Why is Swimmer’s ear painful? How to avoid it?

Swimmer’s ear medically referred to as Otitis Externa is a bacterial infection of the external ear canal, typically caused by longstanding water staying inside of it- In summary, thriving bacteria in damp ear!

Otitis externa in simple terms is defined as an inflammation of the skin lining the ear canal and sometimes may also involve the entire external ear. This condition should not be confused with a middle ear infection (otitis media) that occurs behind the eardrum. Acute otitis externa might be associated with other skin conditions like contact dermatitis, trauma to the skin lining the ear canal and foreign bodies. Otitis externa can also occur if skin and wax accumulate in the ear canal and get wet. The debris in the ear canal traps the moisture and creates a breeding ground for bacteria. Although the infection will generally settle down with antibiotic drops, it may recur if the ear canal is not thoroughly cleaned of debris. The debris can be present as a mixture of earwax and skin.

Swimmer’s Ear: Not Just for Swimmers

You don’t have to be swimming or a swimming Pro to get swimmer’s ear. In most cases, swimmer’s ear occurs when water or moisture is trapped in the ear canal. That means you can get it from taking showers or baths, washing your hair, or being in a moist or humid environment.

Swimmer’s ear can also occur from something getting stuck inside the ear, excessive ear cleaning, or contact with chemicals like hair dye or hairspray. Some skin conditions that affect the ear canal, such as eczema or psoriasis, may make one more prone to developing swimmer’s ear. In addition, individuals that wear ear plugs, ear buds, or hearing aids may be at an increased risk.

How common is this condition?

Although swimmer’s ear is more common in children and young adults, you can get it at any age. It’s estimated that around 1 in 10 people will be affected by it at some point in their lives. The condition is slightly more common in women than men and is most often diagnosed in adults 45 to 75 years of age Swimmer’s Ear (Otitis Externa) – DAN World.

How does this condition present itself and are there any complications?

Otitis externa is almost always accompanied by pain or itching. This condition is almost always caused by a bacterium called pseudomonas and can usually be successfully treated with antibiotic ear drops. Depending on the whether the condition is acute or Chronic and the specific causal bacteria, your doctor may prescribe a specific type of antibiotic to ensure effective and targeted treatment. The ear canal skin can become so inflamed that the swollen walls of the canal collapse on themselves, leading to conductive hearing loss and making it difficult for antibiotic drops to get in. In these cases, in addition to trying oral antibiotics, it may be necessary for a specialist doctor to put a wick in through the swollen canal to draw the antibiotics into where they can do their work.

One rare complication of otitis externa is necrotising otitis externa, which is where an infection spreads from the ear canal into the surrounding bone. This requires prompt treatment with antibiotics and sometimes surgery, as it can be fatal if left untreated Otitis externa | NHS inform.

Otitis externa. image courtesy S bhimji MD

From: Otitis Externa

StatPearls [Internet].

Treasure Island (FL): StatPearls Publishing; 20

Management of Otitis Externa:

We are frequently asked by our patients who are regular swimmers and are newly diagnosed as having this condition, firstly why they are a target of this condition and secondly what they can do about it. The usual advice is that in swimmer’s ear, the ear canal never has a chance to dry out. Bacteria that normally colonize the external canal flourish in the moist environment, causing pain, drainage, and swelling.

People who spend a lot of time in the water and who are prone to otitis externa can prevent infections by using ear drops made of alcohol and vinegar after swimming. This acidifies and dries the canal and prevents excessive growth of bacteria. One MUST always seek a medical advice before trying these. Although NICE (2023) provides a list of ways that one can manage this condition, we suggest that patients seek an initial appointment with their GP for diagnosis and further specialist referral if required.

Further Advice:

. Avoid ear trauma using manual tools
. Avoid inserting cotton wool buds and other things into your ears (including your fingers), as this can damage the sensitive skin in your ear canal.
. Keep your ears clean and dry; consider using over-the-counter acetic acid 2% ear drops or spray.
. Use a bathing cap, ear plugs, or custom-fitted swim molds when swimming.
. DON’T try to remove ear wax. Ear wax helps protect the ear canal from infection. The ear canal could be blocked by ear wax, check with your healthcare provider.
. Consider using ear plugs when swimming or wearing a swimming cap to cover your ears and protect them from water.
. Managing any underlying causes.
- . Seek your doctors advice.
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