Swimmer'S Ear

1 What is Swimmer's Ear?

Swimmer’s ear is a common term for acute otitis externa, the infection of the outer ear. Your earlobe, the ear canal and the eardrum make up the outer ear. The outer ear is supposed to be dry. 

However, activities like swimming (hence the name) can cause water to go inside the ear canal, making it moist that allows growth of bacteria that causes infection.

Acute otitis externa can also be caused by traumatic damage in the ear canal brought by the use of fingers and foreign objects like cotton swabs, which damages the thin skin of ear canal.

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Bacteria are the common cause of acute otitis externa, and can be treated with proper application of eardrops. Swimmer’s ear requires immediate treatment to prevent serious complications.

2 Symptoms

The symptoms of swimmer’s ear are:

  • itching of the ear canal,
  • redness of the inside of the ear,
  • mild pain when earlobe is touched or handled.

Drainage of clear, odorless fluid may or may not be present. 

These symptoms are mild, but can progress and cause more itching, increased pain and redness. In moderate stages, swimmer’s ear may cause excessive fluid discharge, with or without pus, feeling of fullness in the ears, and reduced or muffled hearing.

If left untreated, swimmer’s ear can become severe to cause severe pain that radiates in the head to the neck. The earlobe becomes red while the ear canal swells shut. You may also experience fever and severe pain, in which case you need to see a doctor immediately.

3 Causes

Most cases of swimmer’s ear are caused by bacteria. Viruses and fungi can also cause swimmer’s ear, though rare.

The outer ear is exposed to outside environment but has natural mechanisms to reduce chances of infection. The skin lining the ear canal secretes earwax or cerumen, which coats and makes the skin waterproof. 

Earwax also has antibacterial properties and helps trap dirt and other debris as it makes its way out of the ears. The ear canal also has a somewhat downward sloping profile to help drain fluids out of the ears.

Swimmer’s ear occurs when these natural mechanisms are overwhelmed with outside factors, promoting bacterial growth. Excess moisture in the ear, caused by heavy perspiration or frequent swimming, is conducive to the growth of bacteria. 

Scratching, use of cotton swabs and foreign objects to pick out earwax can damage the integrity of ear canal and introduce bacteria. The ears may also experience sensitivities to hair products and ear jewelry, causing infection.

4 Making a Diagnosis

If you suspect to have swimmer’s ear, you need to go to the doctor to receive a diagnosis. Before you have an appointment, ask ahead if there are blood work or laboratory tests you need to do. It is also recommended you list down symptoms and time they started, medications were taken and any allergies.

Feel free to ask anything to the doctor. Here are some important questions you might want to ask:

  • What are the possible causes?
  • What are the best courses of treatment? When will my symptoms improve?
  • What are the side effects? Any ways to prevent them?
  • What are the things should I watch out for?
  • Do I need follow-ups?
  • How can I prevent having ear infections again?
  • Can you share educational materials or websites to help me understand the condition better?

Your doctor may ask you questions too. Be ready to describe things such as your symptoms and when did it appeared and their progression. You also have to answer things such as instances you swam in polluted water, history of swimmer’s ear or chronic skin conditions, the presence of allergies, use of headphones or earbuds and other ear devices, and if you have your ear examined before.

5 Treatment

The treatment goals for swimmer’s ear are to halt infection and allow healing of the ear canal. Cleaning the ear canal is important. The doctor may instruct you to use a suction device or ear curette to remove debris and excess earwax, but be careful to avoid going too deep in your ears.

The doctor may prescribe certain eardrops. There are different types of eardrops:

  • Acidic solution helps restore the normal environment of the ear canal that hamper’s bacterial growth
  • Steroids are used to reduce and stop inflammation and swelling
  • Antibiotic eardrops kill bacteria
  • Antifungal eardrops kill fungi that may cause ear infection

Applying eardrops on your own might be difficult, so here are some useful tips:

  • Having someone put eardrops to your affected ear is easier than applying them on your own
  • In case of ear swelling, the doctor may insert a cotton or gauze wick to promote drainage and draw the medication into your ear
  • If you have problems with cool drops, hold the bottle in your hands for few minutes before application
  • As much as possible, recline so the affected ear faces up so the medication can travel through the ear canal

The doctor may also prescribe medications such as ibuprofen (Advil), naproxen (Aleve) or acetaminophen (Tylenol) for pain and inflammation. More potent medicines may be provided for severe pain and swelling. If eardrops do not improve symptoms, the doctor may prescribe oral antibiotics.

In the meantime, try to keep the ears dry and avoid irritation. Before bathing put a cotton ball with petroleum jelly to cover the ear canal so water will not enter the ears. Avoid swimming and diving activities that can put water inside the ear canal. 

You also have to avoid flying, which can disturb air pressure inside your ears and cause additional pain. You need to avoid wearing earplugs, hearing aids or headphones for a while until pain and discharge have stopped.

6 Prevention

Keeping the ears dry is a good prevention for swimmer’s ear, especially for recurrent cases. Dry your ears with a soft cloth thoroughly after bathing or swimming. Do tip your head slightly to the side to promote drainage of water. 

You can use a blow-dryer at the lowest setting to dry your ears.

You can use over-the-counter eardrops to quickly dry your ears and kill bacteria, but only use it if you do not have a punctured eardrum. 

You can also make your own eardrops by mixing one part of rubbing alcohol with one part white vinegar. Pour a teaspoonful of the solution in each ear and tilt the head sideways to let it drain.

Bacteria in water are a significant cause of swimmer’s ear. Avoid swimming in polluted or questionable bodies of water. Only swim in swimming pools with adequate chlorine levels, which you can know by using simple testers. 

Never swim or dive after having an ear infection or surgery.

Avoid things that irritate the ears. Try not to use cotton swabs, pens, paper clips or other foreign objects to remove earwax. These things introduce bacteria and can break the thin skin of the ear canal to cause infection. 

Sprays and hair dyes can irritate the ears, so plug a cotton ball into the ears when these products are used.

7 Risks and Complications

Here are the risk factors for swimmer’s ear: 

  • Swim, especially if you swam in bodies of water with high levels of bacteria (like lakes)
  • Swimming in polluted water or in pools with little or no chlorine
  • Frequent use of cotton swabs, hair pins, hair clips and other foreign objects to clean the ears
  • Having skin allergies
  • Ear irritation from jewelry, hair sprays and hair dyes
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