Medically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.
Swimmer’s ear is one of the infections I treat most often in Phuket. Hours in pools and the sea soften the skin of the ear canal and let bacteria in, and I see it most in divers, snorkellers and children who spend all day in the water.
Phuket holidays are hard on ears. Days split between the hotel pool, the sea and snorkelling trips keep the ear canal damp in warm, humid air, exactly what the bacteria behind swimmer’s ear prefer. Divers on training courses and people who flew in with a cold bring a different problem: pressure and fluid behind the eardrum. Most of these ears settle quickly with the right treatment, but guessing which infection you have often leads to the wrong drops.
Two different infections: outer ear and middle ear
Otitis externa (swimmer’s ear)
Otitis externa is inflammation of the skin lining the outer ear canal. Water softens that skin and washes away protective wax, letting bacteria, most often Pseudomonas aeruginosa and Staphylococcus aureus, take hold, and cotton buds, earplugs and scratching make it likelier. Itching turns to pain that worsens when you pull the ear or press the flap in front of it, with muffled hearing and discharge but rarely fever.
Acute otitis media (middle ear infection)
Otitis media is infection behind the eardrum. It usually follows a cold, when the Eustachian tube linking the middle ear to the back of the nose blocks and trapped fluid becomes infected, causing deep, throbbing earache, muffled hearing and sometimes fever. If pressure builds, the eardrum can burst, releasing discharge and easing the pain; most small perforations heal within weeks.
| Problem | Usual trigger | Key features | Usual treatment |
|---|---|---|---|
| Otitis externa | Swimming, humidity, cotton buds | Pain on pulling the ear, itch, discharge | Antibiotic or acidic drops, keep dry |
| Otitis media | Cold or blocked nose | Deep throbbing pain, sometimes fever | Pain relief, amoxicillin if needed |
| Ear barotrauma | Diving or flying with blocked ears | Sudden pain on descent, muffled hearing | Time, decongestant, no diving |
| Impacted wax | Wax pushed in by cotton buds | Blocked, muffled ear, little pain | Softening drops, then removal |
How we examine and treat ear infections
A look with an otoscope, a small light and magnifier, usually settles the diagnosis within a minute: is the canal swollen, is the eardrum red and bulging, and is it intact? That last point matters, because some ear drops should not be used when the eardrum has a hole. With heavy or recurrent discharge, a swab identifies the germ.
Treating swimmer’s ear
Drops beat tablets for otitis externa because they deliver far more medicine to the canal skin. Mild cases may need only an acidic spray; moderate ones need prescription drops combining an antibiotic with a steroid. If the eardrum is perforated or hidden, a quinolone drop such as ciprofloxacin or ofloxacin is preferred, since some other ear-drop antibiotics can harm hearing if they reach the middle ear. A very swollen canal may need a small foam wick to carry drops inside. Treatment usually lasts about a week, with tablets kept for spreading infection, diabetes or weakened immunity. Keep the ear dry: no swimming for about 7 to 10 days, and petroleum-jelly-coated cotton wool in the ear when showering.
Treating a middle ear infection
Many middle ear infections clear within three days without antibiotics, and NICE advises pain relief first for most people. Antibiotics are offered if you are systemically unwell, at high risk, have discharge from a burst eardrum, or are not improving after about three days. Amoxicillin for five to seven days is first-line, with clarithromycin or erythromycin for penicillin allergy.
Looking after a sore ear
Take paracetamol regularly for the first two days (with a high fever in Phuket, avoid ibuprofen until dengue has been considered), and hold a warm, dry flannel over the ear. Keep cotton buds, oils and ear candles out of an infected ear, and never try to flush it.
Pools, surf, diving and flights: the Phuket angle
Long days in pools and warm seawater, surfing at Kata and Kalim in the monsoon swell, and repeated snorkelling trips to Phi Phi soak the canal again and again. Divers face barotrauma: if a cold or infection stops you equalising, the pressure change on descent can injure the eardrum or middle ear. Do not dive with a middle ear infection, a perforated eardrum or swimmer’s ear, and return only once your ear has been checked and equalises easily. If impacted wax is trapping water in the canal, our ear wax removal service can clear it once the infection has settled. Flying with a blocked middle ear can hurt on descent, so swallow, chew or yawn as the plane comes down.
