Preventing Recurring Ear Infections: Swimmer’s Ear, Repeated Middle Ear Infections and What Actually Works
Why some people and children keep getting ear infections, the habits and treatments that break the cycle, and when repeated infections need a specialist.
Part of the Complete Ear Infection Guide.
Key fact: Ear infections that keep coming back usually have a reason that can be changed. For outer ear infections it is almost always water, damaged skin or something being put in the ear. For repeated middle ear infections in children it is colds, smoke exposure and young anatomy, and for adults with repeated one-sided infections it is a reason to see a specialist.
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See ear infection treatments →Two different problems
“Recurring ear infections” can mean two quite different things, and they are prevented in different ways.
| Outer ear (otitis externa) | Middle ear (otitis media) | |
|---|---|---|
| Where | Skin of the ear canal | The space behind the eardrum |
| Who gets it repeatedly | Swimmers, people with eczema in the ear, hearing aid and earbud users, people who clean their ears | Young children, especially those at nursery or exposed to smoke |
| Main trigger | Water and damage to the canal’s protective layer | Colds blocking the Eustachian tube |
| Prevention focus | Keeping the canal dry and intact | Fewer colds, vaccines, smoke-free air |
If you are not sure which kind yours are, middle ear or outer ear infection? explains the simple test that separates them. The basic everyday measures for both are summarised in ear infection red flags and prevention; this guide goes further, for people whose infections keep returning.
Stopping swimmer’s ear coming back
The ear canal protects itself with a thin, slightly acidic, water-repellent layer of wax and skin oils. Swimming, long showers, scratching and cleaning all strip it away, and warm, damp, damaged skin is easily infected. Regular swimmers who get repeated infections usually need a routine rather than a single change.
| Habit | Why it helps |
|---|---|
| Wear well-fitting swimming earplugs or a cap that covers the ears | Keeps water out in the first place; mouldable or custom-fitted plugs seal best |
| Drain and dry the ears after every swim or shower | Tilt the head each way, then use a hairdryer on its lowest, coolest setting held at arm’s length |
| Ask a pharmacist about drying or acidifying ear drops after swimming | Some regular swimmers use them to restore the canal’s acidity; they must not be used with a perforated eardrum or grommets |
| Avoid swimming during an infection and for a few days after | The skin needs time to recover its protective layer |
| Choose cleaner water where you can | Infections are more common after swimming in rivers, lakes and poorly maintained pools |
People who swim or surf in cold water for years can develop bony growths in the ear canal, sometimes called surfer’s ear, which trap water and make infections more frequent. If you are a cold-water swimmer with repeated infections, it is worth having the canal examined.
Looking after the ear canal
Many repeat outer ear infections are started by well-meant cleaning. The canal cleans itself: wax slowly migrates outwards and falls away. Putting anything in to remove it scratches the skin and pushes wax further in.
Leave the wax alone
Wash the outer ear only. If wax builds up and blocks the ear, softening drops or professional removal such as microsuction are safer than cotton buds.
Treat itchy skin
Eczema, psoriasis or seborrhoeic dermatitis in the ear canal makes infection much more likely. Treating the itch stops the scratching that lets bacteria in.
Hearing aids and earbuds
Clean them regularly, let the ears breathe for some hours each day, and do not share earbuds.
Hair and skin products
Keep shampoo, hair dye and hairspray out of the ears, since they irritate the skin of the canal.
Diabetes or weakened immunity changes the picture. Outer ear infections can very occasionally spread into the bone of the skull in people with diabetes or reduced immunity, especially older adults. If that applies to you, have any persistent or severe earache assessed rather than treating repeat infections yourself.
Reducing repeated middle ear infections in children
You cannot change the shape of a young child’s Eustachian tube, but you can reduce how often it gets blocked and infected.
| Measure | Why it helps |
|---|---|
| Keep up to date with vaccinations | The pneumococcal vaccine protects against a common cause of ear infections, and the yearly children’s flu vaccine reduces the colds and flu that trigger them |
| Keep your child away from tobacco smoke | Second-hand smoke clearly increases ear infections and glue ear |
| Breastfeed if you can | Linked with fewer ear infections in the first year |
| Feed bottles with your baby upright, not lying flat | Reduces milk flowing towards the Eustachian tube |
| Limit dummy use after 6 to 12 months | Prolonged dummy use is associated with more ear infections |
| Handwashing and good hygiene at home and nursery | Fewer colds means fewer ear infections |
| Treat allergies that keep the nose blocked | A constantly congested nose keeps the Eustachian tube swollen |
Most children simply grow out of frequent ear infections by school age. How to recognise and manage each episode is covered in ear infections in children: a parent’s guide.
