What is Swimmer’s Ear and What Do You Do About It?

For many of us, summertime means enjoying the water. We love to swim and splash around in rivers, lakes, the ocean and a variety of swimming pools. It can also mean contracting swimmer’s ear. Here’s what you need to know about this common infection and how to prevent and treat it.

Swimmer’s Ear (Acute Otitis Externa) is the name for an infection of the outer ear canal. Usually it is caused by water that becomes trapped in the ear and provides a breeding ground for bacteria that is found in water and soil. The bacteria is soaked up by the skin in the ear canal, causing an infection.

 
Swimmer’s ear is most commonly caused by two types of bacteria:

1. Pseudomonas aeruginosa: This is considered a common bacteria that thrives in moist environments and easily causes infection. It exists in all areas of the world and is commonly found in water, soil and on human skin.
2. Staphylococcus aureus: This is another common bacteria that is usually found on the skin and in the moist areas of the body including the respiratory system and the nose. In addition to swimmer’s ear, this bacteria causes infections like sinusitis, food poisoning and respiratory infections.

 
Swimmer’s ear can also be caused by things outside of the water:

• Ear buds, ear plugs, or hearing aids that break down the skin in the ear canal.
• Objects stuck in the ear that have scratched the skin in the ear canal like Q-tips, hair pins or long fingernails.
• Allergies to beauty products that get in the ears like lotion, shampoo, hair spray and the like.

 
How do you know if you have Swimmer’s Ear?
The symptoms of swimmer’s ear range from mild to severe. Each stage has distinct symptoms.

Mild symptoms:
If you have a mild case of swimmer’s ear you may experience a feeling of irritation in the ear. It may itch or you may see redness just inside your ear canal. You may also see a bit of fluid coming out of your ear.

Moderate symptoms:
If swimmer’s ear is left untreated the symptoms will worsen. You may experience pain and increased itching in your ear. The redness that you first saw will increase as will the fluid coming out of your ear. You may also see pus coming out of your ear. As swimmer’s ear worsens you may feel as though your ear is plugged and it may begin to impair your hearing.

Severe symptoms:
Left untreated, swimmer’s ear will continue to worsen and the symptoms will become more severe. The pain that was inside your ear may spread to the external areas around your ear including your face, head and neck. You may lose hearing in that ear. The redness inside your ear may extend to the outer ear. You may also have swelling in the glands in your neck and you may spike a fever.

 
What are the treatments for swimmer’s ear?
After your doctor diagnoses swimmer’s ear, medications such as ear drops may be prescribed to address the symptoms and pain. Antibiotics and sometimes steroids may be prescribed, depending upon the specific symptoms you are experiencing and the severity of the swimmer’s ear. Your ENT doctor may also recommend that you take over-the-counter medications to address any pain and discomfort you may be experiencing, such as ibuprofen (sold as Advil, Motrin etc.), acetaminophen (sold as Tylenol etc.) or naproxen sodium (sold as Aleve etc.).

While you are taking these medications, adjustments to your activities will support the healing.

• Avoid swimming or wearing headphones.
• If you wear a hearing aid ask your physician for guidelines on how to wear it while the swimmer’s ear is healing.
• Avoid getting water in your ears while taking a shower. Wearing a shower cap or putting cotton balls in your ears can help.

 
Where do swimmers contract swimmer’s ear?
The bacteria that causes swimmer’s ear is more prevalent in natural sources of water like rivers, lakes and the ocean than it is in public and private swimming pools treated with chlorine. Chlorine is added to swimming pools to kill bacteria, but it works only if used correctly and in the right amounts. Given the wide range of owners and operators of pools, it is up to you to protect yourself and your family members from the bacteria that may be in the water.

If you swim in public pools of any type, including your neighbor’s pool, the following tips may help to prevent swimmer’s ear:

1. Look at the water. If it appears to be dirty don’t swim in it. Dirty water contains elevated levels of bacteria that will get in your ears as you swim. If you do swim in dirty water use ear drops (see #3) immediately after getting out of the water.
2. When you get out of the pool, tilt your head to the side to let the water drain from your ears. Shake your head a bit to make sure it all drains out.
3. Purchase ear drops that contain acetic acid, or make your own ear drops out of isopropyl alcohol and white vinegar. Put two or three drops into your ears after swimming. This will help to dry any water that is in the ear canal. Let the drops remain in the ear for a few seconds and then tilt your head to let the liquid drain out.

If you own a pool, make sure that you keep the water as clean as possible. The Centers for Disease Control recommends the following guidelines to ensure proper chlorine use:

• pH 7.2–7.8 and a free chlorine concentration of at least 1 ppm in pools and at least 3 ppm in hot tubs and spas.
• If using cyanuric acid, a chlorine stabilizer, or chlorine products with cyanuric acid (for example, products commonly known as dichlor or trichlor ), the recommendation is pH 7.2–7.8 and a free available chlorine concentration of at least 2 ppm in pools.
• Do not use cyanuric acid or chlorine products with cyanuric acid in hot tubs and spas.

As we mentioned earlier, there are other causes for swimmer’s ear including scratches from poking objects in the ear, hearing aids and ear plugs. Here are suggestions on how to prevent getting swimmer’s ear from those causes:

• Do not stick objects in your ears, including Q-tips. These objects can damage the sensitive skin inside the ear canal and make is susceptible to infection. If you have ear wax, attempts to clean your ears yourself will only push the ear wax deeper into the ear canal.
• For those who wear hearing aids, it is helpful to remove them occasionally to let the ear canal dry out. Clean the hearing aid according to manufacturer’s specifications.
• If at all possible, don’t use earplugs. They can irritate the skin inside the ear canal causing it to break down and make it more susceptible to infection.
• Keep your ears as dry as possible while taking a shower. Make sure to dry your ears after showering.

 
A closing note about chlorine and swimming pools:
You may think that chlorine is making your eyes red when you swim in a public or private swimming pool. Unfortunately that is not the case. It is the combination of chlorine with pee, poop, sweat, and dirt from swimmers’ bodies that is turning them red. Yes, it’s pretty gross. To make sure you are swimming in the cleanest pool possible remember the following:

1. Check to see if you can see the bottom of the pool from the deep end. If you can, the water is clean.
2. You should not be able to smell chlorine.
3. Ask the operator of a public pool to see their inspection results.
4. Teach your children not to swallow the water in the pool.

Summer is a short season and it’s important to enjoy it as much as possible. By following these suggestions you can ensure that your family will have a great time splashing around in the water without getting swimmer’s ear.

 

1: http://www.aafp.org/afp/2012/1201/p1055.html
2: https://www.cdc.gov/healthywater/swimming/residential/disinfection-testing.html
3: https://www.cdc.gov/healthywater/pdf/swimming/resources/share-fun-not-germs-508c.pdf