Swimmer’s Ear: Causes, Symptoms, Prevention and Treatment

We wanted to share some important information on Swimmer’s Ear from Mark J. Shikowitz, M.D., FACS to make sure you and your families have a safe and fun swim season.

Summer can be a great time for children to enjoy themselves but it can also be a very trying time for parents.  There are a few illnesses that become more prevalent during the warm months and otitis externa better know too many as “Swimmer’s Ear” often top the list. It is a painful condition of the outer or visible part of the ear and ear canal and is one of the most common causes of “earache”.  Males and females are affected equally with younger children and teenagers being afflicted most commonly.  Two basic factors which are usually necessary for an external otitis to develop are the presence of bacteria or other microorganisms that can affect the skin and impairment or break in the integrity of the skin of the ear canal that allows the infection to take hold.  In many parts of the country children usually swim only during the summer months and it is the exposure of the ear to water that that has given this condition its common name.  You do not need to be swimming in a pool, favorite swimming hole, beach or lake to get swimmer’s ear.  Water from a bath or shower can start the ball rolling.  People with diabetes or who have a weakened immune system can develop a more serious form of this common problem and should seek medical attention sooner.  Their infections may even require hospitalizations if left untreated.

Causes of Swimmer’s Ear

The external canal (opening into the ear) has several unique features that may lead to recurrent otitis externa.  The outer portion of this canal is flexible and made up of cartilage just like the outside part of the ear.  However, the next segment is made up of bone and the skin attached to the bone is immobile and almost paper thin.  It is this reason that the delicate skin lining of the canal can be easily abraded or torn.  In a large number of cases the injury is caused by the person themselves or their parent by trying to make sure they have a “clean ear”.  Placement of fingernails, hairpins or even a cotton swab can cause the necessary injury.  Remember, this area of skin is extremely sensitive and easily damaged by even slight pressure.  We are reminded of that old saying, “nothing smaller than your elbow should go in your ear”, and now we know why.

Symptoms of Swimmer’s Ear

Pain is the most common symptom and can progress over a few days.  The pain may increase significantly when the ear is touched or pulled.

The outside of the ear may be red and swollen.  If the condition continues the external opening may even swell until it is closed.  The child may now have trouble hearing.

Drainage can often be seen from the ear.  This can be clear or discolored and even look bloody.  An odor may also start to come from the ear.  The outside of the ear may also get crusty.

Children may also complain of ringing sounds (tinnitus) or dizziness.

Prevention and Treatment for Swimmer’s Ear.

As with many illnesses prevention is the best medicine.  Using earplugs or bathing caps designed for swimming will help keep the water out.  If your child had Myringotomy or Ventilation tubes placed in their ear drums for recurrent otitis media or middle ear infections this step is very important for them.  Your Otolaryngologist or ear doctor should be consulted before your child goes swimming.

There are home made or homeopathic remedies that have been used for years with some success.  This includes making a 50:50 mixture of white vinegar and rubbing alcohol and placing a few drops (3-4) in each ear canal after swimming.  This will help dry out any water left in the ear and keep a slightly acidic environment in the ear which prevents the growth of any bacteria or even fungus.  Remember the ear canal is normally slightly acidic as part of its own protective mechanism.

If you or your child does not like the vinegar smell or mess of drops there are now special earplugs which you can place in the ear after swimming that will absorb any left over water or moisture and keep the canal dry.  These are different than ear plugs used to prevent the entry of water.  This is a simple and clean way to prevent Swimmer’s ear. (ClearEars)

Now back to your elbow.  Avoid placing objects in the ear canal that can irritate or scratch the skin.  This includes earplugs from music players etc.

Treatment.

Avoid any further trauma to the ear and apply heat to help control pain.
If the child is not allergic, than over the counter analgesics such as ibuprofen (Advil) or acetaminophen (Tylenol) can be used.

