Swimmer's Ear And Ear Infections

  • Inês Dias Mestrado, Biologia Molecular e Genética, Faculdade de Ciências da Universidade de Lisboa, Portugal
  • Anamika Shivhare M. Dental Surgery (Oral Pathology & Microbiology), Devi Ahilya University


Did you know that there are different types of ear infections? And have you ever heard of the swimmer's ear? Read this article if you have ear pain to discover if an ear infection might be the cause and to learn the symptoms of an ear infection.

Before discussing ear infections and swimmers’ ear infections, let's first go over how our ears are formed. Our ears are distinguished into three sections: the outer ear, the middle ear, and the inner ear. The outer ear includes the visible section of the ears, the external auditory ear canal, and the tympanic membrane.  This area of the ear is where sound is first conducted and where our hearing pathway begins. The second section is known as the middle ear, and this cavity is related to our nose and helps maintain proper pressure in our ears. 

Our hearing organ, the Cochlea, is located in the third section of our ears, often known as the inner ear. With a snail-like appearance, it contains small hair cells that, when stimulated, send impulses to the brain, enabling us to recognise noises.1

Ear infections often happen in the outer and middle ear. 

Explanation of swimmer's ear

The swimmer's ears are recognised by that term because it frequently occurs in summer and tropical climates and because having retained water in the ears is a risk factor. However, this is simply otitis externa or inflammation of the external auditory canal. This inflammation can be infectious or noninfectious.2

Explanation of ear infections

Unlike swimmer's ear, which affects the outer ear, ear infections affect the middle ear and include acute otitis media, chronic suppurative otitis media, otitis media with effusion, and malignant otitis media. Even though anyone can have an ear infection, children between the ages of 6 and 24 months are the most susceptible.3

An ear infection will likely affect 80% of children at some point in their lives, according to a recent study that places acute otitis media second in frequency among paediatric emergency diagnoses, right behind respiratory infections.4

Purpose of the outline

In this piece, we will go deeper into swimmers’  ear and ear infections, explaining why they occur, how to diagnose and treat them, and how to distinguish the swimmer's ear from ear infections.

Swimmer's ear

Definition of swimmer's ear

The external auditory canal is coated with microscopic hairs and glands that secrete cerumen or earwax. Earwax serves as a barrier against the development of bacteria that can lead to inflammation that can be infectious or non-infectious. Otitis externa, often known as swimmer's ear, is an external ear canal inflammation that can strike at any age but is most common in children between the ages of 7 and 14. Since most occurrences take place in humid, tropical environments, the summer season is more often connected with these infections.2,5

Swimming is the major risk factor, and it can raise otitis externa risk by up to 5 times compared to people who don't swim. Other risk factors for swimmer's ear include: 

  • Improper usage of cotton swabs
  • Earplugs or hearing aids
  • Dermatological conditions 
  • Narrow ear canals or ear canal obstructions.5

The most typical symptom is intense pain inside the ear, while other symptoms can vary depending on the stage of the infection.2

Ear infections

Definition of ear infections

Ear infections do not occur solely in the external region of the ear, and they can take numerous types depending on the symptoms and persistence of the infection. Nevertheless, how do these ear infections develop? Otitis media typically appears following viral respiratory tract infections. The nose, nasopharynx, middle ear, and Eustachian tubes are the main areas of these viral infections. 

The Eustachian tubes are the channels that allow equal pressure on both sides of the tympanic membrane to occur. The eustachian tubes getting clogged as a result of oedema brought on by the infection triggers a chain of events that, taken together, provide the middle ear with a prime location for the colonisation of microorganisms like bacteria or viruses. The presence of pus and a reddening of the affected area are two indicators of acute otitis media.3

When these infections are left untreated, suppurative fluid in the middle ear can migrate to other anatomical regions, which can lead to consequences like:

  • Perforations of the tympanic membrane
  • Mastoiditis
  • Labyrinthitis
  • Petrositis
  • Meningitis
  • Brain abscesses
  • Hearing loss
  • Cavernous and lateral sinus thrombosis.3

Differences between swimmer's ear and ear Infections

Comparison of symptoms

As it is possible to see above, swimmers' ear and ear infections can have a lot of things in common, so how can we distinguish them? Although both of these conditions cause ear pain, they can be recognised by the fact that the swimmer's ear is characterised by pain, itching, redness, swelling, and fluid leaking from the ear as its primary symptoms.2

In addition to the swimmer's ear symptoms, ear infections can cause:

  • Fever
  • Fatigue
  • Hearing loss
  • Scaly skin in the ear6

Comparison of causes

The swimmer’s ear, usually, can happen when the ear canal's protective mechanisms and pH are altered and are linked to infections brought on by the bacteria Pseudomonas aeruginosa and Staphylococcus aureus.5

However, ear infections can be brought on by both bacteria and viruses, as well as by co-infection, which refers to simultaneous viral infections. The most frequent microorganisms that result in these infections include:

