Do You Suffer from Ear Infection after Diving?

It hits more people than you think.

During the summer in the swimming pool or in the sea – many people have a problem when water comes into the ears. This is quite uncomfortable – it feels like a slight pressure and all sounds slightly muted. Hopping on one leg, head tilted to the side – there are many home remedies to get the water out again. Often, however, a residue of water remains and develops into an inflammation of the external auditory canal – medically called Otitis Externa.

Otitis Externa External auditory canal inflammation.

The most common symptoms are itching and moderate to severe earache. If the pain radiates down to the outer ear, sleeping on that side is often no longer possible. Depending on the degree of inflammation and the nature of the pathogens, the skin may also be red or swollen. Crusts or pustules may appear, or the ear canal may start to get wet and sticky. If the auditory canal swells, an impaired hearing may occur.  Diving becomes no longer possible, and equalization cannot take place correctly. Inflammation of the external ear canal typically results from the softening of the delicate ear canal skin. Trapped water or minor injuries from cotton swabs, earplugs, or hearing aids can damage the skin. As a result, the skin barrier is weakened and bacteria, fungi or viruses can cause inflammation.

Risk factors:

  • Swimming, moisture, sweating.
  • Poor water quality.
  • Warm water temperatures.
  • A warm climate which increases bacteria growth.
  • Cleaning with cotton swabs, insufficient ear wax formation.
  • Local injuries and skin diseases.
  • Impurities.
  • Anatomical anomalies/changes (such as narrowing of the ear canal).

Most infections of the otitis externa are bacterial and mostly caused by Pseudomonas aeruginosa and Staphylococcus aureus (about 76%).
Pseudomonads and staphylococci are often found in warm water and multiply particularly well at higher temperatures. Heated pools (children’s pools, whirlpools, swimming pools) or even in warmer regions around the globe and wherever higher water temperatures prevail. As a result, in regions with higher water temperatures divers are also more often affected by infections of the ear canal. In addition, since pseudomonads are resistant to chlorine, many inflammations occur especially to active swimmers or children and families who spend a lot of time in swimming pools with chlorinated water. Hence the term “bathing otitis.”

Inflammation of the ear canal is common.

Inflammation of the ear canal occurs in about 10% of the population. Also common in professional water sportsmen, who are regularly in the water for training. Professional and recreational swimmers, diving instructors and professional divers suffer from this complaint. You can succumb to this infection whilst on a leisure-time diving holiday, frequent swimming in the lake or swimming pool with children. The whole family or friends can suffer, although it is not contagious.

A narrowing of the auditory canals (auditory gland exostoses) in both divers and surfers is commonly known as ‘swimmers ear or surfer’s ears’.  People who spend a lot of time in the water suffer from otitis externa as well. Often the auditory canal exostoses are diagnosed as incidental findings. This condition is initially painless and often leads to frequent recurrent inflammation of the ear canal or other problems. If you suffer frequently from this condition, a visit to your doctor should be scheduled. The auditory canal exostosis is probably caused by growth stimuli on the periosteum in adjacent bone tissue.

The Cause?

The exact causes are not all known. A multi-factorial process is highly likely which starts off the Otitis. One of the main causes of the formation seems to be cold water or hot water stimuli. This is due to frequent ingress of water into the external auditory canal. Cold water has a stronger appeal than warm water. Progressive auditory gland exostosis can severely restrict the affected patients and may need to be treated surgically. If an exostosis is detected in time, the further process can be stopped through not allowing water to enter and stay in the ears.

Divers also often struggle with ear problems.

The pressure on the ears due to pressure equalization, multiple dives per day and diving in warmer waters often cause otitis externa. The presence of an auditory canal exostosis favors the development of inflammation. Since these inflammations are usually caused by pseudomonads or staphylococci, which are preferred in warmer waters. Divers in regions with high water temperatures are more likely to suffer from inflammation of the ear, due to the damp, warm climate which is ideal for bacteria.

Often, dives must be cancelled if the pressure balance stops working and there is inflammation in the ear canal. You will require medical care to clear up the problem. A quick recovery is not guaranteed and entrained antibiotic ear drops are often not as fast or available. This is especially annoying when you are at a unique dive site. The aim is, therefore, to prevent ear problems, as far as possible by preventive measures.

Therapy Otitis Externa.

Otitis Externa therapy is carried out locally with antibiotic ear drops. If an antibiogram is present, targeted antibiotic therapy can be initiated, which also prevents the development of resistance. For stronger symptoms and ear canal swelling, corticosteroids can also be used – in case of severe pain, additional appropriate analgesics. In any case, a persistent otitis externa should be examined by the doctor and treated in a targeted manner.

Prophylaxis of Otitis Externa:

There are a few preventative measures that really help. A little TLC before and after each dive should help your ears and guard against infection. Wash them out with abundant clean water after each dive and dry them thoroughly. Post dive, protect the ears from cold wind and draft.

Preventive measures Otitis Externa:

Do not clean the ears with cotton swabs.

If there is water in the ear, tilt the head to the side so that it can run out again. A slight pulling on the earlobe can also help.

To prevent water from becoming trapped in the ears, use water-repellent, anti-infective ear drops.

Avoid using cotton buds on a regular basis to clean your ears. This process pushes back the protective layer of earwax and thus leads to disturbances in the self-cleaning process of the ears. So-called “diver drops” might be used after swimming/diving and often contain acetic acid, alcohol or boric acid. A positive effect has been shown in some studies.

Frequent and prolonged use?

Can damage the sensitive skin of the ear canal by the acid character and alcohol. The only ear drops on the market that can be used preventively are Earol and SwimSeal.


Earol consists of olive oil and tea tree oil and creates a water-repellent film in the ear. Tea tree oil is a natural product with anti-infective prophylaxis.


Works on the same principle, but consists of medically approved silicone oil and Australian tea tree oil. The silicone compound is present as a clear liquid. It is both chemically and biologically inert. Our bodies do not metabolise or absorb Earol in any way. The silicone compound is found in many preparations such as e.g. Medicines & cosmetics. It exerts its effects exclusively locally and is much more water repellent than e.g. other oils, e.g. Olive oil or tea tree oil.

Its higher viscosity makes an evener distribution throughout the external auditory canal more likely to build a water-repellent protective film. A natural anti-infective effect is also achieved by the added Australian Tea Tree Oil. Clinical tests have also shown positive efficacy for SwimSeal in a group of swimmers.

Prophylaxis Surfers Ear/Swimmer Ear.

In order to prevent the emergence of a surfer’s ear or swimmer’s ear, we must prevent (cold) water from getting into the ears and remaining there. In cold conditions, we should wear hoods or caps.

SwimSeal could be an alternative here, as the highly water-repellent film prevents water from remaining in the ear. Due to its fluid texture and application as ear drops, the administration is also possible with narrowed auditory canals.


Protect the ears from water as effectively as possible and no external stimuli should be set. Protective covers such as hoods seem to make a difference. The use of preventative ear drops, which build up a highly water-repellent protective film and have anti-infective properties (such as SwimSeal). Wash and dry the ears thoroughly after each dive, protect them from the direct wind after diving.

Come and experience the exhilarating underwater world with us at Dive Smart Gozo.

We offer a full range of PADI courses, the PADI Open Water course being the most popular among beginners.

Dive Smart Gozo Team