Managing
Swimmer's Ear

What is swimmer’s ear?

When you have swimmer’s ear you have an infection of the outer ear canal (from your eardrum to the outside of your head). Swimmer’s ear is medically known as otitis externa.

The infection most often occurs when the ear canal stays wet long enough for bacteria or other organisms to grow in the fluid. This usually occurs after swimming and is more common in children but can also occur by irritating and damaging the skin in the ear canal by putting fingers or cotton swabs into your ear.

How do you know you have swimmer’s ear?

Swimmer’s ear symptoms are usually mild at first, but they can worsen if your infection is not treated. Symptoms of swimmer’s ear include when the ear becomes itchy, painful or tender, red and swollen. There may be a little swelling or bump (known as a tragus) that you can feel in front of your ear.

When to see your doctor:

Contact your doctor if you have severe pain, a temperature, excessive fluid drainage from your ear or any other severe symptoms.

What causes swimmer’s ear?

Swimmer’s ear is an infection that is usually caused by bacteria, and less commonly, by a fungus.

Your outer ear canals have natural defences that help keep them clean and prevent infection, including glands that secrete the waxy cerumen (ear wax) that forms a water-repellent layer in the ear canal and collects dirt, preventing it from reaching the ear drum.
However, if you have swimmer’s ear, your natural defences have not worked because they have been weakened by one or more of the following:

• Excess moisture in your ear: Typically, this is water that remains in your ear after swimming, but can also include water from bathing, heavy perspiration (sweating) and humid conditions. This fluid build-up creates a favourable environment for bacteria to grow in.
• Damage to the skin in your ear canal: Cleaning your ear with a cotton swab or other instruments, as well as scratching inside your ear with a finger or wearing earbuds or hearing aids, can cause abrasions in the skin of ear canal that bacteria can grow in.
• Allergic reactions: Hair products or jewellery can cause allergic reactions and skin conditions that promote inflammation.

Risk factors for developing swimmer’s ear are:

• Swimming, especially in water that contains a high level of bacteria
• Aggressive cleaning of the ear canal with cotton swabs or other objects
• Use of certain devices, such as earbuds and hearing aids
• Skin allergies or irritation from jewellery or hair sprays and dyes.

How do you prevent swimmer’s ear?

Here are the ways to avoid swimmer’s ear:

• Keep your ears dry: Try not to get water in your ears when you swim or bathe.
• Do not swim in dirty water: This is especially true where it is indicated that there are high levels of micro-organisms like bacteria present.
• Avoid putting foreign objects in your ear: Remember your ear has natural ways of clearing ear wax from your ear so you do NOT need to clean them out with cotton swabs or other objects.
• Try to avoid irritants from entering your ear: For example, when you are applying hair products or the likes.
• Speak to your doctor before swimming if you have recently had an ear infection or surgery.

What treatment is used for swimmer’s ear?

See your doctor or other healthcare provider if you have symptoms of swimmer’s ear.
Your doctor will probably prescribe treatment with antibiotics or antibiotic ear-drops that may also contain cortisone and other anti-inflammatories.
You may also have to use analgesics (pain relievers), like paracetamol or non-steroidal anti-inflammatories such as ibuprofen, to manage your pain.

Importantly, avoid swimming or getting more water in your ears when you are being treated for swimmer’s ear. You may also have to avoid wearing earbuds or hearing aids and may have to avoid sudden pressure changes such as travelling on an airplane.

What are the complications associated with swimmer’s ear?

Swimmer’s ear is usually easily treated, but complications can occur, especially if the condition is left untreated, including:

• Temporary hearing loss (this will go away when the infection clears).
• Long-term infection: An outer ear infection is usually considered chronic if signs and symptoms persist for more than three months. Chronic infections are more difficult to treat and usually occur when the infection is caused by a rare strain of bacteria, a combination of a bacterial and fungal infection, or when there is also an allergic skin reaction, or a skin condition, such as dermatitis or psoriasis, in the ear.
• Deep tissue infection: Rarely, swimmer’s ear can spread and cause infection in the deeper tissues of the skin (cellulitis).
• Bone and cartilage damage (early skull base osteomyelitis): This is a rare complication of swimmer’s ear when the infection spreads to parts of the head and skull, causing severe pain. Older adults and people with weakened immune systems, like those with diabetes, are at more risk of this developing osteomyelitis.
• More-widespread infection: Very rarely, the infection can spread to the brain or the meninges (membranes around the brain) causing encephalitis or meningitis.