Swimmer's ear (otitis externa) in adults: symptoms and when to see a doctor
Swimmer's ear, or otitis externa, is inflammation or infection of the ear canal, often after swimming. It causes pain that gets worse when you pull on the ear, itching and drainage. Confirming it means looking inside the ear with an otoscope, so it usually needs an in-person exam; it is not something we can diagnose by video.
Can we help by telehealth? This is not something we can do by telehealth.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- High fever with ear pain
- Swelling, redness or pain behind the ear
- Sudden hearing loss
- Weakness on one side of the face
- Diabetes or a weakened immune system with very severe ear pain
Help lines:
- 911 — Emergencies
- 1-800-981-0023 — Línea PAS (mental-health crisis line)
- 988 — Suicide & Crisis Lifeline
- 1-800-222-1222 — Poison Help
Swimmer's ear symptoms
Swimmer's ear symptoms usually start in the affected ear after swimming or bathing:
- Ear pain that gets worse when you pull or touch the outer ear
- Itching inside the ear canal
- Yellow, yellow-green, pus-like or foul-smelling drainage
- Hearing loss or a blocked feeling in the ear
Causes: beaches, pools and water
Water that stays in the ear, especially contaminated water, lets bacteria grow in the canal. Scratching or putting objects in the ear, cleaning earwax with cotton swabs, and skin conditions such as eczema or psoriasis also raise the risk.
In Puerto Rico people swim year-round, at beaches such as Isla Verde and Condado and in hotel and condo pools, so swimmer's ear is common among residents and visitors alike.
Swimmer's ear vs. middle-ear infection
Otitis externa affects the canal outside the eardrum: it hurts to move the ear, and it usually starts after swimming. Otitis media is an infection behind the eardrum, common in children, and often comes with a cold.
The two are told apart by looking inside the ear. For children, see ear pain and ear infections in children.
Why it needs an in-person exam
On examination, the ear canal looks red and swollen with flaky skin, and touching the outer ear makes the pain worse. A phone camera cannot show the canal or the eardrum, so by video we cannot confirm the diagnosis or tell whether the eardrum is intact, which matters when choosing drops.
That is why this is not a condition we treat by telehealth. If you have these symptoms, see a doctor or urgent care center that can examine your ear. If you are not sure where to go, see where to go when you are sick.
Treatment
The usual treatment is antibiotic ear drops, for as long as the clinician who examines you directs. If the infection spreads, antibiotics by mouth may be needed. Drops with a corticosteroid may be added to reduce swelling, along with pain relievers. If the canal is very swollen, the clinician may place a wick so the drops can reach inside.
Prevention at the beach and pool
To lower your risk of swimmer's ear at the beach or pool:
- Dry your ears well after swimming: tilt your head to each side and dry the outer ear with a towel.
- Use earplugs when swimming if you get swimmer's ear often.
- Do not scratch your ear or put objects in it, including cotton swabs.
- Check the National Weather Service San Juan beach forecast before you go; it includes rip current risk and the UV index.
If you have diabetes or are older
In older adults and people with diabetes, the infection can spread to the bone around the ear (malignant otitis externa), which needs intravenous antibiotics in hospital. If you have diabetes and your ear pain is severe or getting worse, get seen in person the same day.
Before you book
- You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
- We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
- Real-time video only; we do not do phone-call visits.
- We do not prescribe controlled substances.
Frequently asked questions
- How do I know if I have swimmer's ear?
- The typical sign is pain that gets worse when you pull or touch the outer ear, especially after swimming, with itching or drainage. To confirm it, a clinician has to look into your ear canal in person.
- Can you treat swimmer's ear by telehealth?
- No. The ear canal has to be examined to confirm the diagnosis and check that the eardrum is intact before drops are chosen. Please see a doctor or urgent care center that can examine you.
- Can I go back in the water with swimmer's ear?
- Ask the clinician who examines you. In general, keeping the ear dry while the infection is treated is recommended.
- When is it an emergency?
- If you have a high fever, swelling or redness behind the ear, weakness on one side of your face, or diabetes with very severe pain, go to the emergency room.
Sources
- MedlinePlus (NIH): Swimmer's ear (accessed 2026-09-30)
- National Weather Service San Juan: beach forecast (accessed 2026-09-30)