Repeated middle ear infections in adults
Middle ear infections are much less common in adults, so repeated ones deserve a closer look. Common contributors are smoking, allergic rhinitis or chronic sinus problems keeping the nose blocked, and Eustachian tubes that do not open well. Treating a persistently blocked nose, for example with a steroid nasal spray if allergy is the cause, and stopping smoking both help.
An adult with repeated infections, fluid or a blocked feeling in one ear only, especially if it does not clear between episodes, should be examined by a GP and may need referral to an ear, nose and throat specialist. Occasionally a one-sided blockage at the back of the nose is the cause, and it needs to be looked for.
When repeated infections need a specialist
See a GP about referral to an ear, nose and throat specialist if:
- a child has frequent middle ear infections, for example three or more in six months or four or more in a year
- hearing stays reduced, or glue ear lasts more than three months
- a child’s speech, language or behaviour seems affected by hearing
- an outer ear infection keeps returning despite good ear care, or has not cleared with treatment
- discharge from the ear continues for more than a couple of weeks
- an adult has repeated infections or persistent fluid in one ear
Specialist options include grommets for children with persistent glue ear or very frequent infections, cleaning of the ear canal under a microscope, and treatment of underlying skin or nasal problems.
Ear Infection Keeps Coming Back?
Our pharmacist independent prescribers can help with the current flare and advise whether repeated infections need a GP or specialist review, after a GPhC-regulated online consultation.
See ear infection treatments →Frequently Asked Questions
Why do I keep getting ear infections?
For outer ear infections, the usual reasons are water in the ear from swimming or showering, cleaning the ears with cotton buds or fingers, eczema or other skin conditions in the ear canal, and hearing aids or earbuds. For repeated middle ear infections in adults, a constantly blocked nose from allergies or sinus problems, smoking, or poorly functioning Eustachian tubes are common causes, and repeated one-sided infections should be checked by a GP.
How do I stop getting swimmer’s ear?
Keep water out with well-fitting earplugs or a swim cap, drain and dry your ears after every swim or shower, avoid cleaning inside the ear, and treat any itchy skin in the ear canal. Some regular swimmers use drying or acidifying ear drops after swimming; ask a pharmacist, and do not use them if you have a perforated eardrum or grommets.
Do cotton buds cause ear infections?
They can. Cotton buds scratch the delicate skin of the ear canal and strip its protective layer, which lets bacteria in. They also push wax deeper. The ear cleans itself, so wash only the outer ear, and use softening drops or professional removal if wax blocks the ear.
How can I stop my child getting so many ear infections?
Keep vaccinations up to date, including the pneumococcal and yearly children’s flu vaccines, keep your child away from tobacco smoke, feed bottles with your baby upright, limit dummy use after 6 to 12 months, and encourage handwashing to reduce colds. Most children grow out of frequent ear infections by school age.
How many ear infections is too many for a child?
There is no exact cut-off, but frequent infections, for example three or more in six months or four or more in a year, are a reason to ask your GP about referral to an ear, nose and throat specialist, as is hearing that stays reduced or glue ear lasting more than three months.
Can grommets stop ear infections?
Grommets are small tubes placed in the eardrum that let air into the middle ear and fluid drain out. They are mainly used for glue ear that affects hearing, and they can also reduce very frequent middle ear infections in some children. They usually fall out on their own after 6 to 12 months.
References
- National Institute for Health and Care Excellence. Clinical Knowledge Summaries: Otitis externa; Otitis media — acute; Otitis media with effusion. cks.nice.org.uk
- National Institute for Health and Care Excellence. Otitis media with effusion in under 12s: surgery (CG60). nice.org.uk
- NHS. Ear infections. nhs.uk
- NHS. Earwax build-up. nhs.uk
- UK Health Security Agency. The routine immunisation schedule. gov.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Do not put drops in an ear with a perforated eardrum or grommets unless advised to by a clinician, and have persistent or severe earache assessed if you have diabetes or weakened immunity. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.