The first line of medical treatment for swimmer’s ear is antibiotic drops or a form of acidic acid drops. (These are stronger than the home remedy which will not work once the infection takes hold)  Oral antibiotics are usually not used for swimmer’s ear.  There are many different types of medicated drops and which one is selected will be up to your health care professional.  Some of the drops may contain anti-inflammatory agents such as a steroid which can help in shortening the recovery. Avoid any more swimming and keep the ear dry until the infection has completely resolved.

Special Cases.

Any child with a weakened immune system can have a more severe and prolonged course.  Parents of diabetic children should be especially on the look out for this condition.  Although less common, this type of infection can also be caused by a fungus.  Children who have had repeated infections and multiple courses of antibiotic drops can then develop a mycotic or fungal infection.  The repeated use of antibiotics can also eliminate the normal bacteria found in the ear and allow the fungus to grow.  Antibiotic drops have no effect on fungus and if the drops contain a steroid to help bring down the inflammation, they can even make it worse.  If the infection does not seem to go away after a longer period of time than usual, you should bring your child to a specialist.  If the ear canal has already swollen shut the specialist may place a “wick” in the ear to help open the canal and allow the medicine to go where it is needed.  This may only be for a few days.

Most of all summer should be a fun time for every one.

Dr. Shikowitz is the Vice Chairman of the Department of Otolaryngology at the North Shore/LIJ Healthcare System in New Hyde Park, New York and a Professor of Otolaryngology at the Albert Einstein College of Medicine in Bronx, New York.  He has offered technical assistance in the development of our ClearEars product.

Summer Ear Care Tips

Summer is finally here. Before you jump off that diving board or takeoff to your summer vacation destination, protect your ears with these tips from Otolaryngology (Ear, Nose, and Throat) expert Dr. Mark J. Shikowitz. Dr. Shikowitz is a Professor of Otolaryngology at Albert Einstein College of Medicine and the Vice Chairman, Department of Otolaryngology and Communicative Disorders at Long Island Jewish Medical Center.
Healthy Swimming Guidelines:

Hitting the pool or the beach can expose you to the risk of developing Swimmer’s ear—a painful infection of the outer ear and ear canal caused by excessive water exposure. These tips can help prevent ear infections from putting a damper on your summer fun.

•    Use ear plugs such as BioEars to prevent water from entering the ear canal. BioEars, soft silicone earplugs, are the first earplugs with exclusive Microban® antimicrobial technology, which prevents earplug degradation. BioEars are available at Rite Aid and other fine stores.

•    If water becomes trapped in the ear, try the world’s first-ever water absorbing earplugs called ClearEars. ClearEars should be inserted into the ears after water activities and held in place until they gently expand to give a snug, comfortable fit. Safe for children and adults, ClearEars provide convenient, on the spot relief in 5-10 minutes. ClearEars are available at CVS, Walgreens, and Duane Reade and http://www.cirrushealthcare.com for a suggested retail price of $5.99 for a package of 5 pair.

•    If ear pain persists, see a doctor who can prescribe antibiotic drops to bring down the inflammation.

•    Following treatment of swimmers ear, avoid exposure to water for several days. Allowing water into the ear canal will prolong the healing process.

Tips for Plane Trips: During takeoff and landing, rapid changes in air pressure can cause pain in the ears. Plane-proof your ears by following these simple steps.

•    Take a decongestant 24 hours before flying to keep air passages and ears clear.

•    Chew gum or drink fluids through altitude changes during flight to equalize the pressure in the middle ear.

•    Use a set of EarPlanes, comfortable earplugs, for take-offs and landings or altitude changes during the flight to equalize the pressure in the middle ear. EarPlanes can be found in all drug, discount and airport stores.

•    Hold the nose and swallow to alleviate ear pressure in the middle ear.

•    Use ¼ percent Neo-Synephrine nasal spray shortly after boarding the aircraft and again 45 minutes before the aircraft is due to land to keep the nasal passages open.

•    Try not to fly when you have a cold or upper respiratory infection, as you are more likely to experience ear problems.

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