Swimmer’s ear isn’t just an annoying itch after a day at the pool. It’s a real infection - and if you ignore it, it can turn painful, serious, or even lead to complications. Otitis externa, the medical name for swimmer’s ear, happens when the skin lining your ear canal gets infected. It’s not the same as a middle ear infection. This one lives in the outer canal, the tube that runs from your eardrum to the outside of your ear. It’s common, especially in warm, humid places like Cape Town, where swimming is part of daily life. About 1 in 10 Americans get it each year, and the numbers are similar here. The good news? It’s treatable. The bad news? Many people try to fix it themselves and make it worse.
Why Your Ear Gets Infected After Swimming
Your ear canal has a natural defense system. It’s slightly acidic - around pH 5.0 to 5.7 - and it’s lined with earwax, which acts like a protective barrier. When water gets trapped, especially after swimming or showering, that balance breaks. The skin softens, cracks, or gets irritated. Then bacteria or fungi move in. The usual suspects? Pseudomonas aeruginosa, a water-loving bug that thrives in pools and hot tubs, causes 35% to 54% of cases. Staphylococcus aureus is next, often from scratching or using cotton swabs. Fungi like Aspergillus show up in about 10% of cases, especially if you’ve been using steroid drops too long or have diabetes.
It’s not just swimmers. People who clean their ears too often, use hearing aids, or wear earbuds all day are also at risk. Anything that scrapes the skin or traps moisture invites trouble. The first sign? Itching. Then comes pain when you tug on your earlobe or press on the little bump in front of the ear. You might feel fullness, muffled hearing, or see a little discharge. If you have a fever or the pain is severe, it’s not just a mild case. You’re looking at moderate to severe otitis externa.
What Works: The Best Ear Drops for Swimmer’s Ear
Treatment isn’t one-size-fits-all. The right drop depends on what’s causing the infection and how bad it is. Here’s what actually works, based on clinical data and real-world use.
For mild cases (itching, slight redness, no swelling): A 2% acetic acid solution with hydrocortisone - like Vosol HC Otic - is the go-to. It’s cheap (around $15), available over the counter, and works well. Studies show it clears up about 85% of mild cases in a week. The acetic acid restores the ear’s natural acidity, killing bacteria. The hydrocortisone reduces swelling and itching. It’s also great for prevention. Use a few drops after swimming to keep your ears dry and acidic. Many swimmers swear by it.
For moderate to severe cases (pain, swelling, blocked canal): You need something stronger. The gold standard is a combination drop with an antibiotic and a steroid. Ciprodex (ciprofloxacin and dexamethasone) is the most common. It’s effective in 92% of cases within seven days. The ciprofloxacin kills bacteria like Pseudomonas and Staph. The dexamethasone reduces inflammation fast. This combo is why most doctors skip oral antibiotics - they don’t add much benefit and can cause more side effects like stomach upset or rashes.
Generic versions like ofloxacin otic are cheaper (around $45) and still effective, though they don’t have the steroid. That means they take longer to reduce swelling. Some people use them when cost is a barrier. But if you’re in pain and your ear is swollen shut, you’re better off with the combo.
For fungal infections (otomycosis): If your ear looks white or grayish with flaky debris, and it’s not improving with bacterial drops, you’ve got fungus. Clotrimazole 1% solution works in 93% of cases. You won’t find this over the counter. You need a prescription. Acetic acid won’t touch fungal infections - it’s useless here. Using the wrong drop delays healing by days or even weeks.
Why Some Drops Fail - And What You’re Doing Wrong
It’s not just about which drop you use. How you use it matters just as much. A 2021 study found that 40% of treatment failures happened because people didn’t follow the steps correctly.
Here’s what you must do:
- Wipe the outer ear with a dry cloth - don’t stick anything inside.
- Warm the bottle in your hands for a minute. Cold drops can make you dizzy.
- Lie on your side with the infected ear facing up.
- Put in the exact number of drops your doctor prescribed (usually 5).
- Stay still for at least 5 minutes. Let the drops soak in. Gently tug your earlobe to help the liquid flow deeper.
