Swimmer's ear

Doctors can usually diagnose swimmer's ear during an office visit. If your infection is advanced or persists, you might need further evaluation.

Initial testing

Your doctor will likely diagnose swimmer's ear based on symptoms you report, questions he or she asks, and an office examination. You probably won't need a lab test at your first visit. Your doctor's initial evaluation will usually include:

• Examining your ear canal with a lighted instrument (otoscope). Your ear canal might appear red, swollen and scaly. There might be skin flakes or other debris in the ear canal.
• Looking at your eardrum (tympanic membrane) to be sure it isn't torn or damaged. If the view of your eardrum is blocked, your doctor will clear your ear canal with a small suction device or an instrument with a tiny loop or scoop on the end.

Further testing

Depending on the initial assessment, symptom severity or the stage of your swimmer's ear, your doctor might recommend additional evaluation, including sending a sample of fluid from your ear to test for bacteria or fungus.

In addition:

• If your eardrum is damaged or torn, your doctor will likely refer you to an ear, nose and throat specialist (ENT). The specialist will examine the condition of your middle ear to determine if that's the primary site of infection. This examination is important because some treatments intended for an infection in the outer ear canal aren't appropriate for treating the middle ear.
• If your infection doesn't respond to treatment, your doctor might take a sample of discharge or debris from your ear at a later appointment and send it to a lab to identify the microorganism causing your infection.

The goal of treatment is to stop the infection and allow your ear canal to heal.

Cleaning

Cleaning your outer ear canal is necessary to help eardrops flow to all infected areas. Your doctor will use a suction device or ear curette to clean away discharge, clumps of earwax, flaky skin and other debris.

Medications for infection

For most cases of swimmer's ear, your doctor will prescribe eardrops that have some combination of the following ingredients, depending on the type and seriousness of your infection:

• Acidic solution to help restore your ear's normal antibacterial environment
• Steroid to reduce inflammation
• Antibiotic to fight bacteria
• Antifungal medication to fight infection caused by a fungus

Ask your doctor about the best method for taking your eardrops. Some ideas that may help you use eardrops include the following:

• Reduce the discomfort of cool drops by holding the bottle in your hand for a few minutes to bring the temperature of the drops closer to body temperature.
• Lie on your side with your infected ear up for a few minutes to help medication travel through the full length of your ear canal.
• If possible, have someone help you put the drops in your ear.
• To put drops in a child's or adult's ear, pull the ear up and back.

If your ear canal is completely blocked by swelling, inflammation or excess discharge, your doctor might insert a wick made of cotton or gauze to promote drainage and help draw medication into your ear canal.

If your infection is more advanced or doesn't respond to treatment with eardrops, your doctor might prescribe oral antibiotics.

Medications for pain

Your doctor might recommend easing the discomfort of swimmer's ear with over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others).

If your pain is severe or your swimmer's ear is more advanced, your doctor might prescribe a stronger medication for pain relief.

Helping your treatment work

During treatment, do the following to help keep your ears dry and avoid further irritation:

• Don't swim or go scuba diving.
• Don't wear an earplug, a hearing aid or earbuds before pain or discharge has stopped.
• Avoid getting water in your ear canal when showering or bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a shower or bath.

Here are some suggestions to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they started
• All medications, vitamins and supplements you take, including doses
• Your allergies, such as skin reactions or drug allergies
• Questions to ask your doctor

Some basic questions to ask your doctor about swimmer's ear include:

• What is likely causing problems with my ear?
• What is the best treatment?
• When should I expect improvement?
• Do I need to make a follow-up appointment?
• If I have swimmer's ear, how can I keep from getting it again?
• Do you have brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• Have you been swimming lately?
• Do you swim often?
• Where do you swim?
• Have you ever had swimmer's ear before?
• Do you use cotton swabs or other objects to clean your ears?
• Do you use earbuds or other ear devices?
• Have you had any other recent ear examinations or procedures?