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Recurrent otitis externa in swimmers is a common yet frustrating condition that can lead to repeated discomfort, impaired hearing, and frequent clinic visits for a patient.
Read the case and peer insights below to learn how to manage this condition, with practical takeaways for preventing recurrence and improving patient outcomes. Then log in or sign up to see the consensus.
A 38-year-old man presents with his fourth episode of otitis externa in one year, always after swimming in chlorinated pools. He uses over-the-counter drying drops, but still has frequent symptoms.
Questions for consult
1. Should this patient be referred to ENT at this stage or trial longer-term prophylaxis?
2. Are repeated topical antibiotic courses acceptable, or do they risk resistance or canal injury?
3. How do you balance lifestyle and prevention in recurring but non-severe ENT conditions?
Consults
Key takeaways for treating recurrent otitis externa in swimmers:
- Prioritize prevention
Use custom-fitted earplugs, effective drying agents, and skin-protective measures to reduce recurrence. - Use antibiotics judiciously
Limit repeated topical antibiotic courses to avoid resistance, altered flora, and fungal superinfection risk. - Consider specialist evaluation
ENT referral may be warranted to rule out anatomical abnormalities or resistant organisms.
Cardiology
"1. I would not refer at this point. There are conservative measures that have not yet been trialed. Earplugs in particular could be helpful in preventing water in the canal and subsequent infection.
2. Repeated topical abx can alter canal flora and put patient at risk for secondary infections.
3. This is a shared decision making situation in which the benefits of these activities need to be balanced with the risks of repeated infections."
Family Practice
"Given this patient’s recurrent otitis externa despite over-the-counter prophylaxis, an ENT referral is reasonable to evaluate for underlying canal abnormalities, chronic inflammation, or resistant organisms. While repeated short courses of topical antibiotics are generally safe, overuse can promote resistance, sensitize skin, and risk canal irritation—particularly with aminoglycoside-containing drops.
Long-term management should focus on prevention (e.g., custom swim plugs, optimized ear-drying techniques, alternative prophylactic solutions) while balancing the patient’s swimming lifestyle to reduce recurrence without unnecessary treatment cycles."
Family Practice
"I would start with swimmer's earplugs. Also, I would review the ingredients of his OTC Gtts. I usually recommend a mix of 50% rubbing alcohol and 50% white vinegar.
You could also consider an application of baby oil after the ears are dry. This prevents skin breakdown, which encourages superficial infections. Random swimmers usually don't get OE as they have sufficient cerumen coating of the EAC."
Family Practice
"Treat the infection, but take a culture to verify appropriate treatment. Yes, refer to ENT and audiology.
Pediatrics
- "Needs custom fitted earplugs.
- Aggressive use of drying agents after swimming.
- Avoid Q-tips or excessive cleaning of ear. Wax helps protect.
- Too many courses of topical ABX gtts raises the risk of fungal superinfection."
Discover additional peer perspectives on managing recurrent otitis externa in swimmers, or share your own approach, by reading the full case on Healthcasts.
