The short version
- Swimmer’s ear (acute otitis externa) is an infection of the ear canal, almost always bacterial, linked to water, sweat and warm humid air[1][2].
- It led to an estimated 2.4 million US health care visits in 2007, and 53% of visits were adults[2].
- Ear drops, not antibiotic tablets, are the first treatment for uncomplicated cases; symptoms last about 6 days after antibiotic and steroid drops start[1][3].
- US Navy divers had a 44% higher risk of otitis externa than other sailors[4].
What swimmer’s ear is, and why water workers get it
The 2014 US clinical practice guideline defines acute otitis externa as diffuse inflammation of the ear canal, sometimes reaching the outer ear or eardrum[1]. The CDC links it to water exposure, bathing, heavy sweating and warm, humid environments[2], which describes a dive boat or a summer engine room well.
| Measure, United States[2] | Figure |
|---|---|
| Health care visits, 2007 | About 2.4 million (8.1 per 1,000 people) |
| Share of visits by adults 20 and over | 53% |
| Highest rate | Children aged 5 to 9 (18.6 per 1,000) |
| Direct cost | Up to $0.5 billion a year; nearly 600,000 clinician hours |
| Season and region | Peaks in summer; highest rate in the South |
Symptoms, and what else it could be
The CDC describes pain, tenderness, redness and swelling of the ear canal, sometimes with pus[2]. A Cochrane review adds itchiness, discharge and muffled hearing[3]. The guideline asks clinicians to rule out other causes of ear pain and discharge before calling it swimmer’s ear[1].
Divers have a longer list of ear problems: middle-ear barotrauma is the most common diving ENT injury, and otitis externa and bony canal growths sit alongside it[5]. Ear pain after a dive is not automatically swimmer’s ear. See ear, nose and throat problems at sea.
Swimmer’s ear treatment: what the evidence says
| Question | Answer |
|---|---|
| Drops or tablets? | Drops first. No oral antibiotics for uncomplicated cases unless infection spreads beyond the canal or the person has risk factors[1] |
| Which drops? | Across 19 trials and 3,382 people in a Cochrane review, most topical drops worked about equally well[3] |
| Do drops beat placebo? | Antibiotic drops with steroid: odds ratio 11 against placebo drops in one trial[3] |
| Acetic acid (vinegar-type) drops? | Comparable at week 1, but less effective when treatment ran longer, with symptoms about 2 days longer[3] |
| How long? | At least a week; continue while symptoms last, for up to 7 more days[3] |
Pain control is a strong recommendation in the guideline[1]. If the canal is swollen shut, a clinician may clean it or place a wick so drops can reach the infection[1].
Managing swimmer’s ear on board
- Keep the ear dry and stop diving or swimming until it settles.
- Give pain relief matched to how bad the pain is[1].
- Get radio medical advice before using drops. A perforated eardrum or ear tube needs a non-ototoxic drop[1].
- Use the drops exactly as the physician explains; the guideline stresses teaching people how to put drops in[1].
- Review at 48 to 72 hours. No improvement means the diagnosis needs checking[1].
- Log it in the medical log.
When swimmer’s ear is more than a nuisance
Diabetes, a weakened immune system, prior radiotherapy, a perforated eardrum or an ear tube change how swimmer’s ear is managed[1]. Infection spreading beyond the ear canal is a reason for systemic treatment[1]; at sea, that calls for a medevac decision.
Prevention for divers and crews, and surfer’s ear
The CDC lists ear plugs, swim caps and alcohol-based ear-drying solutions as prevention measures[2]. For divers the stakes are real: in US Navy records for 2016 to 2022, divers had a relative risk of 1.44 for otitis externa compared with other sailors[4].
| Surfer’s ear evidence | Finding |
|---|---|
| Systematic review, 19 studies[6] | 2,032 of 2,997 surfers had bony canal growths; prevalence 53% to 90%, mean 67.8% |
| German wind and kitesurfers[7] | 75.1% of 130 people affected; 19.9% severe |
Surfer’s ear grows with cold water and wind exposure and can cause hearing loss and repeated infections[6]. Crews working cold, windy decks with wet ears share that exposure, so ear protection belongs in the kit. For divers, see commercial diving medical requirements.
A diver with swimmer’s ear stays out of the water until it clears, so the ear care plan should exist before the season starts. Discovery Health MD writes it: maritime medical consulting for the ear care and return-to-dive protocol, and ship medical chest management for stocking the right drops and drying solution. Ask a physician to review your crew ear care plan.
Common questions
What is swimmer’s ear?
An infection and inflammation of the ear canal, also called acute otitis externa, almost always bacterial[1].
What is the best treatment for swimmer’s ear?
Ear drops plus pain relief; oral antibiotics are not the first choice for uncomplicated cases[1].
How long does swimmer’s ear last?
With antibiotic and steroid drops, symptoms last about six days after treatment starts[3].
Do swimmer’s ear drops work?
Yes. Antibiotic drops with steroid were far more effective than placebo drops in a trial in the Cochrane review[3].
Can you swim or dive with swimmer’s ear?
Keeping water out is part of prevention, so stay out until it settles; the CDC lists ear plugs and swim caps[2].
How do you prevent swimmer’s ear?
Reduce water in the ears with ear plugs, swim caps and alcohol-based ear-drying drops[2].
Is surfer’s ear the same as swimmer’s ear?
No. Surfer’s ear is bony growth in the canal from cold water and wind, though it can lead to repeat infections[6].
