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Swimmer's
ear
Water normally flows into and out of our
ears without causing any problems. We can nearly always shower, bathe, swim, and
walk in the rain without incident — which is remarkable, considering how large
and deep an opening the ear provides. We're protected by the ear's shape, which
tips fluid out, and by its lining, which has acidic properties that protect
against bacteria and fungi.
When your ear is exposed to excess
moisture, however, water can remain trapped in your ear canal. The skin inside
becomes soggy, diluting the acidity that normally prevents infection. A cut in
the lining of the ear canal also can allow bacteria to penetrate the skin. When
this happens, bacteria and fungi from contaminated water or from objects placed
in the ear can grow and cause a condition called swimmer's ear (acute otitis
externa, or external otitis).
Swimmer's ear is an infection of your outer
ear and ear canal. It can be associated with a middle ear infection (otitis
media) when the eardrum ruptures.
Usually, self-care steps can relieve the
symptoms of swimmer's ear. However, a severe case of swimmer's ear will require
a trip to your doctor.
Signs and symptoms
Outer ear infection
Signs and symptoms of swimmer's ear usually
appear within a few days of exposure to contaminated water, and may include:
 | Severe pain on
moving your outer ear (pinna or auricle) or pushing on the little
"bump" (tragus) in front of your ear.
| Pain or discomfort
in or around your ear. Usually only one ear is involved.
| Itching of your
outer ear.
| Swelling in your ear
or lymph nodes in your neck.
| Feeling of fullness
or stuffiness in your ear.
| Hearing loss. |
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Swimmer's ear also may cause your outer ear
to appear red with scaly or flaking skin.
Causes
Causes of swimmer's ear may include:
| Persistent moisture
in your ear from swimming, bathing or living in a moist environment
| Exposure to an
infectious organism from swimming in polluted water
| Skin breakage caused
by a foreign object (such as a cotton swab or pencil) scratching or rubbing
your ear, or attempting to clean earwax (cerumen) from your ear canal
| Bacteria growth
fostered by hair sprays or hair dyes in your ear |
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Risk factors
Swimmer's ear is common in children and in
young adults. You may be at increased risk of infection if a skin condition such
as eczema causes you to scratch your ears excessively. Earwax buildup or
blockage also may increase your risk by trapping water in your ear and
increasing the likelihood that you'll cut the skin while cleaning your ear.
Other ear problems also may increase your
risk of swimmer's ear, including small ear canals that don't drain well and
chronic middle-ear infections that moisten and perforate the eardrum.
If you're an older adult or have an
underlying medical condition such as diabetes, your immune system may be
impaired, increasing your risk of swimmer's ear. If you have poorly managed
diabetes, you're at increased risk of developing severe, painful swimmer's ear
that may be difficult to treat.
When to seek medical advice
Make an appointment with your doctor if you
have pain or swelling in your ear or drainage from your ear. Swimmer's ear is
not usually an emergency, but it is important to see a doctor right away if you
have any signs or symptoms of swimmer's ear and have an underlying disease that
may impair your immune system.
Your doctor will examine the inside of your
ear and, if indicated, refer you to a doctor who specializes in the care of ear,
nose and throat disorders (otolaryngologist).
Call your doctor immediately if an
infection that's already being treated produces new signs or symptoms,
especially fever, redness of the skin behind your ear, or increased drainage
from or severe pain in or around your ear.
Screening and diagnosis
To examine the inside of your ear, your
doctor may use a lighted instrument (otoscope). The inside of your ear and your
ear canal may appear red and swollen. Your ear canal also may appear scaly, with
flaking skin. If you have drainage from your ear, your doctor may culture a
sample to determine if the cause of the infection is bacteria or fungi.
Complications
Swimmer's ear usually isn't serious, but
complications can occur if it isn't treated. Complications may include:
| Hearing
loss. Muffled hearing almost always lasts only until the infection
is gone.
| Recurrent
outer ear infections (chronic otitis externa). Swimmer's ear may
not respond to treatment or may keep coming back in some people. This can
lead to infection in the surrounding skin (cellulitis).
| Bone and
cartilage damage (malignant otitis externa). An outer ear infection
that spreads can cause inflammation and damage to the bones and cartilage at
the base of your skull, often causing increasingly severe pain. Older adults
and people with diabetes are at increased risk. Despite its name, this
condition has nothing to do with cancer (malignancy).
| More
widespread infection. If swimmer's ear develops into malignant
otitis externa, the infection also may spread and affect other parts of your
body, such as the brain or cranial nerves |
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Treatment
The goal of treating swimmer's ear is to
clear up the infection. Treatment may include:
| Cleaning.
Clearing your outer ear and ear canal of any drainage and flaky skin allows
topical medications to work more effectively. Your doctor may perform this
procedure with a suction device or a cotton-tipped probe. To prevent further
irritation or injury, don't clean inside your own ear unless your doctor
instructs you to do so.
| Topical
medications. Your doctor may prescribe eardrops containing
antibiotics to fight infection and corticosteroids to reduce itching and
inflammation. Use eardrops abundantly (four to five drops at a time) to
penetrate the end of your ear canal. If your ear canal is swollen, your
doctor may insert a special wick into your ear to allow the drops to reach
the end of your ear canal.
| Oral
medications. In some cases, doctors suggest using oral medications
in addition to topical treatments. Nonsteroidal anti-inflammatory drugs (NSAIDs),
such as aspirin or ibuprofen (Advil, Motrin, others), may help ease severe
ear pain. Ask your doctor which over-the-counter pain medication is best for
you. Always take NSAIDS with food.
| Lifestyle
modifications. Don't swim, fly or scuba dive during treatment for
swimmer's ear. Taking a shower may be acceptable if you clear all water from
your ear afterward. Talk to your doctor about your bathing habits. |
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Prevention
Follow these tips to avoid swimmer's ear:
| Dry your ears
thoroughly after exposure to moisture from swimming or bathing. Dry only
your outer ear slowly and gently with a soft towel or cloth. Never insert
your finger or any other object into your ear.
| Avoid swimming in
polluted water.
| Use earplugs
designed specifically to keep water out of your ears when swimming.
| Mix 1 part white
vinegar with 1 part alcohol to make an effective eardrop to use before and
after swimming. Pour 1 teaspoon of the solution into each ear and let it
drain back out. This mixture may help prevent the growth of bacteria and
fungi that can cause swimmer's ear.
| Use oil or lanolin
eardrops in your ears before swimming to prevent the effects of water.
| Never attempt to dig
out excess or hardened earwax with items such as a cotton swab, paper clip
or hairpin. Using these items can pack material deeper into your ear canal
and irritate the thin skin inside your ear.
| Avoid substances
that may irritate your ear, such as hair sprays and hair dyes. Put cotton
balls in your ears when applying these products.
| If you already have
an ear infection or have recently had ear surgery, talk to your doctor
before you swim. |
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Self-care
If the aching is mild and there's no
drainage from your ear, try these steps:
| Place a warm (not
hot) heating pad over or against your ear to help reduce pain.
| Try over-the-counter
anti-inflammatory drugs to ease your discomfort.
| Keep your ear dry
while it's healing. Use earplugs when showering or bathing.
| Don't swim or clean
your ears until the infection is gone. |
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