What is Swimmer’s ear?
Swimmer’s ear is a redness or swelling (inflammation), irritation, or infection of your outer ear canal, commonly known as otitis externa. It is commonly caused by water remaining in your ear after swimming. This creates an environment that supports bacterial growth.
The ear canal is a cavity that goes from the opening of the ear to the eardrum. Water can get trapped in the ear canal especially after swimming hence the name swimmer’s ear. The water may cause problems:
- It can help germs such as bacteria and fungi grow.
- It can soften the skin. This can let germs into the skin.
- It can wash away earwax. The wax acts as a natural guard against infection.
Swimmer’s ear is a painful condition that often happens to children, and to swimmers of all ages. It is not contagious.
Causes of Swimmer’s ear
One of the main causes of swimmer’s ear is too much wetness in the ear. This can happen when you swim. But it can also happen for other reasons. These include:
- Being in warm, humid, or damp places
- Cleaning or scratching your ear canal using your fingers, cotton swabs, or other objects that my damage your ear canal.
- Having an injury to the ear canal
- Having dry ear canal skin
- Having an object (foreign body) in the ear canal
- Having too much earwax
- Having eczema or other inflammatory skin conditions
- Having small ear canals that do not drain well enough
Your ears’ natural defences:
Your outer ear canals have natural defences that help keep them clean and prevent infection.
Protective features include:
- Glands that secrete a waxy substance (cerumen). These secretions form a thin, water-repellent film on the skin inside your ear. Cerumen is also slightly acidic, which helps further discourage bacterial growth.
Cerumen also collects dirt, dead skin cells and other debris and helps move these particles out of your ear, leaving the normal earwax you find at the opening of your ear canal.
- Cartilage that partly covers the ear canal. This helps prevent foreign bodies from entering the canal.
Who is at risk of swimmer’s ear?
Swimmer’s ear is more common in children, but it can also happen in adults. When your ears protective barriers are removed such as when swimming often, the water removes earwax and softens the skin in the ear enabling bacteria to settle in and infection thereby resulting.
You can also harm the skin in the ear by wearing hearing aids, ear buds, or earplugs.
These things also put you at greater risk for swimmer’s ear:
- Having contact with germs in spas or unclean pool water
- Having a cut in the skin of your ear canal
- Hurting your ear canal by putting cotton swabs, fingers, or other objects inside your ears
- Using headphones, hearing aids, or swimming caps
- Having a skin condition such as eczema
Symptoms of swimmer’s ear
Swimmer’s ear symptoms are usually mild at first, but they can worsen if your infection isn’t treated or spreads. Doctors often classify swimmer’s ear according to mild, moderate and advanced stages of progression. The symptoms of swimmer’s ear may look like other health problems. Your ear nurse can check your ears if concerned. However, you should always contact your doctor if you have any symptoms of swimmer’s ear even if they are mild so that appropriate treatment can be prescribed such as antibiotic ear drops.
Mild signs and symptoms
- Itching in your ear canal
- Slight redness inside your ear
- Mild discomfort that’s made worse by pulling on your outer ear (pinna or auricle) or pushing on the little “bump” in front of your ear (tragus)
- Some drainage of clear, odourless fluid
Moderate progression
- More-intense itching
- Increasing pain
- More-extensive redness in your ear
- Excessive fluid drainage
- Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
- Decreased or muffled hearing
Advanced progression
- Severe pain that might radiate to your face, neck or side of your head
- Complete blockage of your ear canal
- Redness or swelling of your outer ear
- Swelling in the lymph nodes in your neck
- Fever
How to treat swimmer’s ear
Outer ear infection is usually successfully treated by:
- Removal of any blockage or debris in the outer ear canal. Your ear nurse can remove the infected debris gently and safely using micro-suction. Drops work faster to kill the infection when the ear canal is empty
- Use of corticosteroid and antibiotic ear drops to control inflammation and infection
- Avoidance of contributing factors (bathing and swimming) until the infection has cleared, wear a shower cap to avoid water getting into your ear
- Moisture in the ear, and irritation of the skin in the ear canal, should be avoided.
- Paracetamol or ibuprofen can be taken for pain relief. More severe cases may require oral antibiotics
- Do not put anything into your ear including cotton buds. Putting ear buds / hearing aids into your ear whilst you have an ear infection will reintroduce the infection back and forth. Clean your hearing aids and do not reinsert till your ear is clear of the infection.
- Avoid scratching or touching your ear
Your doctor will usually prescribe medicated ear drops. If possible, get someone to apply the ear drops for you, it is easier than trying to do it yourself. Complete the full dose as instructed, by not completing the course could cause the infection to return.
In most cases, treatment will improve symptoms within 1 to 3 days. Most people will have few or no symptoms by the end of the first week of treatment. If your symptoms haven’t improved by then, see your doctor.
Complications if left treated:
If left untreated, swimmer’s ear may cause other problems such as:
- Hearing loss from a swollen and inflamed ear canal. Hearing often returns to normal when the infection clears up
- Ear infections that keep coming back
- Bone and cartilage damage
- Infection spreading to nearby tissue, the skull, brain, or the nerves that start directly in the brain (cranial nerves) – life threatening
Prevention
The following ear hygiene practices can help to prevent outer ear infection:
- Avoid inserting objects (e.g. cotton buds, bobby clips paper clips, keys etc) into the ear canal
- Avoid washing the ears with soap
- Avoid swimming in polluted water (look for signs at beaches and lakes alerting swimmers to high bacterial levels)
- Avoid putting head under in spas, hot pools
- Use earplugs. If you can keep water out of your ear canal, you’re much less likely to have a problem. Choose earplugs that are designed for swimming. A bathing cap that covers your ears can help, too.
- If you know you don’t have a punctured eardrum, you can use Vosol Eardrops available from the pharmacy after swimming to dry the canal.
- Empty the ear canals of water after swimming or bathing by holding the head horizontally or using a hair dryer on a low setting.
- If you have had a recent infection it is very important to keep your ears dry by using a swimming cap or earplugs. After an infection the waterproof layer in your ear canal has been damaged and takes up to a month for this to recover. This makes you more susceptible to getting another infection in a short period of time.
Frequent use of earplugs can injure the ear canal, which may increase the chances of outer ear infection occurring.
