Ear infection - outer ear - chronic

Alternative names
Swimmer’s ear - chronic; Otitis externa - chronic


Swimmer’s ear is an inflammation, irritation, or infection of the outer ear and ear canal. Swimmer’s ear usually responds to treatment, but a small number of cases become chronic. This means the infection does not go away, or it comes back multiple times.

See also swimmer’s ear - acute.

Causes, incidence, and risk factors

Swimmer’s ear (otitis externa) is fairly common. It consists of inflammation, irritation, or infection of the outer ear and ear canal. Swimming in polluted water is one way to contract swimmer’s ear. Moisture predisposes the ear to infection from fungus or water-loving bacteria such as pseudomonas. Swimming is not the only cause, however - the condition can be caused by scratching the ear or an object stuck in it.

Chronic swimmer’s ear may result from inadequate treatment, or may suggest the presence of a disease in underlying bone, a complication called malignant otitis externa.


  • Ear pain - may worsen with pulling on the external ear  
  • Itching of the ear or ear canal  
  • Persistent drainage from the ear - yellow, yellow-green, pus, or foul smelling  
  • Hearing loss

Signs and tests

When the physician looks in the ear, it appears red and swollen, including the ear canal. The ear canal may appear eczema-like, with scaly shedding of skin. Touching or moving the outer ear increases the pain. It may be difficult for the physician to see the eardrum with an otoscope, or the eardrum may appear red.

The outermost part of the ear, the tragus, may ultimately become infected, and appear red and swollen.


The goal is to cure the infection, usually with ear drops containing antibiotics. Corticosteroids can reduce itching and inflammation. Sometimes other remedies such as acetic acid (vinegar) drops may be used.

If the ear canal is very swollen, a wick may be placed in the ear to allow the drops to travel to the end of the canal. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may help relieve pain.

In elderly individuals or diabetics with persistent ear pain or drainage, malignant otitis externa is a possibility. The ears should be evaluated with CT scanning to look for bone erosion. Malignant otitis externa is treated with high-dose intravenous antibiotics effective against Pseudomonas aeruginosa.

Expectations (prognosis)
Chronic swimmer’s ear usually responds to treatment. Treatment may be prolonged or repeated. If untreated, complications may develop.


  • Infection of the surrounding skin  
  • Malignant otitis externa, which can cause bone infection, hoarseness, and difficulty swallowing

Calling your health care provider
Call for an appointment with your health care provider if you have symptoms of chronic swimmer’s ear, or if acute swimmer’s ear does not respond to treatment.

Dry the ear thoroughly after swimming. Individuals who swim frequently should consider earplugs. Swimmer’s ear from any cause should be treated completely, and treatment should not be stopped sooner than recommended by the doctor.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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