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

Otitis externa, or swimmer’s ear, isn’t just an uncomfortable nuisance-it’s a real infection that can turn a fun day at the pool into days of pain. Unlike middle ear infections, which happen behind the eardrum, swimmer’s ear attacks the skin lining your outer ear canal-the tube that runs from your eardrum to the outside of your head. It’s common, especially after swimming, but it’s also treatable-if you know which drops actually work and how to use them right.

Why Your Ear Gets Infected After Swimming

Swimming is the classic trigger, but it’s not the water itself that causes the problem. It’s what happens when water gets trapped in your ear canal. That moisture creates a perfect breeding ground for bacteria and fungi. Your ear canal is naturally acidic-between pH 5.0 and 5.7-which keeps germs in check. But when water washes away earwax (cerumen), that protective layer disappears. Suddenly, bacteria like Pseudomonas aeruginosa and Staphylococcus aureus move in.

It’s not just swimmers who get it. People who shower often, use cotton swabs, or wear hearing aids or earbuds are also at higher risk. Scratching the ear canal with a cotton swab-even gently-can create tiny cuts that let bacteria slip in. That’s why you shouldn’t stick anything inside your ear, no matter how itchy it feels.

Each year, about 1 in 10 Americans get swimmer’s ear, according to CDC data. The highest rates are in kids aged 7 to 12 and adults between 45 and 64. Men are slightly more likely to get it than women, likely because they swim more often or have narrower ear canals.

How Bad Is It? Recognizing the Levels

Not all cases are the same. The severity falls into three clear stages:

• Mild: Your ear itches. You might feel a little fullness or mild discomfort. The canal is slightly swollen, but you can still hear fine. This happens in about 45% of cases.
• Moderate: Pain increases, especially when you tug on your earlobe or chew. The canal is partially blocked by swelling. Hearing may feel muffled. This affects 35% of cases.
• Severe: Intense pain, swelling that completely blocks the canal, fever above 101°F, and swollen lymph nodes around your neck. You might even have discharge. This occurs in about 20% of cases and needs quick attention.

Left untreated, severe cases can lead to complications like malignant otitis externa-a rare but dangerous infection that spreads to the bone. It’s seen in less than 0.03% of cases but is more common in people with diabetes or weakened immune systems.

What Drops Actually Work? The Science Behind the Treatments

The right ear drop depends on what’s causing the infection. Bacterial? Fungal? Mild or severe? Here’s what the data says works best.

For Mild Cases: Acetic Acid + Hydrocortisone

Over-the-counter drops like Swim-Ear (2% acetic acid with hydrocortisone) are the first-line choice for mild cases. They work in two ways: acetic acid restores the ear’s natural acidity, making it hard for bacteria to survive, and hydrocortisone reduces swelling and itching.

Studies show these drops clear up mild infections in 85% of cases within a week. They’re also great for prevention. Using them right after swimming cuts your risk of infection by 65%. They cost around $15 a bottle-far cheaper than prescriptions.

But here’s the catch: they don’t work on fungal infections. If your ear is itchy, flaky, and has black or white debris inside, you might have otomycosis (fungal swimmer’s ear). Acetic acid won’t touch that. You’ll need clotrimazole 1% solution, which clears fungal cases in 93% of people.

For Moderate to Severe Cases: Ciprofloxacin + Dexamethasone (Ciprodex)

When the infection is worse, you need stronger medicine. Ciprodex-a prescription drop with the antibiotic ciprofloxacin and the steroid dexamethasone-is the gold standard. It kills the most common bacteria, reduces swelling fast, and eases pain.

Clinical trials show it resolves symptoms in 92% of patients within 7 days. Many users report pain dropping dramatically within 24 hours. It’s the most prescribed drop in the U.S., holding 42% of the market share.

But it’s expensive: around $147.50 without insurance. That’s why many switch to generic ofloxacin drops, which cost about $45 and are still 90% effective. The downside? Ofloxacin doesn’t include a steroid, so swelling may take longer to go down.

