Ear pain on a Mallorca holiday

Ear pain after swimming: spotting swimmer's ear

If your ear starts hurting one to two days after swimming and the pain clearly increases when you pull on the earlobe, it is almost always swimmer's ear — an infection of the outer ear canal, medically otitis externa. It is by far the most common cause of ear pain on a beach holiday.

Why it happens here: water softens the protective oily layer in the ear canal, salt and chlorinated water irritate the skin further, and the warmth encourages bacteria to grow. Add mechanical irritation from earplugs, in-ear headphones or a finger in an itchy ear.

• Traction pain: pulling on the earlobe or pressing the tragus (the small cartilage in front of the canal) clearly hurts — the most typical sign.
• Itching before the pain: it often starts one to two days earlier with itching in the ear canal.
• Pressure and fullness in the ear, hearing as if through cotton wool.
• Discharge: watery, yellowish or foul-smelling.
• Usually one-sided and usually without high fever.

Blocked ear: water, earwax or a cold?

A blocked ear on holiday almost always has one of three causes — water in the ear canal, a plug of earwax, or a pressure-equalisation problem during a cold. Which one it is decides what you may safely do yourself.

Water in the ear: appears right after swimming, gurgles when you move your head, and does not hurt. Tilt your head to the side, pull gently on the earlobe and lie briefly on the affected ear. Dab the outer ear dry with a corner of a towel — do not wipe inside the canal. A hairdryer on the lowest setting, about 30 cm away, also helps.

Earwax plug: builds up gradually and often gets suddenly worse after contact with water, because the plug swells. Typical are muffled hearing and pressure without severe pain. Softening ear drops from the pharmacy are the right first step; the plug is then removed by irrigation at the doctor.

Cold and pressure equalisation: a cold first, pressure when swallowing or yawning, often on both sides, frequently after a flight. Decongestant nose drops for a few days and gentle pressure equalisation usually help.

Two things never: no cotton buds — they push the plug deeper and injure the ear-canal skin, which is what lets the infection start in the first place. And no ear candles: there is no proven benefit, while burns and eardrum injuries have been reported.

Swimmer's ear or middle ear infection? The difference

The decisive test is pulling on the ear: if tugging the earlobe or pressing the tragus hurts, the problem sits outside in the ear canal. If the pain stays unchanged and sits deep inside, that points to the middle ear.

Swimmer's ear (outer): traction and pressure pain, itching beforehand, discharge, a swollen ear canal, usually after water contact, usually one-sided, rarely with high fever.

Middle ear infection (inner): pain deep in the ear, often throbbing, usually following a cold, frequently with fever, far more common in children — and no traction pain on the earlobe. If severe pain suddenly eases and fluid runs from the ear, the eardrum may have perforated. That is not an emergency, but it should be looked at promptly.

Do not wait — go to hospital: swelling, redness and tenderness behind the ear, an ear that sticks out, high fever and feeling seriously unwell can indicate mastoiditis, an infection of the bone behind the ear. Equally urgent: sudden hearing loss in one ear, even without pain. That is an ENT emergency and should be assessed the same day.

If you are unsure, have it looked at. An otoscopy takes two minutes and answers the outer-or-inner question straight away.

What helps immediately against ear pain?

The fastest relief is a painkiller — ibuprofen or paracetamol at the dose you normally use. Ear pain generally responds well, and it buys you the time to have the cause clarified calmly.

• Keep the ear dry: no swimming and no diving for now. In the shower, place a cotton ball smeared with petroleum jelly loosely in the outer ear (do not push it into the canal).
• Warmth or cold — take whichever feels better. Both are fine; neither makes anything worse.
• Sleep with your head raised: an elevated upper body eases the pressure in the ear.
• Put nothing into the ear — no cotton buds, no fingers, no ear candles.

What I can do on a house call

The key step is looking inside the ear. With the otoscope I see the ear canal and the eardrum directly — within a few minutes that settles whether the infection is outer or middle ear, whether the eardrum is intact, and whether an earwax plug is the problem.

• Otoscopy of ear canal and eardrum — the examination that decides the diagnosis.
• Careful ear irrigation for an earwax plug, provided the eardrum is intact.
• Ear drops on a private prescription: the effective antibiotic and anti-inflammatory drops are prescription-only in Spain. I issue the prescription on the spot and you collect it at the nearest farmacia.
• Pain management and, with a middle ear infection, the decision whether an antibiotic is needed or whether it is safe to wait.

The house call costs a flat €250–450 depending on the time of day — you pay on site and receive a private invoice for your travel health insurance. I call you back personally about your enquiry; there is no switchboard and no call centre.

Being straight with you: when you need an ENT specialist

I am a licensed physician (Germany 2021) — not an ENT specialist. The common holiday ear problems — swimmer's ear, an earwax plug, an uncomplicated middle ear infection and pain management — I treat on the spot at your accommodation.

I send you to an ENT doctor or to hospital for: suspected eardrum injury, suspected mastoiditis, sudden hearing loss, vertigo with hearing loss, chronic or repeatedly recurring problems, and whenever ear microscopy or suction under direct vision is needed. I tell you that during the visit — not after two days have been lost.

Ear pain in children

In children, ear pain is more often a middle ear infection than in adults, because their Eustachian tube is shorter and flatter, so germs from the nose and throat reach the middle ear more easily.

Small children rarely say "my ear hurts". Watch for: grabbing or rubbing the ear, crying more when lying down, refusing to drink, fever, marked restlessness at night, and a sudden change in how they respond to sound.

First steps: a weight-appropriate painkiller, sleeping with the upper body raised, and plenty of fluids. For a child under two with ear pain and fever, have it looked at earlier than you would for an older child.

Call 112 or go to hospital immediately for: feeling seriously unwell, a stiff neck, swelling or redness behind the ear, a seizure, or a child you cannot properly rouse. I am a doctor for acute holiday complaints, including in children — but I am not a paediatrician and no substitute for a paediatrician, an emergency department or 112.

Prevention: ears and water

The most effective prevention is mundane: get your ears dry after every swim — and put nothing inside them.

• After every swim: tilt your head to the side, pull gently on the earlobe so the water runs out, then dab the outer ear dry.
• Hairdryer on the lowest setting, about 30 cm away, a few seconds per ear.
• No cotton buds — they are the most common avoidable cause of an ear-canal infection.
• Earplugs or a swim cap if you are prone to swimmer's ear, but keep them clean and dry.
• Shower briefly after the pool to rinse chlorine residue out of the ear canal.
• For recurrent swimmer's ear: there are drying drops for prophylaxis. They are only suitable with an intact eardrum — please have that checked first rather than using them on spec.

Frequently asked questions