What is Swimmers Ear?

Swimmer’s ear or otitis externa is defined as the infection of the outer ear canal. Otitis externa is mostly developed in ears that are exposed to moisture. It is most prevalent in people who enjoy a lot of diving or swimming time. There are more cases of otitis externa in the summer. This is due to the fact that people engage in more swimming activities in this period.
This infection can also affect the ear pinna or the tympanic membrane. Swimmer’s ear can either be a fungus or bacterial infection. According to Clinical Practice Guidelines, nearly all the cases of swimmer’s ear (98%) in North America are caused by bacterial. The most common bacterial include Pseudomonas aeruginosa with 20%-60% prevalence and Staphylococcus aureus which has a 10%-70% prevalence. There are other gram-negative pathogens that can cause swimmer’s ear other than Pseudomonas aeruginosa. However, these pathogens are responsible for about 2% to 3% of otitis externa in large clinical series.
There are two major types of Otitis externa the Acute Otitis Externa (AOE) and the Chronic Otitis Externa (COE). The involvement of fungi in AOE is very much uncommon, however, it can be a commonplace in COE. Fungal involvement can also occur after the treatment of AOE with less often systemic or topical antibiotics.
Treating swimmer’s ear or otitis externa with topical antibiotics can be very effective for AOE when compared to oral antibiotics. In other words, oral antibiotics are less effective for the treatment of swimmer's ear. Notwithstanding, about 20%-40% of AOE patients are treated with oral antibiotics without a simultaneous administration of the topical antibiotics. In most cases, these oral antibiotics are less effective or even ineffective against Pseudomonas aeruginosa and Staphylococcus aureus and may lead to a lot of unwanted side effects. This is due to the fact that they are distributed around the body.

Causes of Swimmer’s Ear

The major cause of this infection is too much exposure of the ear to moisture. Swimming or diving activities can bring the germs that cause otitis externa directly into the auricular duct. While cases of swimmer’s ear might be more prevalent in those who are constantly exposed to water, there are also cases in people who do not swim. Cleaning the ear canal too frequently mostly with cotton swabs or sharp objects can cause otitis externa in non-swimmers.
Cleaning the ear canal too frequently can lead to the removal of cerumen from the ear. Cerumen is very important in the prevention of moisture from the ear. This substance creates a slightly acidic pH in the ear that inhibits the growth of Pseudomonas aeruginosa in the ear which is the major cause of the swimmer’s ear. Additional causes of the swimmer’s ear may include the use of alkaline eardrops and soapy deposits in the ear.
Other causes of Otitis externa include local trauma caused to the ear as a result of the self-cleaning attempt, excessive wearing of hearing aids and ear irrigation. Fragments from dermatological conditions can also boost the growth of this infection.
AOE is mostly prevalent in regions where the climate is warmer with increased humidity and contact with water through swimming. Most researches also link AOE to the quality of water in terms of bacterial load. Nonetheless, this is not always true for all cases.
The pathogens that cause AOE however, are present in most swimming pools and hot tubs. Even pools and tubs that maintain high-quality water standards may also contain the pathogens that cause AOE.
It is also important to note that the organisms that cause AOE are present in the healthy outer ear canal. Thus, the outer ear canal can also be a cause of this infection. Individuals with type A blood group tend to be more susceptible to this infection. There may be some differences between the subspecies of Pseudomonas causing AOE and other Pseudomonas infections.

Symptoms of Swimmer’s Ear (Otitis Externa)

There are quite a number of symptoms that are associated with swimmer’s ear. Swimmer’s ear symptoms are often mild at the inception of the infection. These symptoms can become worse if the infection is not managed on time.
The disease can also spread progressively without proper care. Otitis externa is classified according to the phase of progression by doctors. These phases include mild, moderate and advanced phases. One of the major symptoms is severe pain in the ear that worsens over time. The pain becomes more severe when the outer ear is pulled or pressed.
Redness of the outer ear may be noticed and in severe cases, swelling. AOE can lead to the inflammation and enlargement of the lymph nodes around the outer ear. Pus may also gather in the ear canal and be discharged through the ear opening. This pus is usually yellowish-green in color. The collection of pus or swelling in the affected ear can cause hearing difficulty in the affected ear.
Symptoms of the mild phase of Swimmer’s ear.
The mild signs of swimmer’s ear include:

  • Mild itching in the auditory canal

  • Slight redness may be noticed inside the auditory canal.

  • Slight redness of the eye on the affected side of the face.

  • Increased pain can be worsened by pulling the auricle or pressing the tragus.

  • Clear odorless fluid can be noticed in the affected ear.

Symptoms of the moderate phase.

  • There is increased itching of the ear canal

  • The pain increases progressively

  • The inflammation in the ear becomes more visible and large

  • Fluid drainage increases

  • Feeling of partial blockage in the ear and increased hearing difficulty.

Symptoms of the advanced phase of Swimmer’s ear

  • Pain becomes excessively severe. This pain can radiate on the face, side of the head or neck

  • The ear becomes completely blocked at this stage

  • The outer ear now becomes very swollen or red.