Avoid These: Neomycin and Polymyxin Drops

You might see older drops like Cortisporin (neomycin-polymyxin) still sold. They’re cheaper and used to be common. But here’s the problem: they carry a 5-7% risk of causing allergic skin reactions. Worse, if your eardrum is perforated-which you might not even know-neomycin can damage your hearing. The FDA warns against using them if you have any history of ear surgery or ruptured eardrums.

How to Use Ear Drops Right (Most People Get It Wrong)

Even the best drop won’t work if you use it wrong. A 2021 study found that 40% of people reduce their treatment’s effectiveness by skipping one key step: positioning.

Here’s how to do it right:

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) to straighten the canal.
5. Instill the exact number of drops prescribed.
6. Stay still for 5 minutes. This lets the medicine reach deep into the canal.
7. Then, gently place a cotton ball at the ear opening to keep the drops in.
8. Don’t use cotton swabs inside your ear. They push debris deeper and remove medicine.

Skipping the 5-minute wait cuts effectiveness by up to 40%. If your ear canal is swollen shut, your doctor may need to insert a tiny sponge-like wick to help the drops reach the infection. It’s uncomfortable, but 65% of patients say it’s worth it.

What Doesn’t Work-and Why

Many people try home remedies: vinegar rinses, garlic oil, hydrogen peroxide. None of these are proven to cure swimmer’s ear. Some can even make it worse.

Oral antibiotics? They’re rarely needed. The American Academy of Otolaryngology says they add only 5-7% more benefit than topical drops but increase side effects like nausea and diarrhea by 15%. Don’t take pills unless you have a fever, swelling that spreads, or diabetes.

And never use ear drops if you have a ruptured eardrum unless your doctor says so. Some ingredients can permanently damage your hearing.

When to See a Doctor

You can treat mild cases at home. But call your doctor if:

• Pain doesn’t improve after 2 days of using drops
• You have a fever above 101°F
• Your hearing gets worse
• You have diabetes and symptoms don’t improve quickly
• You see pus, blood, or foul-smelling discharge

Also, if you’ve tried over-the-counter drops and it didn’t help, you might have a fungal infection or something else entirely. Self-misdiagnosis delays proper care by 7-10 days on average, according to forum data.

Preventing It Next Time

The best treatment is prevention:

• Use acetic acid drops after swimming or showering.
• Dry your ears with a towel or a hairdryer on low heat, held at least a foot away.
• Avoid cotton swabs, bobby pins, or anything inside your ear canal.
• If you swim often, consider custom-fitted earplugs.
• Don’t share earbuds or headphones.

People who use acetic acid drops after swimming cut their risk by two-thirds. It’s that simple.

What’s New in 2026

In March 2023, the FDA approved a new extended-release version of ofloxacin called OtiRx. It lasts 24 hours, so you only need one application a day instead of two. Early results show 94% effectiveness.

Researchers are also testing microbiome-based treatments-drops that restore good bacteria in the ear canal instead of killing everything. These are still in trials, but they could mean fewer infections and less antibiotic resistance.

Meanwhile, telemedicine is making diagnosis easier. Mayo Clinic found video visits correctly identify swimmer’s ear 88% of the time. You might not even need to leave your house.

But the biggest threat isn’t the infection-it’s misuse. The FDA reports that 18% of ER visits for worsening ear infections are from people who used the wrong OTC drops first. Don’t be one of them.

Final Takeaway

Swimmer’s ear is common, treatable, and preventable. The key is matching the right drop to your symptoms and using it correctly. For mild cases, OTC acetic acid drops are cheap, effective, and great for prevention. For worse infections, Ciprodex or generic ofloxacin drops are your best bet. Skip the home remedies. Don’t use cotton swabs. And if it doesn’t improve fast, see a doctor. Your ear canal is delicate-treat it with care.