Swimmer's Ear and Earwax Problems on Koh Phangan

Why do ears get infected on a beach holiday ?

Because the ear canal is a warm, narrow, dead-end tube, and a week of swimming turns it into an ideal culture dish. Water sits in it after every swim, the protective layer of wax that normally repels moisture gets washed away, and the skin softens. Bacteria that live harmlessly on skin find themselves somewhere warm, wet and undefended.

That is otitis externa — swimmer's ear — and on an island where people are in the sea several times a day it is close to an occupational hazard. It is not caused by dirty water specifically, which is the common assumption. Clean seawater and a hotel pool produce it just as readily, because the problem is the time the canal spends wet rather than what is in the water.

How do you tell what is actually wrong ?

You often cannot, which is the practical argument for being looked at rather than guessing. Four different problems produce an uncomfortable, blocked, painful ear, and the treatment differs for each.

The pull test

One simple distinction you can make at home. If pulling gently on the outer ear or pressing the small flap in front of the canal is noticeably painful, that points to the outer ear canal — infection territory. If it is not tender to touch but feels full and muffled inside, that points further in, toward wax, fluid or the middle ear.

It is a useful signal rather than a diagnosis. The two frequently coexist, which is exactly why an examination settles it and guesswork does not.

Why are over-the-counter drops a bad idea ?

Because several common ear drops must not be used if the eardrum is perforated, and you cannot tell whether it is without looking. A perforation can happen from a pressure injury, from an infection that has pushed through, or from an old injury you never knew about. Putting the wrong preparation into a perforated ear can do real damage.

The other problem is that drops aimed at infection do nothing for impacted wax, and drops aimed at softening wax can make an infected canal considerably more uncomfortable. People routinely use what a friend has left over, get no improvement in three days, and arrive having made the original problem harder to examine.

What does earwax removal involve ?

An examination first, then removal using a technique appropriate to what is found. Wax that has been repeatedly wet and then dried expands and compacts against the canal wall, which is why the problem so often appears on holiday rather than at home.

The relief is usually immediate and disproportionate to how minor the procedure is. People arrive convinced they have an infection and leave hearing normally twenty minutes later, which is also why it is worth having done rather than waiting for it to resolve on its own. It does not resolve on its own; water keeps arriving.

At our Koh Phangan clinic the ear is examined with a digital otoscope first, and wax is removed by ear irrigation where that is what the examination shows. Any procedure fee is quoted before it is done.

What should you not put in your ear ?

1. Cotton buds. They push wax inward and scratch the canal, creating the breach infection needs.
2. Ear candles. No benefit, and a genuine burn risk.
3. Olive oil, if infection is possible. Fine for softening wax, unhelpful on an inflamed canal.
4. Someone else's prescription drops. Wrong preparation, unknown eardrum status.
5. Hydrogen peroxide or alcohol. Irritating to an already inflamed canal.
6. Fingers, towels or tissue corners. The same scratching problem as cotton buds.

The general rule that ear specialists repeat is to put nothing smaller than your elbow into your ear. It sounds flippant and it is the single most useful instruction in this article.

Middle ear problems are a different matter

Everything above concerns the outer ear canal, which is where holiday ear problems overwhelmingly sit. Middle ear infection behaves differently: it follows a cold rather than swimming, the pain is deeper and often worse lying down, and pulling the outer ear does not hurt. It is more common in children and frequently accompanies congestion.

The distinction matters because the treatment is different and because a middle ear infection that bursts the eardrum produces sudden relief of pain alongside discharge, which patients understandably interpret as improvement. Sudden pain relief with discharge should be examined rather than celebrated.

How do you prevent it ?

• Dry the ears after swimming — tilt the head each way and dry the outer ear gently
• Do not dig at water you can feel trapped; it usually drains with time and gravity
• Consider drying drops if you swim daily and are prone to this, but ask first
• Keep shampoo and soap out of the canal where you can
• Let wax do its job rather than removing it preventively at home
• Take a break from the water at the first sign of itching rather than the first sign of pain

That last point does more than any product. Itching is the early warning for outer ear infection, and a day out of the sea at that stage frequently prevents the week of drops that follows ignoring it.

For divers specifically, the picture is different and pressure injury becomes the bigger risk — that side is covered by our diving medicine service. The NHS page on ear infections is a sound general reference.

Why it keeps coming back

Recurrence is the complaint people find most frustrating, and it usually has a mechanical explanation rather than a mysterious one. The canal was never fully dry before swimming resumed, wax was removed too enthusiastically at home leaving no natural protection, or cotton buds have created a cycle of scratching and irritation that never quite closes.

If this is your third ear infection in as many trips, that pattern is worth raising at the visit rather than treating each episode in isolation. Drying habits, whether to use preventive drops, and whether something structural in the canal is holding water are all answerable questions.

Should you be seen ?

• Discharge, bleeding, sudden hearing loss or dizziness → same day
• Pain that is worsening rather than settling → same day
• Ear blocked for several days after swimming → worth coming in; often wax
• Itching that has started to hurt → come in before it progresses
• About to fly or dive with a blocked ear → be seen first
• Mild blockage that cleared by itself → leave it alone, dry after swimming

The full scope of the Koh Phangan clinic covers what else can be handled in the same visit, and the practical detail is in our guide to seeing a doctor on Koh Phangan.