Why is the inside of my ear itchy?

Swimmer’s ear also known as otitis externa, is an infection in the outer ear canal, which runs from your eardrum to the outside of your head. Swimmer’s ear is  often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth.

Swimmer’s ear is more common among children in their teens and young adults. It may occur with a middle ear infection or a respiratory infection such as a cold.

Swimming in unclean water can lead to swimmer’s ear. Bacteria commonly often found in water can cause ear infections. Rarely, the infection may be caused by a fungus.

Other causes of swimmer’s ear include:

• Scratching the ear or inside the ear
• Getting something stuck in the ear

Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer’s ear by damaging the thin layer of skin lining your ear canal.

Trying to clean (wax from the ear canal) with cotton swabs or small objects can damage the skin.

The most common cause of this infection is bacteria invading the skin inside your ear canal. Prompt treatment can help prevent complications and more-serious infections.

Long-term (chronic) swimmer’s ear may be due to:

• Allergic reaction to something placed in the ear
• Chronic skin conditions, such as eczema or psoriasis

Swimmer’s ear symptoms are usually mild at first, but they may get worse if your infection isn’t treated or spreads. Doctors often classify swimmer’s ear according to mild, moderate and advanced stages of progression.

Signs and symptoms of swimmer’s ear may include:

• Itching inside the ear (common)
• Pain inside the ear that gets worse when you tug on the outer ear (common)
• Sensation that the ear is blocked or full
• Drainage from the ear
• Fever
• Decreased hearing
• Intense pain that may spread to the neck, face, or side of the head
• Swollen lymph nodes around the ear or in the upper neck
• Redness or swelling of the skin around the ear

Mild signs and symptoms:

• Itching in your ear canal
• Slight redness inside your ear
• Mild discomfort that’s made worse by pulling on your outer ear (pinna, or auricle) or pushing on the little “bump” (tragus) in front of your ear
• Some drainage of clear, odorless fluid

Moderate progression:

• More intense itching
• Increasing pain
• More extensive redness in your ear
• Excessive fluid drainage
• Discharge of pus
• Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
• Decreased or muffled hearing

Advanced progression:

• Severe pain that may radiate to your face, neck or side of your head
• Complete blockage of your ear canal
• Redness or swelling of your outer ear
• Swelling in the lymph nodes in your neck
• Fever

Your doctor’s treatment for swimmer’s ear will depend on how severe the pain and the infection are. For most outer ear infections, your doctor may prescribe ear drops containing antibiotics possibly mixed with medicine to help improve swelling and inflammation. These will help fight the infection and ease swelling of the ear canal. Ear drops are usually given several times a day for 7 to 10 days.

If the opening into your ear is narrowed by swelling, your doctor may clean your ear and insert a wick into your ear canal to help carry ear drops into the ear more effectively. For a severe infection, you might also get antibiotic liquid or pills to take. Your doctor may send some of the fluid draining from your ear to a lab to help identify what type of germ is causing the infection.

How long does swimmer’s ear last?

If it’s treated with prescription ear drops, swimmer’s ear is usually cured within 7 to 10 days. The pain should lessen within a few days of treatment.

External otitis is not contagious, so you don’t have to limit your contact with friends as long as you’re feeling well enough to socialize.

Itchy painful ear causes

Swimmer’s ear is an infection that’s usually caused by bacteria commonly found in water and soil. Infections caused by a fungus or a virus are less common.

Your ear’s natural defenses

Your outer ear canals have natural defenses that help keep them clean and prevent infection. Protective features include:

• Glands that secrete a waxy substance (cerumen). These secretions form a thin, water-repellent film on the skin inside your ear. Cerumen is also slightly acidic, which helps further discourage bacterial growth. In addition, cerumen collects dirt, dead skin cells and other debris and helps move these particles out of your ear. The waxy clump that results is the familiar earwax you find at the opening of your ear canal.
• Downward slope of your ear canal. Your ear canal slopes down slightly from your middle ear to your outer ear, helping water drain out.

How the infection occurs

If you have swimmer’s ear, your natural defenses have been overwhelmed. Conditions that can weaken your ear’s defenses and promote bacterial growth include:

• Excess moisture in your ear. Heavy perspiration, prolonged humid weather or water that remains in your ear after swimming can create a favorable environment for bacteria.
• Scratches or abrasions in your ear canal. Cleaning your ear with a cotton swab or hairpin, scratching inside your ear with a finger, or wearing headphones or hearing aids can cause small breaks in the skin that allow bacteria to grow.
• Sensitivity reactions. Hair products or jewelry can cause allergies and skin conditions that promote infection.