  • The lymph nodes in the neck become swollen.

  • Feeling of dizziness and fever.

Risk Factors of Swimmer’s Ear

There are a couple of factors that can increase your risk of getting infected by swimmer’s ear. These factors include:

  • Swimming: this can increase your chances of getting infected. The pathogens that cause swimmer’s ear are mainly found in pools and tubs. If you are a frequent swimmer you are at higher risk of contracting the infection.

  • Allowing water with a high level of bacterial enter the ear: the higher the bacterial level in the water, the greater your chances of getting infected by swimmer’s ear.

  • Cleaning of the ear canal in a hostile way with cotton swabs and other sharp objects: Aggressively cleaning the ear with cotton swabs and other sharp objects can lead to breakage in the ear canal. This can make it easy for the pathogens that cause swimmer’s ear to easily attack the ear.

  •  Extended use of devices such as hearing aids and earbuds can increase your chance: suing devices such as the hearing aid and ear buds can increase your chances of infection. These devices can cause local tension in the ear and the disruption of the normal pH leading to increased chances of infection.

  • Skin sensitivities or irritation caused by hair spray, and hair dyes: Care products such as hair spray and hair dyes coming in contact with the ear can disrupt the normal pH of the ear thereby increasing your chances of getting infected.

  • People with small ear canal are more likely to contact infection: small ear canals are more likely to retain water and moisture which increases your chances of been infected.

  • Some skin conditions such as eczema, psoriasis, and acne: these skin conditions also constitute risk factors of the swimmer’s ear.

  • Using swim cap, excessive accumulation of earwax: Using swim caps for long periods can lead to the buildup of moisture in the ear. This increases the chances of the pathogens that cause swimmer’s ear to grow. Excessive accumulation of ear wax can cause water to stay trapped inside the ear. This can also increase your chances of getting infected.

Diagnosis of Swimmer’s Ear

Once you notice any of the symptoms even the mildest, it is advisable to visit your doctor. An examination of the ear is carried out using an otoscope (a handheld device for ear examination). Some of the signs the doctor will be checking for includes:

  • Redness and inflammation of the outer ear.

  • Scaly or flaky skin in and around the auditory canal.

  • Examination to ascertain if there is any damage to the eardrum.

During an examination, the doctor will also request for information concerning the following:

  • Your Personal medical history.

  • The kind of symptoms you are experiencing.

  • Your recent activities include how often you cleaned the ear, inserting, flushing and even swimming. He might also want to know your cotton swab use habits.

In cases where the auditory canal is blocked, the doctor might consider scraping with the use of a special device called the ear curette. The curette is specially designed for scrapping away debris from the auditory canal. A suction device can also be used to clear the auditory canal.
In cases where damage has already occurred to the eardrum, the doctor will refer the patient to an ENT specialist for further examination of the cause and damage done to the ear by the infection.
In rare cases where there is little or no improvement to the ear after administration of treatment, the doctor might consider taking samples of the debris from the ear for further testing. This will help to determine the root cause of the problem and provide the best solution for it.
The use of x-rays and blood tests may be used but are, however, rarely required. This is due to the fact that it can be easily diagnosed through physical examination.
For persons over the age of 50 with ear pain visiting the doctor, it is most likely for doctors to rule out temporal arteritis or malignancy. This condition leads to damaged or inflamed arteries.

Treatment for Swimmer’s Ear

The treatment for swimmers ear does not involve complex procedures. It is usually a direct procedure. Some of the treatment options include the following:

  • The use of painkillers: Painkillers like ibuprofen and acetaminophen (Tylenol) amongst others can be used to relieve pain and discomfort.

  • Doctors can also prescribe ear drops for the treatment of swimmer’s ear: The prescribed ear drops typically contain acidic acid or an astringent, an antibiotic treatment, and anti-fungal formulation or a compound of all of them.

  • The use of micro-suction: In some cases, the ear specialist uses a micro-suction to clear the ear canal to make treatment with ear drops more effective.

  • The use of the ear wick can be employed for an effective administration of treatment: The ear wick is a soft gauze plunge manufactured from cotton that is inserted into the ear. This plunge is covered with medication. This ensures that medication is administered directly into the ear.

In the case of moderate to advanced otitis, other kinds of treatment may be considered as well. In the case of moderate otitis caused by skin allergy or other skin issues, the doctor will consider treating the skin condition first before prescribing treatment for otitis.
Eardrops or ear spray may be administered for a period of 7 days. Eardrops and spray contain corticosteroids and acetic acid respectively. Where these prove ineffective, the use of anti-fungal ear drops will be prescribed.
For advanced otitis, the pus-filled inflammation will usually burst and heal in a few days without the need for treatment.
Where the symptoms remain prevalent for more than a week, the doctor may consider prescribing antibiotics. In situations where there is severe pain and the inflammation refuses to burst on its own, the doctor can consider draining it manually. He can also prescribe painkillers to reduce pain.