When to see a doctor
People with diabetes or a weakened immune system should be seen early with any ear pain, because a rare, serious form called necrotising otitis externa can spread to the skull bone. Sudden hearing loss in one ear without an obvious cause, such as wax or infection, also needs same-day assessment.
Prevention and early detection
For swimmer’s ear, drying is everything: tilt your head to drain water after swimming, towel the outer ear, and if needed use a hair dryer on its lowest setting at arm’s length. People prone to otitis externa can use acidifying drops around swims, and cotton buds should stay out of ears altogether. For middle ear problems, avoid diving or flying with a heavy cold and equalise gently, early and often. Early detection is simple: pain on pulling the outer ear is the first sign of swimmer’s ear, and treating it before the canal swells shut gets you back in the water sooner. Recurrent infections need an ear, nose and throat specialist.
How to get your ear checked with us
Walk in any time at our Bangtao (Cherngtalay) clinic, the Kata-Karon clinic near the Kata and Karon beaches, or the Patong clinic. Most ear visits finish in under 30 minutes, with drops from our on-site pharmacy. Message us on WhatsApp or call +66 81 718 9080, and if earache kept you up all night, book a doctor hotel visit in Phuket instead. We confirm the price on WhatsApp before your visit, bill most travel insurers directly, write a medical report if your dive operator or insurer needs one, and refer to a hospital ENT specialist when required.
Related treatments and services
Middle ear infections usually follow a respiratory virus, so if yours began with sudden fever and aches see flu treatment, or COVID-19 treatment after a positive test. Throat infections often cause referred pain in the ear, so see sore throat treatment and tonsillitis treatment if swallowing hurts. A dust-mite blocked nose makes equalising harder (see allergy treatment), divers with asthma should read our asthma treatment guide, and a chest infection after a cold is covered under bronchitis treatment. See also our walk-in doctor in Phuket service and all the conditions we treat.
Summary
Swimmer’s ear hurts when you pull the ear and needs prescription drops and a dry ear for about a week; a middle ear infection follows a cold and often clears within three days. Stay out of the water until your ear is checked, and seek urgent care for swelling behind the ear, facial weakness or a stiff neck.
“Dry your ears gently after swimming and avoid cotton buds. If your ear becomes painful or discharges, keep it dry and see us before the next swim.”
Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket
Frequently asked questions
How can I tell swimmer’s ear from a middle ear infection?
Swimmer’s ear usually hurts more when you pull the outer ear or press the flap in front of it, often itches, and appears after swimming. A middle ear infection causes deeper, throbbing pain after a cold, sometimes with fever, and pulling the ear does not worsen it. The treatments differ, so an otoscope check is worth it before choosing drops.
Can I keep swimming or diving while I use ear drops?
It is best not to. Water washes out the drops and keeps the canal skin soft and infected, so doctors usually advise no swimming for about 7 to 10 days with swimmer’s ear. Diving with any active ear infection risks pressure injury because you may not be able to equalise. Wait until the pain has gone and your ear has been checked.
Will my insurance cover an ear infection visit?
Most travel insurance policies cover acute ear infections that start during the trip, subject to the excess and terms of your policy. We bill most travel insurers directly and can provide a medical report, receipt and itemised invoice for any claim. The price is confirmed on WhatsApp before your visit.
Do I need an appointment, and how fast will the drops work?
No appointment is needed at any of our three clinics, which are open 24 hours a day, and patients are usually seen within minutes. With the right prescription drops, swimmer’s ear pain usually eases within two to three days, though you should finish the course. A middle ear infection often improves within three days either way.
Can a doctor examine my ear at my hotel?
Yes. A doctor can visit your hotel, villa or condo anywhere in Phuket at any time, examine your ear with an otoscope and prescribe drops or other treatment. A hotel visit helps at night, when earache is often worst, or for a child too uncomfortable to travel. Message us on WhatsApp with your location.
Is it safe to fly home with an ear infection?
Usually, yes, though a blocked middle ear can be painful during descent. Swallowing, chewing and yawning help, and the doctor may suggest a short decongestant course. Swimmer’s ear alone does not usually affect flying, and a recently perforated eardrum is generally not a reason to cancel, but ask the doctor if you are unsure.
Sources
The NHS covers middle and outer ear infections on its ear infections page and its otitis externa page. NICE sets out when antibiotics help in its acute otitis media prescribing guideline.
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This page is general health information and not a substitute for a medical consultation.