Otitis Externa: Swimmer’s Ear Causes and Drops That Actually Work

Swimmer’s ear isn’t just a nuisance-it’s painful, frustrating, and often misunderstood. If you’ve ever felt that sharp, burning ache deep in your ear after a swim, or noticed your ear feeling full and tender to the touch, you’re not alone. About 1 in 10 Americans gets otitis externa each year, according to CDC estimates from 2022. It’s not just for kids who spend all summer in the pool. Adults who swim, shower, or even use earbuds frequently are just as at risk. The real issue? Most people treat it wrong-using the wrong drops, skipping key steps, or waiting too long to get help.

What Exactly Is Swimmer’s Ear?

Otitis externa, or swimmer’s ear, is an infection of the outer ear canal-the tube that runs from your eardrum to the outside of your head. It’s not the same as a middle ear infection (otitis media), which happens behind the eardrum. Swimmer’s ear is a skin infection. The skin inside your ear canal gets irritated, swollen, and then infected. This usually happens when water gets trapped, washing away the ear’s natural protective layer of wax and oils. Without that barrier, bacteria and fungi move in.

The ear canal normally has a slightly acidic pH between 5.0 and 5.7. That acidity keeps germs from growing. But when water sits in the canal, it neutralizes that pH. Sweat, shampoo, or even too much earwax removal can do the same thing. Suddenly, the environment becomes a breeding ground. The most common bacteria? Pseudomonas aeruginosa, responsible for over half of cases. Staphylococcus aureus is next. Fungi like Aspergillus cause about 1 in 10 cases, especially in humid climates or after prolonged antibiotic use.

How Bad Can It Get?

Not all cases are the same. Symptoms range from mild to severe, and how you treat it depends on where you fall.

• Mild (45% of cases): Itchy ear, slight redness, mild discomfort when tugging the earlobe. You might hear a faint ringing or feel like your ear is plugged.
• Moderate (35%): Pain increases, especially when chewing or moving your jaw. The ear canal starts to swell shut. You may notice some discharge-clear, yellow, or even foul-smelling.
• Severe (20%): The canal is completely blocked by swelling. Pain is intense, sometimes radiating to your neck or face. Fever above 101°F, swollen lymph nodes, and even temporary hearing loss can happen. This is when you need to see a doctor immediately.

Left untreated, severe cases can lead to malignant otitis externa-a rare but dangerous condition where the infection spreads to the bone around the ear. It mostly affects older adults with diabetes or weakened immune systems. The good news? It’s extremely rare, affecting only about 0.03% of cases.

Which Ear Drops Actually Work?

There are three main types of ear drops used to treat swimmer’s ear. Not all are created equal. Choosing the right one depends on your symptoms and whether the infection is bacterial or fungal.

1. Antibiotic-Steroid Drops (Best for Moderate to Severe Cases)

These are the gold standard for anything beyond mild discomfort. The most common is Ciprodex (ciprofloxacin 0.3% + dexamethasone 0.1%). It kills bacteria and reduces swelling at the same time. According to FDA clinical trials from 2019, it resolves symptoms in 92% of patients within 7 days.

Generic alternatives like ofloxacin (OtiRx, approved in March 2023) are just as effective and often cheaper. OtiRx’s new extended-release formula means you only need to use it once a day instead of twice.

Why steroids matter: The swelling in your ear canal is what makes it feel blocked and painful. Steroids shrink that swelling fast. Without them, antibiotic drops alone only work about 75% of the time.

2. Acetic Acid with Hydrocortisone (Best for Mild Cases and Prevention)

Over-the-counter drops like VoSoL HC Otic or Swim-Ear contain 2% acetic acid and hydrocortisone. They’re perfect for early signs-or for preventing infection after swimming.

Acetic acid restores the ear’s natural acidity, killing bacteria and fungi. Hydrocortisone reduces itching and swelling. Studies show an 85% success rate for mild cases. But here’s the catch: if your ear canal is already swollen shut, these drops won’t penetrate. They’re not strong enough for moderate or severe infections.

They’re also the best long-term tool. Using a few drops after swimming reduces your risk of recurrence by 65%, according to Mayo Clinic data.