Risk factors for itchy painful ear

Factors that may increase your risk of swimmer’s ear include:

• Swimming
• Swimming in water with elevated bacteria levels, such as a lake rather than a well-maintained pool
• A narrow ear canal — for example, in a child — that can more easily trap water
• Aggressive cleaning of the ear canal with cotton swabs or other objects
• Use of certain devices, such as headphones or a hearing aid
• Skin allergies or irritation from jewelry, hair spray or hair dyes

Itchy painful ear complications

Swimmer’s ear usually isn’t serious if treated promptly, but complications can occur.

• Temporary hearing loss. You may experience muffled hearing that usually gets better after the infection clears up.
• Long-term infection (chronic otitis externa). An outer ear infection is usually considered chronic if signs and symptoms persist for more than three months. Chronic infections are more common if there are conditions that make treatment difficult, such as a rare strain of bacteria, an allergic skin reaction, an allergic reaction to antibiotic eardrops, or a combination of a bacterial and fungal infection.
• Deep tissue infection (cellulitis). Rarely, swimmer’s ear may result in the spread of infection into deep layers and connective tissues of the skin.
• Bone and cartilage damage (necrotizing otitis externa). An outer ear infection that spreads can cause inflammation and damage to the skin and cartilage of the outer ear and bones of the lower part of the skull, causing increasingly severe pain. Older adults, people with diabetes or people with weakened immune systems are at increased risk of this complication. Necrotizing otitis externa is also known as malignant otitis externa, but it’s not a cancer.
• More widespread infection. If swimmer’s ear develops into necrotizing otitis externa, the infection may spread and affect other parts of your body, such as the brain or nearby nerves. This rare complication can be life-threatening.

Itchy painful ear prevention

Follow these tips to avoid swimmer’s ear:

• Keep your ears dry. Dry your ears thoroughly after exposure to moisture from swimming or bathing. Dry only your outer ear, wiping it slowly and gently with a soft towel or cloth. Tip your head to the side to help water drain from your ear canal. You can dry your ears with a blow dryer if you put it on the lowest setting and hold it at least a foot (about 0.3 meters) away from the ear.
• At-home preventive treatment. If you know you don’t have a punctured eardrum, you can use homemade preventive eardrops before and after swimming. A mixture of 1 part white vinegar to 1 part rubbing alcohol may help promote drying and prevent the growth of bacteria and fungi that can cause swimmer’s ear. Pour 1 teaspoon (about 5 milliliters) of the solution into each ear and let it drain back out. Similar over-the-counter solutions may be available at your drugstore.
• Swim wisely. Watch for signs alerting swimmers to high bacterial counts and don’t swim on those days.
• Avoid putting foreign objects in your ear. Never attempt to scratch an itch or dig out earwax with items such as a cotton swab, paper clip or hairpin. Using these items can pack material deeper into your ear canal, irritate the thin skin inside your ear or break the skin.
• Protect your ears from irritants. Put cotton balls in your ears while applying products such as hair sprays and hair dyes.
• Use caution after an ear infection or surgery. If you’ve recently had an ear infection or ear surgery, talk to your doctor before you go swimming.

Itchy inner ear diagnosis

Doctors can usually diagnose swimmer’s ear during an office visit. If your infection is at an advanced stage or persists, you may 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:

• Examination of your ear canal with a lighted instrument (otoscope). Your ear canal may appear red, swollen and scaly. Flakes of skin and other debris may be present in the ear canal.
• Visualization of 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 (ear curette).

Further testing

Depending on the initial assessment, symptom severity or the stage of your swimmer’s ear, your doctor may recommend additional evaluation.

• 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 may take a sample of discharge or debris from your ear at a later appointment and send it to a lab to identify the exact microorganism causing your infection.

Itchy ear remedy

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 any 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 an 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.

If your ear canal is completely blocked by swelling, inflammation or excess discharge, your doctor may 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 may prescribe oral antibiotics.

Medications for pain

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

If your pain is severe or your swimmer’s ear is at a more advanced stage, your doctor may prescribe a stronger medication for pain relief.

Helping your treatment work

During treatment, the following steps will help keep your ears dry and avoid further irritation:

• Don’t swim or scuba dive.
• Avoid flying.
• Don’t wear an earplug, hearing aid or headphones before pain or discharge has stopped.
• Avoid getting water in your ear canal when bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a bath.