How do I know if it is swimmer’s ear and not a middle-ear infection?

Otitis externa affects the outer canal, so the classic clue is pain when you pull or press on the outer ear, or when chewing, often with itch and discharge. A doctor confirms it by examining the ear canal. Middle-ear infections sit behind the eardrum and behave differently.

Can I just use cotton buds to clean out the discharge?

No. Cotton buds are one of the main causes — they scratch the canal skin and push debris deeper. Cleaning should be done by a doctor; at home, keep the ear dry and leave it alone.

How long does it take to get better?

With proper drops and a dry ear, symptoms often improve within a day or two and settle over several days. If it is not improving, is getting worse, or the pain is severe, go back to the doctor.

When should I see a doctor urgently?

Seek care for severe pain, spreading redness or swelling around the ear, fever, or if it is not improving. People with diabetes or a weakened immune system should seek prompt care for any significant ear-canal infection.

What is malignant otitis externa?

A rare but serious complication, mainly in people with diabetes or a weakened immune system, where infection spreads from the canal into the surrounding skull-base bone. It is potentially life-threatening and needs urgent hospital treatment — which is why high-risk people must not delay care.

Otitis Externa (Swimmer’s Ear): Causes & Treatment (Singapore)

Written & reviewed by the BestDoctors.sg editorial team · Last updated 1 Sep 2026 · General information, not medical advice

Quick answer. Otitis externa – commonly called swimmer’s ear – is inflammation or infection of the skin lining the outer ear canal, usually bacterial and sometimes fungal. It is especially common in Singapore’s hot, humid climate and among swimmers, because trapped moisture breaks down the canal’s protective skin. Typical symptoms are ear pain (classically worse when you tug the ear or chew), itch, discharge, and a blocked feeling with reduced hearing. Treatment centres on a doctor cleaning the ear, medicated ear drops, keeping the ear dry, and pain relief – and not poking the ear with cotton buds. People with diabetes or a weakened immune system need prompt care.

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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.

Swimmer’s ear is very common in a climate like Singapore’s – and the two habits that cause the most trouble are letting water sit in the ear and cleaning it with cotton buds.

What it is and why it is common here

Otitis externa is inflammation, and often infection, of the outer ear canal – the short tube that runs from the opening of the ear to the eardrum. It is a different problem from a middle-ear infection (otitis media), which sits behind the eardrum and is more common in young children.

The ear canal is normally protected by a thin, slightly acidic layer of wax (cerumen) that repels water and discourages bacteria and fungi from growing. When that protective barrier is disturbed – by water, scratching or skin disease – germs that normally live harmlessly on the skin can multiply and inflame the canal. In Singapore’s persistent heat and humidity, and with frequent swimming, water is easily left trapped in the canal, protective wax is washed away, and the softened, waterlogged skin becomes an ideal environment for infection. This is why otitis externa is often called swimmer’s ear and is seen so often here throughout the year.

Symptoms

The hallmark of otitis externa is ear pain that is often worse when you tug or push on the outer ear (the pinna or the small flap in front of the canal), or when chewing. Other common features include:

Itch in the ear canal, which can be prominent, particularly in fungal cases;
Discharge – watery, cloudy or sometimes smelly;
A blocked or full feeling in the ear and reduced hearing, especially if swelling or debris narrows the canal;
Redness and swelling of the canal, sometimes with tenderness around the ear.

Symptoms usually affect one ear, though both can be involved. In more severe cases the canal can swell almost shut, hearing drops noticeably, and pain becomes intense. Fungal infection tends to cause more itch and a longer, more stubborn course.

What causes it

Otitis externa develops when the protective skin of the canal is damaged or waterlogged. Common contributors include:

Moisture – water trapped after swimming, showering or sweating in humid weather;
Scratching or cotton-bud use that grazes the delicate canal skin and strips away protective wax – a very common trigger;
Skin conditions such as eczema, psoriasis or seborrhoeic dermatitis that make the canal skin more fragile and itchy.

The resulting infection is most often bacterial, but fungal infection (otomycosis) is also common, especially after prolonged moisture or repeated antibiotic drops. Irritation from products such as hair dyes, sprays or certain ear drops can also inflame the canal.

Who is at risk

Anyone can develop swimmer’s ear, but the risk is higher for:

Swimmers and others with frequent water exposure;
People living in hot, humid conditions – a year-round factor in Singapore;
Cotton-bud users and anyone who regularly cleans or scratches inside the ear;
People with eczema, psoriasis or other chronic skin conditions;
Hearing-aid, earphone or earplug users, where devices trap moisture and can rub the canal;
People with diabetes or a weakened immune system, who are at higher risk of severe infection.

