Fact Checked

Swimmer’s Ear: The Painful Ear Infection that Doesn’t Always Originate from Swimming

I was recently enjoying a socially distant night out with some friends when suddenly, I had excruciating pain in my left ear. Ear pain is nothing new to me—I have suffered from ear issues my entire life and still get frequent ear infections. This pain felt slightly different than my usual ear infections, though. The ear felt tender to the touch, and the pain was more intense. The next morning, I went to my ENT, who diagnosed me with swimmer’s ear and prescribed antibiotic ear drops.

What is Swimmer’s Ear?

Swimmer’s ear is a bacterial infection of the ear canal (although a virus or fungus may also be the culprit in some cases). The infection tends to occur when water lingers in the outer ear for too long, allowing a moist environment for bacteria to grow. Scratching or scraping out ear wax allows the bacteria to enter deeper layers of the skin. 

Swimmer’s ear is also called otitis externa, meaning an infection of the skin of the outer ear canal. The infection more commonly occurs in children but may occur in people of any age and is not contagious. 

Although swimmer’s ear is frequently associated with being in water (that pool party or trip to the beach), the infection can also occur even if you haven’t been swimming. 

Is Swimmer’s Ear the Same as a “Regular” Ear Infection?

During the winter months, children frequently suffer from ear infections. These common types of infections are called acute otitis media (middle ear infections). Bacteria or viruses can cause a middle ear infection, which may or may not require oral prescription antibiotics (such as amoxicillin).  

In contrast, swimmer’s ear affects the outer ear. Continue reading to learn more about swimmer’s ear.

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How Frequent is Swimmers’ Ear?

Those little ears can cost big money. A study published in Morbidity and Mortality Weekly estimated that annually in the US, swimmer’s ear causes 2.4 million visits to a healthcare provider and costs approximately $500,000. Most doctor visits were in the summer months. 

What are the Symptoms of Swimmers’ Ear?

Swimmer’s ear symptoms may be mild initially, but can progress if not treated and is further categorized below: 

Symptoms of mild progression: itching, slight redness, mild discomfort, a small amount of clear drainage

Symptoms of moderate progression: increased itching and pain, more redness in the ear, excessive fluid drainage, a feeling of fullness in the ear, decreased hearing

Symptoms of advanced progression: severe pain that may radiate around the face/neck/head, complete ear canal blockage, redness and swelling of the outer ear, lymph node swelling, fever

How is Swimmer’s Ear Diagnosed?

Your healthcare provider will use an otoscope to look into the ear. He or she will look at the external ear canal for swelling and redness of the skin and draining fluid. 

What is the Usual Treatment for Swimmers’ Ear?

Early symptoms of swimmer’s ear can be treated by avoiding water and using non-prescriotion ear drops. The drops create a dry, acidic environment, making it difficult for bacteria to survive. *Do not use these drops in ears that have tubes, any pain, or a tear in the eardrum*

Prescription topical antibiotics (with or without a steroid) in the form of eardrops are primarily used to treat swimmer’s ear. Common examples include Cortisporin, Ciprodex, or ofloxacin ear drops. Your ENT may also suction out debris when needed. If the ear canal is swollen shut, your ENT may need to place an ear wick into the canal, helping the antibiotics reach the infection. 

Oral antibiotics are rarely needed to treat swimmer’s ear. 

For pain relief, over-the-counter (OTC) medications such as Tylenol (acetaminophen) or nonsteroidal anti-inflammatory medications such as Advil (ibuprofen) may be used. Ask your healthcare provider for medical advice if you are not sure which OTC pain-reliever is appropriate for you. 

Most patients will start to feel better within one to three days. It’s essential to finish the full course of topical antibiotics (usually 10-14 days) even if you feel better to ensure bacteria do not return. 

How can I Prevent Swimmer’s Ear?

Here are some helpful prevention tips: 

  • Limit time exposed to water
  • Keep the ear canal as dry as possible. When you shower, use a cotton ball covered in petroleum jelly (Vaseline). Alternatively, you can use wax earplugs *only use earplugs designed to keep water out*.
  • If you get water in your ears, dry them thoroughly. Tip your head from side to side to drain water. You can also use a hairdryer on the lowest setting, held at least 12 inches (one foot) away.
  • Do not use cotton swabs or Q-tips to clean your ears, or any other items (like a pen) to scratch your ears. These “tools” can push wax further into the ear, instead of removing it and scratch/scrape the ear, increasing the risk of infection. Your healthcare provider can safely remove excess wax for you. 
  • You can use non-prescription ear drops to help dry up any extra water in the ear. Ask your pharmacist for help in selecting an appropriate product or how to make the eardrops at home properly. *do not use non-prescription ear drops if you have any ear pain or a tear in your eardrum (perforated eardrum), or have had ear surgery (e.g., tubes in the ears)*  

Should I See a Doctor if I Think I Have Swimmer’s Ear?

Yes. Swimmer’s ear can progress to a more advanced stage that can be very painful. Contact your healthcare provider immediately if you have symptoms of swimmer’s ear. A quick diagnosis and treatment will help you have a faster recovery and less pain and complications. 

If you have severe pain or fever and your primary doctor or ENT specialist is not available, go to the emergency room. 

References:

  1. Swimming and Ear Infections. Centers for Disease Control and Prevention Website. https://www.cdc.gov/healthywater/swimming/swimmers/rwi/ear-infections.html Accessed August 10, 2020.
  2. Ear Infection. Centers for Disease Control and Prevention Website.  https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/ear-infection.html Accessed August 10, 2020.
  3. Estimated Burden of Acute Otitis Externa --- United States, 2003--2007. Centers for Disease Control and Prevention Website.  Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a2.htm?s_cid=mm6019a2_w Accessed August 10, 2020. 
  4. Swimmer’s Ear. Mayo Clinic Website https://www.mayoclinic.org/diseases-conditions/swimmers-ear/symptoms-causes/syc-20351682 Accessed August 10, 2020. 
  5. Swimmer’s Ear. Harvard Health Publishing/Harvard Medical School Website. https://www.health.harvard.edu/a_to_z/swimmers-ear-otitis-externa-a-to-z Accessed August 10, 2020. 
  6. Acute Otitis Externa: An Update. American Family Physician Website. https://www.aafp.org/afp/2012/1201/p1055.html Accessed August 10, 2020
Published September 10th, 2020 by Dr. Karen Berger, PharmD
Fact Checked by Chris Riley

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