This summer, avoid the pain of swimmer’s ear

Few things are more refreshing than a dip in a lake on a hot day. But as you and your children enjoy your swimming this summer, keep an eye on your ears. A condition called swimmer’s ear can lead to a lot of misery. 
Fortunately, there are plenty of ways to prevent and treat this common infection.

What is swimmer’s ear? 

Swimmer’s ear is an infection of the external, or outer, ear canal. The outer ear canal goes from the opening of the ear to the ear drum. The medical term for this is otitis externa. It commonly results from water in the ear after swimming, but can be from other causes, such as hearing aids, cotton swabs, certain skin conditions or anything that damages the skin of the ear canal. Water creates a moist environment that allows bacteria to grow and infect the ear canal. It’s frequently caused by the bacteria pseudomonas aeruginosa, but other bacteria and fungus can also cause swimmer’s ear.

What are the symptoms of swimmer’s ear? 

The symptoms can vary from mild to severe. These include pain, redness of the ear and ear canal, and drainage. A classic sign of swimmer’s ear is the pain becoming worse by pulling the outer ear or pushing the piece of cartilage at the front of the ear. Other symptoms include itching, ear fullness or pressure and decreased hearing. In rare cases, this can become more severe and cause pain throughout the face and neck, fever or swollen lymph nodes in the neck.

Is it painful? 

One of the hallmark symptoms of swimmer’s ear is pain. This can start out as a vague discomfort and rapidly progress to more intense pain. This is usually made worse by pulling the outer ear or pushing the piece of cartilage at the front of the ear.

Is it contagious? 

Fortunately, it’s not contagious.

How can a parent recognize swimmer’s ear in a young child? 

Pain is the most common symptom, especially if it’s made worse by pulling the outer ear or pushing the piece of cartilage at the front of the ear. Drainage of fluid from the ear may also occur. In advanced cases, the outer ear may also become red and painful.

How long does it last? 

It generally lasts up to seven to 10 days but this can vary, especially in chronic cases that can continue for weeks and months. Treatment usually decreases the duration of symptoms.

Will it go away by itself? 

In mild cases, swimmer’s ear can resolve on its own. But because of the discomfort, most patients will seek care as the treatments are very effective at decreasing the symptoms.

What is the possible long-term damage of swimmer’s ear? 

Long-term damage is unusual in most cases. However, the infection can become chronic due to resistant bacteria, skin conditions (dermatitis, psoriasis) and other reasons. Other long-term issues can occur if the infection spreads into the deep layers of skin, cartilage and bone. This can cause increasingly severe pain, damage to cranial nerves and more widespread infection. Thankfully, these cases are unusual and most of these patients have underlying medical conditions that helped the infection become more severe.

How do you treat swimmer’s ear? 

Having a physician clean the ear of drainage and debris can be very helpful in treating the infection. Additionally, antibiotic ear drops, many times combined with a steroid drop, are very effective at quickly treating swimmer’s ear. There are multiple types of these ear drops that are effective. Pain medications such as acetaminophen and ibuprofen are very helpful with the discomfort. 

How can you prevent yourself or your children from getting it? 

Keeping the ears dry is the best way to prevent swimmer’s ear, but this can obviously be difficult with swimming. Using ear plugs can help prevent moisture in the outer ear canal. If the ear drum is intact and there’s not any history of ear issues in the past, 1:1 white vinegar and rubbing alcohol used after swimming can help prevent swimmer’s ear. The ear also creates natural barriers to infection, such as ear wax, and patients should avoid removing this with cotton swabs. Cotton swabs can also cause damage to the skin in the ear canal that can potentially cause or increase the risk of developing swimmer’s ear.

Does the type of water you swim in (pools vs. lakes, for instance) matter? 

Water with higher bacteria loads can increase the risk of swimmer’s ear. This includes both pools and lakes, especially depending on how well the pool is maintained. 

How can you tell the difference between swimmer’s ear and a middle ear infection? 

A middle ear infection is very common, especially in children. Most middle ear infections will cause pain, hearing loss and possibly drainage, similar to swimmer’s ear. However, a middle ear infection doesn’t cause pain when pulling the outer ear or pushing the piece of cartilage at the front of the ear. Those with middle ear infections may also have a history of these infections and may have ear tubes or other prior surgeries, and usually have more hearing loss. Middle ear infections usually don’t cause redness of the outer ear canal or ear. It’s important for a physician to differentiate these two, especially because the treatment can be quite different.

Can you still swim with swimmer’s ear? 

Ideally, we recommend you avoid swimming or getting any other moisture in the ear until the symptoms have subsided. In routine cases, this is likely not an issue but it can possibly lead to reinfection or more difficulty with the treatment.
Jameson Mattingly is an otolaryngologist at The Ohio State University Wexner Medical Center and an assistant professor in the Ohio State College of Medicine.