FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

WATER IN EAR CANAL CAN CAUSE “SWIMMER’S EAR” INFECTION

Question: Every summer one of my kids gets swimmer’s ear. What causes this, and can I do anything to prevent this problem besides not allowing swimming?

Answer: Acute otitis externa, commonly called “swimmer’s ear,” is an infection of the outer ear canal. It is usually bacterial in origin, but it can also be caused by a fungus. While it is a very common infection in children between the ages of 7 and 12, anyone at any age can come down with this malady.

Swimmer’s ear is five times more likely to occur in swimmers than non-swimmers, hence the name. This infection is frequently a one-sided problem, but it can affect both ears. Water from bathing can also cause swimmer’s ear.

The ear canal is the perfect place for bacteria and fungi to grow. It is warm, dark and moist. Normally earwax and oils in the ear canal protect it, but getting water in your ear while swimming can cause these to wash off. This causes the ear canals to dry out which makes them more susceptible to infection.

Swimming in water that is untreated -- such as lakes, rivers or streams -- can bring infectious bacteria directly into your ear canals. However, even if you swim in “clean” chlorinated pools, you can still get an infection because of the extra drying effect that treated water has on the delicate skin inside your ear.

If you could see the infection inside your ear canal, it probably wouldn’t look much worse than a minor, slightly red scratch -- like what you occasionally see on your arm or face. But these scratches can be quite irritating inside the ear because you have very little tissue padding between the skin, and the cartilage and bone underneath. When the infected skin in the ear canal swells up, it creates painful pressure.

It’s not surprising, then, that pain is usually the symptom that brings the swimmer’s ear sufferer into the doctor’s office. The person may comment to the doctor that the pain is made worse by chewing or wiggling the ear. He or she might also complain of itching, some drainage from the ear and mild hearing loss. There are usually no systemic symptoms like fever or runny nose.

Acute otitis externa is easily treated by using prescription antibiotic ear drops for several days, avoiding swimming or getting water in the ear, and using over-the-counter pain medication. Occasionally an outer ear infection can be associated with a deeper middle ear infection. In these cases, oral antibiotics will be needed as well.

Prevention is the best way to deal with swimmer’s ear. Some people do seem prone to this problem. If you are one of these folks, there are a few things you can do to decrease the likelihood of an external ear canal infection. You can try to avoid getting water in your ears while swimming by using ear plugs or a tight-fitting bathing cap. Drying the ear canals with a hair dryer set on the very lowest heat level can sometimes be of benefit. There are also several over-the-counter ear drops that you can use before and after you swim to help prevent otitis externa. But, if your preventive measures fail and you do develop an infection, you need a trip to the doctor to get the appropriate diagnosis and treatment.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.