dry, don’t use cotton buds, and see your GP if it is painful or doesn’t improve within a few days. Your own doctor can advise you on the rules and options in your country.

1. 1Keep your ear clean and dry. Bend your head forward when you shower and wash your hair, so no water or soap runs into your ear. Do not go swimming until the symptoms have gone.
2. 2Do not poke around in your ear. According to the Dutch GP guidance, this is the most important advice. No cotton buds, no fingers, and do not push earwax deeper.
3. 3Keep shampoo, hairspray and perfume out of your ear. They irritate the skin even more.
4. 4Take paracetamol if it is very painful. Follow the dose on the package leaflet.
5. 5No improvement after a few days? Then call your GP during working hours. They can clean your ear and prescribe acidic ear drops, which help the skin protect itself against bacteria, together with an anti-inflammatory.

With those ear drops, the inflammation usually clears within 1 to 3 weeks. With sensitive skin, eczema or an allergy it can take longer.

When to call your GP

Call your GP during working hours if:

• the pain does not ease after a few days or gets worse;
• fluid, pus or blood comes from your ear;
• the hearing loss does not go away;
• the symptoms come back after every swim;
• it concerns a child with grommets or a known ear problem.

Short-lived pain from cold water, or a muffled feeling that fades after a few hours, is usually harmless. If in doubt, have it looked at. Swimmer’s ear that you leave too long only gets more painful.

How to prevent swimmer’s ear

The Dutch GP guidance lists a few simple measures: keep your ear canal clean and dry, dry the outside of your ear and the entrance of the ear canal well after swimming or showering, and use earplugs or cotton wool with petroleum jelly when swimming if water often gets into your ear. If you keep getting symptoms despite these measures, you can ask your GP for prescription ear drops to use after swimming.

Cotton wool with petroleum jelly and universal plugs help for a one-off, but rarely seal completely. Every ear canal has a different shape, and standard plugs easily come loose in the water. If you swim often, or swimmer’s ear keeps coming back, keeping water out for good is the solution.

Our custom swimming earplugs, the Dry Ears (€119.95), are made of soft silicone, also in a floating version, so a plug that falls out stays on the surface. The water filter only attenuates about 5 dB: water stays out, but you can still hear the lifeguard, your swimming coach or a conversation at the side of the pool. For surfing and sailing they are available with a detachable cord. Want to hear music under water too? Read music while swimming with Dry Music.

For children, we recommend a minimum age of 4; for children under 12 we talk to the parents first. Children’s ears grow, so check regularly that the plugs still fit well. If your child has grommets, ask the treating doctor which type suits best.

We take your ear impressions at one of our locations in the Netherlands, Belgium or Paphos (Cyprus) and make the plugs in our own 3D lab in Eindhoven. Not near one of our locations? Have impressions taken locally and send them to us. Production takes about 15 working days, and a rush order is available. You get at least 2 years’ warranty and a 6-month comfort guarantee: if they do not fit well, we adjust them free of charge.