- Do not use cotton swabs, ear picks, or Q-tips. You’re wiping out the medicine.
People skip the 5-minute wait. They think, “I’ll just sit up.” That’s a mistake. The drops need time to reach the infected skin. If your ear canal is swollen shut, drops won’t get through. That’s when a doctor may insert an ear wick - a tiny sponge that absorbs the drops and slowly delivers them deep inside. It’s uncomfortable, but it works.
Cost, Resistance, and What’s New
Ciprodex costs about $147.50 without insurance. That’s why many people try OTC options first. But if you’re past the itching stage, you’re wasting time. The cost difference is real, but so is the risk of prolonged pain or complications.
There’s also a growing concern: antibiotic resistance. Between 2015 and 2020, fluoroquinolone-resistant Pseudomonas strains increased by 12%. Overprescribing drops - especially when the infection isn’t bacterial - is part of the problem. That’s why doctors are more cautious now. If you’ve had swimmer’s ear before and it came back quickly, you might need a culture test to see what’s really growing in your ear.
New developments are on the horizon. In March 2023, the FDA approved a new version of ofloxacin with extended-release tech. It lasts 24 hours, so you only need one dose a day instead of two. Early results show 94% effectiveness. Researchers are also testing microbiome treatments - essentially, repopulating the ear with good bacteria to prevent future infections. They’re still in trials, but the idea is promising.
When to See a Doctor - And When Not to
You don’t need to run to the clinic for mild itching. Try the OTC acetic acid drops first. But if:
- The pain is severe or getting worse after 2 days
- Your ear canal is completely blocked
- You have a fever above 101°F (38.3°C)
- You have diabetes or a weakened immune system
- You’ve tried OTC drops for 5 days with no improvement
- then see a doctor. Delaying care increases the risk of malignant otitis externa, a rare but dangerous infection that can spread to the skull bone. It’s seen in fewer than 1 in 3,000 cases, but it’s serious. Diabetics are at higher risk. If you’re one of them, don’t wait.
Prevention Is the Best Medicine
Swimmer’s ear isn’t inevitable. Here’s how to avoid it:
- Dry your ears thoroughly after swimming or showering. Tilt your head and gently pull your earlobe to let water drain.
- Use a hair dryer on low heat, held at arm’s length, to dry the canal.
- Use 2% acetic acid drops after swimming - even if you don’t have symptoms. It cuts recurrence risk by 65%.
- Avoid cotton swabs. Your ear doesn’t need cleaning - it cleans itself.
- Use swimmer’s earplugs or a tight-fitting silicone cap if you swim often.
It’s simple. But most people don’t do it. They think, “I’ll just wait and see.” By then, it’s too late.
Can I use hydrogen peroxide or vinegar to treat swimmer’s ear?
No. While vinegar (acetic acid) is used in medical drops, household vinegar is too strong and can burn your skin. Hydrogen peroxide can damage the delicate skin in your ear canal and worsen inflammation. Only use solutions made for ear use - like 2% acetic acid with hydrocortisone - and follow the instructions exactly.
Is swimmer’s ear contagious?
No. You can’t catch it from someone else. It’s caused by bacteria or fungi that grow in your own ear canal when conditions are right - usually after water exposure. But sharing earphones, towels, or earplugs can spread the germs to your own ears if they’re already damp or irritated.
Can I still swim if I have swimmer’s ear?
Not until the infection clears. Water will delay healing and can make it worse. Wait at least 7 to 10 days after symptoms disappear. When you do swim again, use ear drops afterward to prevent it from coming back.
Why do some ear drops hurt when I put them in?
It’s normal to feel a brief stinging, especially if your ear canal is inflamed. That’s the medication working. But if the pain lasts more than a few minutes or gets worse, stop using it. You might be allergic to a component, or the drop isn’t right for your infection. Call your doctor.
Are oral antibiotics needed for swimmer’s ear?
Rarely. Topical drops work better because they target the infection directly. Oral antibiotics add side effects - like diarrhea or rashes - without much extra benefit. They’re only used if the infection spreads beyond the ear canal, which is uncommon.