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Swimmer’s ear is an infection that can occur after spending a long time in the water or outdoors in the wind and rain. It affects the skin that covers the outer ear canal, which leads to the eardrum.
Despite the name, swimmer’s ear is more common in people who are not swimmers, according to the University of Iowa. Individuals who spend a lot of time outdoors, such as farmers, often get the infection.
The medical name for swimmer’s ear is acute diffuse external otitis.
Bacteria can accumulate in the water. While swimming, in areas of fresh water, for example, some can enter the ear and remain for a long time, especially if the water becomes trapped by wax.
The ear has ways of protecting itself from infection, but these work best when the area is dry. If the ear is damp, bacteria can thrive, resulting in infection.
Fungal infections can also occur in the ear. However, in 98 percent of cases in North America, swimmer’s ear results from exposure to bacteria.
According to the Centers for Disease Control and Prevention (CDC), swimmer’s ear is responsible for 2.4 million healthcare visits in the United States each year.
In most cases, a doctor can easily treat the infection, and receiving treatment early can prevent complications.
There are three types of external otitis.
Swimmer’s ear (acute diffuse external otitis)
This is the most common type of external otitis. It can last for up to 3 weeks, and it affects the entire ear canal.
A rash can extend to the outer ear and the eardrum.
Signs and symptoms include:
- redness and swelling in the outer ear and ear canal
- pain in the area
- scaly skin, which may peel off, in and around the ear canal
- watery or pus-like discharge, which may smell bad
- itching and irritation in and around the ear canal
- tenderness when moving the ear or jaw
- sore and swollen lymph nodes, or “glands,” in the throat
- some hearing loss, if the swelling inside the ear is significant
Other types of external otitis
Acute localized external otitis occurs when a hair follicle in the ear becomes infected. A painful, pus-filled bump, called a furuncle, may form in the ear canal. This infection is a type of furunculosis.
Chronic external otitis can result from infection, allergies, or a skin condition, such as eczema. To warrant the diagnosis, the symptoms must persist for at least 3 months, and they can last for years.
The ear has several ways of protecting itself from infection.
Cerumen, or earwax, is produced by glands in the ear canal, and it performs several functions.
For example, earwax:
- forms a thin, waterproof film on the skin of the ear canal
- contains acids and antibacterial properties, which combat bacteria
- collects debris, dead skin, and dirt and transports them out of the ear, where they appear as a waxy clump at the opening of the ear canal
The shape of the ear canal is also important. It slopes downward from the middle to the outer ear, so that liquid can drain.
External otitis can develop when the ear canal’s defenses cannot cope with an infection or an allergic reaction.
The following factors increase the likelihood of contracting swimmer’s ear:
- swimming, especially in water with high levels of bacteria
- cleaning, prodding, scratching, or scraping the ear canal with a cotton swab
- wearing a swim cap, using a hearing aid, or having a lot of earwax, which can trap water inside the ear
- having a skin condition, such as eczema, acne, or psoriasis
- having a small ear canal
Children are especially vulnerable to swimmer’s ear.
Not only swimmers get swimmer’s ear, however. It commonly affects farmers and other people who spend a lot of time outdoors.
The doctor will examine the ear canal using a handheld device called an otoscope.
They will check for:
- flaky or scaly skin
- damage to the eardrum
They will also ask about a person’s:
- medical history
- recent experiences, including swimming and inserting things into the ear, such as cotton swabs
If there is a blockage, the doctor may use an ear curette, a tiny instrument designed for scraping away debris, or a suction device to clear the ear canal.
If there is damage to the eardrum, the doctor will refer the patient to an ear, nose, and throat specialist, who will check whether the infection originated in the middle ear.
If symptoms do not improve, the doctor may test a sample of debris or discharge to learn more about the underlying issue.
Treatment for swimmer’s ear is usually straightforward.
Painkillers: Acetaminophen (Tylenol), for example, can relieve discomfort.
Ear drops: The recommended drops usually contain an astringent or acidic acid, a corticosteroid, an antibiotic medication, an antifungal preparation, or a combination.
Microsuction: A specialist may use suction to clean the ear, making the drops more effective.
Ear wick: This is a soft cotton gauze plug covered with medication, and a doctor will insert it into the ear canal. The aim is to help medicine to enter the area. A person should replace the ear wick every 2 or 3 days.
Treatment for other types of external otitis
Chronic external otitis: If the underlying problem is an allergy or skin issue, a physician will treat this condition first.
They may instruct a person to use ear drops for 7 days, as well as a spray. The spray will contain acetic acid, and the drops will contain a corticosteroid. If this does not work, antifungal ear drops can help.
Acute localized external otitis: The pus-filled bump will often burst and heal in a few days without treatment.
The following strategies can help a person to treat all types of external otitis.
Keeping the ear dry: Use a shower cap when bathing, and avoid swimming until the infection has healed.
Removing any discharge and debris gently: Under a doctor’s supervision, use cotton wool to clear the outer ear only, without prodding deeply.
Using a warm compress: Place a warm towel over the ear to help relieve pain.
Removing any devices: Earplugs, earrings, and hearing aids can aggravate symptoms and cause an allergic reaction.
Checking for side effects: Ear drops containing neomycin or propylene glycol can trigger allergic reactions.
External otitis is not usually serious. When a person receives treatment, complications are rare.
Without treatment, however, the infection can enter the deep tissue, causing more serious complications, including:
- An abscess: A pus-filled growth can develop in or around the affected ear.
- Cellulitis: This skin infection occurs when bacteria enter the deep layers of skin.
- Stenosis: This can occur when thick, dry skin accumulates in the ear canal, narrowing it, and potentially leading to hearing loss.
- Otomycosis: This fungal infection can develop as a complication of external otitis.
Malignant external otitis, or necrotizing external otitis
If the infection reaches the bone and cartilage of the outer ear, it can cause inflammation and damage that extends to the lower part of the skull.
The condition is very painful, and it can be life-threatening. Those most at risk are adults with weakened immune systems.
If the infection spreads to the eardrum, a buildup of pus can cause inflammation in the area and perforate the eardrum.
This will normally heal within 2 months. A doctor may prescribe oral antibiotics, and it is important to keep the ear dry.
To prevent ear infections, avoid swimming in polluted water and keep the ears as dry as possible.
To dry the ears after swimming, the Merck Manual suggests mixing a solution of equal parts rubbing alcohol and white vinegar and putting two drops in each ear after swimming.
The alcohol will evaporate any water trapped in the ear, while the vinegar changes the ear’s pH, preventing the bacteria from growing.
Other ways of preventing infection include:
- drying the outer ear with cotton wool or a towel
- tipping the head with the ear pointed downward and pulling the earlobes in different directions or shaking the head to remove trapped water
- drying the ears with a hairdryer on a low setting, held at least 1 foot from the ear
- wearing well-fitting earplugs or a swim cap that covers the ears
- rinsing the ears with clean water after swimming in a chlorinated pool
Never put cotton swabs or other foreign objects such as hairpins into the ear. This can cause further damage and force unwanted material deeper inside the ear canal.
Earwax naturally flows outward, so a person should only use cotton swabs to remove it from the outer ear. A healthcare professional should treat any wax buildup inside the ear.
Products such as hair sprays or dyes can irritate the ear, increasing the risk of external otitis. To prevent this, gently place cotton balls in the ears before applying the products. Be careful not to push the cotton balls into the ear canal.
After treatment for an ear infection, a physician will tell a person when they can safely swim again.