How it is diagnosed

A GP, polyclinic doctor or ENT specialist can usually diagnose otitis externa by examining the ear canal with an otoscope, looking for redness, swelling, discharge and debris, and checking whether moving the outer ear is painful. Where possible the eardrum is inspected to make sure it is intact and to distinguish outer- from middle-ear disease. In persistent, recurrent or non-healing cases – or when a fungal cause is suspected – a swab of the discharge may be taken to guide treatment. No blood tests or scans are usually needed for straightforward cases.

Complications

Most cases settle quickly with treatment, but problems can arise. The infection can spread to nearby skin (causing swelling and redness around the ear), and otitis externa is prone to recurrence or becoming long-standing (chronic), particularly if moisture, cotton-bud habits or an underlying skin condition are not addressed. Severe swelling can temporarily block the canal and muffle hearing.

Rarely, in older people with diabetes or a weakened immune system, the infection can spread from the canal into the surrounding bone at the base of the skull – a serious condition called malignant (necrotising) otitis externa. It causes severe, deep, persistent ear pain (often worse at night) and needs urgent specialist assessment and prolonged treatment. It is uncommon, but it is the main reason people in these higher-risk groups should never ignore a stubborn or worsening ear infection.

Treatment

Treatment focuses on clearing the infection and settling the inflammation while keeping the canal dry:

Keeping the ear dry – avoiding swimming and keeping water out during bathing so drops can work and the skin can heal;
Cleaning the canal (aural toilet) – a doctor may gently clear discharge and debris so that medicated drops can reach the skin; this is often the single most helpful step;
Medicated ear drops as prescribed – typically antibiotic and/or anti-inflammatory (steroid) drops, or antifungal drops if a fungal cause is found;
Pain relief – simple over-the-counter painkillers usually help while the infection settles.

Symptoms often improve within a day or two of starting drops. Oral antibiotics (tablets) are usually not needed and are reserved for infection that is spreading beyond the canal or for higher-risk patients. It is important to complete the prescribed course and to keep the ear dry throughout, as stopping early or getting the ear wet again is a common reason for the infection returning.

Prevention and living with it

Because swimmer’s ear tends to come back, prevention matters:

Keep ears dry. After swimming or showering, tilt the head to each side to let water drain and dry the outer ear gently with a towel;
Do not use cotton buds or poke inside the ear – this strips protective wax and grazes the skin. The ear is largely self-cleaning;
Consider keeping water out during a flare or if you swim often (for example with a swimming cap or well-fitting earplugs), and dry hearing aids or earbuds and give the ears a break from them;
Treat underlying skin conditions such as eczema, which keeps the canal skin healthier and less prone to infection.

When to see a doctor and red flags

See a GP, polyclinic doctor or ENT specialist if the ear is painful, discharging or blocked, if symptoms are not improving after a couple of days, or if swimmer’s ear keeps coming back. Seek prompt medical care if you have any of the following:

Severe or spreading pain, or redness and swelling of the face or around the ear;
Fever, or feeling generally unwell with the ear infection;
Ear symptoms in someone with diabetes or a weakened immune system – rarely the infection can become serious (malignant otitis externa) and needs urgent assessment.

For trustworthy general health information in Singapore, HealthHub is a useful starting point, but an in-person examination is the only way to confirm the diagnosis and choose the right ear drops.

Related ear, nose & throat conditions

Sources

NHS — outer ear infection (otitis externa): symptoms, self-care (keep ear dry, no cotton buds), when to see a doctor.
Mayo Clinic — swimmer’s ear: causes (trapped moisture, damaged canal skin), symptoms, diabetic/malignant-OE warning.
Harvard Health — treatment (aural toilet before drops) and prevention.
NHS prescribing guidance — drop choice (antibiotic/antifungal/steroid); when oral antibiotics are indicated. NCBI — malignant otitis externa in diabetics/immunocompromised.

General information only. This guide is general information about an ear, nose or throat condition and is not a diagnosis or personalised medical advice. See a doctor — a GP or an ENT specialist — for assessment, tests and treatment. Sudden hearing loss in one ear should be seen urgently, and call 995 for sudden severe vertigo with a bad headache, slurred speech, double vision or one-sided weakness.

Otitis Externa (Swimmer’s Ear) in Singapore