Home remedies for prevention and treatment Swimmer’s Ear

Ø Treatment

There are couple of ways to prevent and treat swimmer’s ear or otitis externa at home. These home remedies include the following:

  • Ensuring the ear is dry at all times: The use of shower caps when bathing and staying out of the water can help ensure that the affected ear heals faster.

  • Getting rid of debris and discharge in the ear gently: this process is best performed by a doctor or under the supervision of a doctor. Cotton wool can be used to clean the outer ear alone. Avoid pushing cotton wool or swabs deep into the ear.

  • You can use a warm compress to relieve pain: get a warm towel and place it over the ear, this can help reduce pain.

  • Avoid the use of ear devices when you notice symptoms: discontinue the use of earplugs, hearing aids and any other device that causes allergic reactions to the ear the moment symptoms are noticed.

  • Check for side effects from the use of ear drops: the use of eardrops that contain propylene glycol or neomycin can trigger allergic reactions. Watch out for them and discontinue use.

Ø Prevention  

It is more important to prevent an ear infection from occurring in the first place. The best way to prevent the infection is by ensuring that the ear is kept as dry as possible. Minimize the number of times you swim and most of all stay away from dirty and polluted waters.

  • Ensure you dry the ears after a swim. According to the Merck Manual, mixing a solution of alcohol and vinegar in equal portions and putting two drops in both ears after a swim can be very helpful. Alcohol will help get rid of any water trapped in the ear after a swim. While vinegar will help to prevent any growth of bacterial by changing the pH of the ear.


  • Make sure you dry the outer ear with cotton wool or towel after swimming. You can tilt the head to one side and pull the earlobes in different directions to get rid of any water trapped in the ear.


  • You can use a hairdryer to dry out the ear. However, the dryer must be used with caution. It must be placed at least1ft away and set to low.


  • Invest in the right size of earplugs and also wear swim caps that cover the ears properly.


  • After swimming in a chlorine-treated pool, it is very important to rinse the ears again with clean water.


  • Avoid the use of cotton swabs and other sharp objects to clean the ear. These can force debris deeper into the auditory canal and cause infection. Cotton swabs should only be used in cleaning the outer ear. Wax naturally flow out to the outer ear. When wax build up in the inner auditory canal, it should be taken care of by the ear professional.


  • You should be careful about the way you use products such as hair sprays and dyes. These products have been reported to cause irritation that leads to otitis externa. To prevent these products from coming in contact with the ears, it is advisable to place cotton balls carefully on the ears before using these beauty products.


Is it Advisable to Use OTC drugs to Treat Swimmer’s Ear?

A good number of people will opt for OTC drugs and eardrops the moment they notice the symptoms of Swimmer’s ear. This approach is not advisable and therefore, must be discouraged. This is due to the fact that there are different causative pathogens for swimmer’s ear infection. It is, therefore, the duty of the healthcare professionals to ascertain the actual cause (whether fungi or bacterial) of swimmer’s ear, in order to determine the right treatment for it.
OTC pain medications such as Ibuprofen, acetaminophen, and aspirin have been found useful for the treatment of the swimmer’s ear, but, they only serve as remedy for pain and not treatment.
However, it is important to avoid the use of nonprescription ear drops for the treatment of swimmer’s ear. It is very important to see a doctor and obtain proper prescriptions when you notice any symptoms of swimmer’s ear.
Desist from attempting to treat ear infections at home. Self-medication can worsen the condition and make it difficult to heal. Just like other parts of the body, treating ear infection such as swimmer’s ear must also be taken seriously.
Famous names like Richard Thomas whose role in the TV series The Waltons is one of the famous people at the fore of the fight against deafness and raising awareness in a lot of other issues concerning hearing health. This includes the awareness about the swimmer’s ear.
It is definitely not surprising to see Richard Thomas playing such an important role. He is one among the many that have suffered a partial hearing loss as a result of cochlear otosclerosis. While his case was detected in time and treatment began, the condition had already done a reasonable amount of damage to his hearing.
In his speech, he encourages people to take quick action when they notice that a hearing loss is setting in. Expedite action can save you a lifetime of regret. Richard Thomas remains a strong advocate for hearing health and offers his services as the national chairman of the “Better Hearing Institute (BHI)).
It is important to understand that there are no small ear infections. No matter how insignificant the symptoms may seem, it is important to seek proper medical attention.

Swimmer’s ear complications

This condition is not always very serious and complications are of often rare the moment treatment commences. When treatment fails to commence as at when due, the infection may affect the deep tissues. This can lead to severe complications. Some of the complications that can arise from the non-treatment of Otitis externa includes the following:
Abscess: This is usually filled with pus and located in or around the affected area.
Cellulitis: this is a more serious condition and it occurs when bacteria enters the deep layer of the skin.
Stenosis: This situation happens as a result of dry skin accumulation in the auditory canal. This can lead to partial or total hearing loss in the affected ear.
Otomycosis: A complication of otitis externa can lead to a fungal infection known as Otomycosis.