3. Antifungal Drops (For Fungal Infections)

If your ear itches like crazy, you see white or gray flaky debris, and antibiotic drops don’t help-it’s probably fungal. Clotrimazole 1% is the go-to. It works in 93% of cases within a week, based on a 2021 JAMA Otolaryngology study.

Don’t use acetic acid or antibiotic drops for this. They won’t touch the fungus. In fact, using them delays real treatment by days or even weeks. Many people don’t realize they have a fungal infection until they’ve tried everything else.

What Drops to Avoid

Some older drops still get prescribed, but they’re risky. Neomycin-polymyxin (like Cortisporin) is cheaper and available over the counter, but it carries a 5-7% risk of causing contact dermatitis. Worse, if you have a perforated eardrum-which you might not even know about-neomycin can cause permanent hearing damage. The FDA warns against it for this reason.

And don’t use hydrogen peroxide, alcohol, or vinegar straight from the bottle. These dry out the skin and make things worse. They’re not sterile, and they’re not formulated for the ear canal.

How to Use Ear Drops Correctly (It’s Not as Simple as You Think)

Even the best drops won’t work if you don’t use them right. A 2021 study found that 32% of people apply drops incorrectly, cutting their effectiveness by nearly half.

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. Pull your earlobe gently up and back (for adults) or down and back (for kids) to straighten the canal.
5. Instill the exact number of drops prescribed.
6. Stay on your side for at least 5 minutes. This lets the drops reach deep into the canal.
7. Use a clean tissue to wipe away any excess that drips out. Do not stick anything inside the ear-not cotton swabs, not fingers, not hairpins.

If your ear canal is swollen shut, you might need an ear wick-a tiny sponge inserted by a doctor to help drops reach the infection. It’s uncomfortable, but it works. About 65% of patients say it’s necessary, even if it’s not pleasant.

When to See a Doctor

You don’t need to rush to the ER for mild symptoms. But if you have:

• Pain that doesn’t improve after 2 days of using drops
• Fever above 101°F
• Swelling that spreads to your neck or face
• Drainage that smells bad or looks like pus
• History of diabetes or a weakened immune system

Then see a doctor immediately. These are red flags.

Also, if you’ve tried OTC drops for 3-4 days with no improvement, it’s time. You might have a fungal infection or a more serious bacterial strain. Delaying treatment can turn a simple case into a chronic one.

Cost and Accessibility

Prescription drops like Ciprodex cost around $147.50 without insurance. That’s steep. But generic ofloxacin is about $45. OTC acetic acid drops like Swim-Ear are $15 and just as effective for prevention and mild cases.

Insurance usually covers prescription drops, but you might still pay a copay. If cost is an issue, ask your doctor for a generic. Many pharmacies offer discount programs. And if you swim often, keeping a bottle of Swim-Ear on hand is a smart investment.

Preventing Future Infections

The best treatment is prevention. Here’s what works:

• Dry your ears thoroughly after swimming or showering. Tilt your head and gently tug the earlobe to help water drain.
• Use a hairdryer on the lowest, coolest setting from a distance to dry the ear canal.
• Use acetic acid drops (like Swim-Ear) after swimming-not just when you feel symptoms.
• Avoid cotton swabs. They push wax deeper and scrape the skin, creating openings for infection.
• If you wear hearing aids or earbuds often, clean them regularly and give your ears a break.

People who swim regularly and use preventive drops after each session cut their risk of infection by more than half. It’s that simple.

What Doesn’t Work (And Why People Get Frustrated)

Many people try home remedies: garlic oil, tea tree oil, olive oil, or even heat lamps. None of these have scientific backing. Some can even make things worse by trapping moisture or irritating the skin.

Another big mistake? Assuming it’s a middle ear infection. If you’ve had ear infections as a child, you might think this is the same thing. But middle ear infections don’t cause pain when you tug your earlobe. Swimmer’s ear does. That’s a key difference.

And don’t ignore it. “I’ll just wait it out” is the most common reason people end up in urgent care with worsening symptoms. Most cases clear up in 7-10 days with the right treatment. Without it? They can drag on for months.