As summer temperatures climb, the cool waters of local lakes and ponds offer welcome relief from the heat. But a refreshing swim can sometimes leave behind an unwelcome souvenir: swimmer’s ear.
Although the painful infection can develop after swimming in a chlorinated pool, the risk is significantly higher in natural bodies of freshwater. Bacteria flourish in untreated water, especially in hot weather. When water becomes trapped in a warm ear canal, it can break down the skin’s protective barrier, creating an ideal breeding ground for microbes to grow.
Swimmer’s ear, formally known as acute otitis externa, accounts for more than half a million emergency room visits each year, and affects an estimated 1 in 10 Americans during their lifetime. The non-contagious infection of the ear canal typically stems from bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus. Less commonly, fungi such as Candida are responsible.
Once the infection develops, the delicate lining of the ear canal becomes inflamed and swollen, causing pain and itching. The inflammation frequently spreads to the outer ear, and the infected skin can ooze pus or fluid. Many people experience a feeling of fullness in the ear, muffled hearing, or temporary hearing loss.
Anyone can develop swimmer’s ear, but those who swim are five times more likely to develop it than those who don’t. Removing ear wax — which serves as an important water-resistant barrier that naturally deters infection — also increases the risk. Using bobby pins, paper clips, cotton swabs, or other objects to clean the ears can cause micro tears in the delicate skin of the ear canal, which may promote bacterial growth.
People who wear hearing aids or earbuds may also be more susceptible to infection because the devices can cause ear irritation, trap moisture, and if unclean, increase bacterial counts. Individuals with immune-mediated skin conditions, like eczema and seborrhea, are also at higher risk.
Swimmer’s ear rarely resolves without treatment, so it’s best to see your primary care provider at the first sign of symptoms. The typical treatment is a seven-day course of prescription ear drops, which usually provides relief within 48 hours. For mild infections, the active ingredient is acetic acid: It is drying, and restores the ear canal’s acidic pH balance. The drops usually include a steroid to reduce inflammation, hasten healing, and ease pain. For moderate to severe infections, antibiotic or antifungal drops are often needed. Oral prescription medications, including antibiotics, are rarely required; over-the-counter acetaminophen or ibuprofen, if not contra-indicated, can manage pain.
The best treatment, however, is prevention.
To prevent swimmer’s ear, check freshwater quality before swimming. Information on Dutchess and Columbia county waterbody status can be found on the New York State Department of Environmental Conservation website.
Limit your time in the water to hour-long sessions. Don’t stick anything into your ear canals; instead, rely on the ear’s natural cleaning process to get rid of earwax. Ask your clinician about earwax softening drops if you think you have excessive earwax. Avoid earplugs while swimming unless they are specifically designed to be water-tight. Minimize earbud use; keep hearing aids clean.
If water gets trapped in your ear canal, gently dry the outer ear with a soft towel, then tilt your head so the blocked side is down. Gently pull and jiggle your earlobe upward and backward to straighten the canal. If needed, hop on one foot to let gravity break the surface tension and release the liquid.
Water enthusiasts and those prone to swimmer’s ear can benefit from preventive vinegar eardrops, which dry the ear canal and restore its acidic pH. The American Academy of Otolaryngology-Head and Neck Surgery recommends the use of homemade eardrops — but only if there are no eardrum perforations or pressure-equalizing tubes, so first check with your provider. Mix equal parts white vinegar and rubbing alcohol in a clean dropper bottle. After swimming, tilt your head and put three to four drops into ear canals; wait 30 seconds, then tilt your head the other way to let the drops drain out.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.