  • From bacteria
    • Streptococcus pneumoniae
    • Haemophilus influenzae
    • Moraxella catarrhalis
  • From virus:
    • Respiratory syncytial virus (RSV)
    • Coronaviruses
    • Influenza viruses
    • Adenoviruses
    • Human metapneumovirus3

Comparison of treatment options

A doctor can make the diagnosis for both ear infections and swimmers’ ears. Typically, the swimmer's ear in most cases resolves applying mild acidic solutions prescribed with boric or acetic acid.7

A medical professional may perform a physical examination with an otoscope, as well as tympanocentesis or tympanometry. Following diagnosis, the doctor may recommend antibiotics and pain relievers such as paracetamol for ear infections in the event of a swimmer's ear as well as ear infection.3,5

Also, a myringotomy, a surgical treatment to release the pressure brought on by extra fluid, may be necessary for those who experience recurrent acute middle ear otitis.3

Comparison of prevention strategies

In the case of the swimmer’s ear, avoiding water in the ears, such as by wearing swim moulds that are specifically suited for you when you swim, is one strategy to prevent it. Nonetheless, we should use a towel to dry our ears if water gets in the ear canal. We shouldn't attempt to clean the ear canal or remove earwax using cotton buds or other objects. See your doctor if you believe that earwax may be blocking your ear canal.2

However, to minimise ear infections, keep immunisations up to date, avoid smoky environments, and avoid using dummies in children beyond the age of six months.6

The link between swimmer's ear and ear infections

Explanation of the connection

Despite the fact that both illnesses are ear infections, we usually refer to middle ear infections (acute otitis media) when we talk about ear infections. When the outer ear is infected, it is referred to as the swimmer's ear (external otitis).5

How swimmer's ear can lead to ear infections

Ear infections and swimmer's ear are two types of ear infections. While swimmer's ear complications can lead to the infection spreading to other anatomical regions like the bones and cartilage (malignant otitis externa), it typically spreads outside the ear canal. Even so, it can be quite challenging to distinguish acute otitis media from eardrum rupture when there is a significant amount of suppurative fluid (pus).8

Risk factors for developing both conditions

Among the risk factors for swimmer's ear are:

  • Swimming
  • Improper use of cotton swabs, earplugs or hearing aids, 
  • Dermatological disorders like psoriasis or dermatitis
  • Narrow ear canals
  • Ear canal obstructions
  • Radiotherapy or chemotherapy
  • Stress
  • Compromised immune system.5

However, risk factors for ear infections include:

  • Illnesses that lower immunity
  • Genetic susceptibility
  • Anatomical abnormalities in the palate
  • Ciliary malfunction
  • Vitamin A insufficiency
  • Allergies
  • Respiratory illnesses
  • Family history of recurrent otitis
  • Low socioeconomic level3


Both swimmers’ ear and ear infections are ear disorders that can result in pain and ear redness. They are illnesses that primarily afflict children, though ear infections can also affect toddlers. They typically need to see a doctor, and a physical examination using an otoscope is the primary method of diagnosis.

They may have diverse causes and are distinct diseases, yet it can be challenging to tell them apart.


  1. THE EAR [Internet]. [cited 2023 Apr 4]. Available from: https://www.leedsth.nhs.uk/a-z-of-services/hearing-and-balance-centre-audiology/the-ear/
  2. Ear Infections | Healthy Swimming | Healthy Water | CDC [Internet]. 2022 [cited 2023 Apr 4]. Available from: https://www.cdc.gov/healthywater/swimming/swimmers/rwi/ear-infections.html
  3. Danishyar A, Ashurst JV. Acute Otitis Media. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Apr 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470332/
  4. Meherali S, Campbell A, Hartling L, Scott S. Understanding Parents’ Experiences and Information Needs on Pediatric Acute Otitis Media: A Qualitative Study. J Patient Exp. 2019 Mar;6(1):53–61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572929/
  5. Medina-Blasini Y, Sharman T. Otitis Externa. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Apr 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK556055/
  6. Ear infections [Internet]. nhs.uk. 2018 [cited 2023 Apr 4]. Available from: https://www.nhs.uk/conditions/ear-infections/
  7. Swimmer’s Ear (Otitis Externa) [Internet]. ENT Health. [cited 2023 Apr 7]. Available from: https://www.enthealth.org/conditions/swimmers-ear-otitis-externa/
  8. External Otitis (Acute) - Ear, Nose, and Throat Disorders [Internet]. MSD Manual Professional Edition. [cited 2023 Apr 7]. Available from: https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/external-ear-disorders/external-otitis-acute
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Inês Dias

Master's Degree, Molecular Biology and Genetics, Faculty of Sciences, University of Lisbon

Inês is a scientist in the field of Biomedical Sciences, with a wealth of experience in various laboratory procedures. Her expertise is evident in her work as clinical analysis technician, performing puncture procedures for the collection of biological samples. She has also played a key role in COVID-19 sample processing in a laboratory setting. Recently obtained her master’s in Molecular Biology and Genetics from the Faculty of Sciences at the University of Lisbon.

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