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Swimmer’s Ear

An infection of the outer ear canal, swimmer’s ear, affects the ear from your eardrum all along the canal that runs to the outside of your head. It gains its name because it’s frequently caused by water remaining in your ear canal following a swim or bath. By remaining in the ear canal, the water causes moisture which, in turn, spurs the growth of bacteria inside your ear, leading to infection.

Despite the name, swimmer’s ear can also be caused by putting objects in the ear, including fingers and cotton swabs. While this is often done in an attempt to clean the ear, it can damage the thin layers of skin that line your ear canal.

While it’s more commonly known as swimmer’s ear, its official name is otitis externa. Swimmer’s ear is usually easily treated with some eardrops. Prompt treatment is critical as it can avert complications or the development of serious infections.

Symptoms

Symptoms of swimmer’s ear usually begin as mild, but they can easily grow worse if the infection goes untreated or spreads. The infection is usually classified by doctors by several stages of severity, beginning with mild, progressing to moderate, and finally becoming advanced.

Symptoms and signs of a mild infection include:

  • Itching inside your ear canal
  • Redness in your ear
  • Mild discomfort in your ear which worsens if you pull on your outer ear (the pinna or auricle) and push on the small bump in front of the ear canal opening (the tragus)
  • The discharge of a clear and odourless liquid
  • Moderate progression
  • Intensified itching
  • Increased pain
  • Extensive redness inside your ear
  • Excessive discharge of fluid
  • The sensation of fullness within your ear, or the feeling that your ear canal is partly blocked by debris or fluid
  • Muffled hearing
  • Advanced progression
  • Severe pain, not only in your ear but radiating to your neck, the side of your head, and your face
  • A completely blocked ear canal
  • Swelling or redness of the outer ear
  • Swollen lymph nodes in the neck
  • Fever

When to see your doctor

Even if your symptoms of swimmer’s ear are only mild, it’s important to contact your doctor so they can treat you before it grows worse. If you have either severe pain or fever, it’s vital you visit an emergency room or see your GP immediately.

Causes of swimmer’s ear

The infection behind swimmer’s ear is usually the result of bacteria, though a virus or fungus can less commonly trigger it.

Natural defences

While ears are relatively easily damaged by foreign invaders, they do have some fairly useful natural defences that strive to keep them free from infection and ensure they are clean These include:

The lining of the ear canal has a thin but water-repellent film across it which discourages the growth of bacteria.

Earwax builds up as a result of this film, along with dead skin cells from within the ear, and other debris that travels into the ear canal. The formation of ear wax actually keeps the ear clean.

The shape of the ear itself is designed to prevent the entry of foreign bodies.

How the ear becomes infected

Despite your natural defences, it is possible for your ear to succumb to moisture in the ear canal, which is the perfect breeding ground for bacteria.

Contaminated water can also lead to infection if your ear is exposed to it.

There is sensitive skin within the ear that’s easily damaged, opening the door to infection.

Risk factors

Several risk factors can increase the chances of swimmer’s ear developing. These include:

  • Excess moisture within your ear canal as a result of humid weather, heavy perspiration, or water staying in the ear following a swim or bathing.
  • Exposing the ear to contaminated water containing high levels of bacteria.
  • Using cotton buds, swabs, fingernails, hair pins and other items to clean the ear and cause abrasions or scratches.
  • Hearing devices, earbuds (headphones) and other devices that sit within the ear itself and cause the skin to break.

Complications

While swimmer’s ear isn’t usually a serious infection if it’s properly treated, there can be complications. These include temporary hearing loss, which leads to the sense that everything is muffled. Usually, once the infection clears, your hearing will go back to normal.

Another unpleasant complication is a long-term infection or chronic otitis externa. Should your signs and symptoms continue for longer than three months, it’s usually considered to be a chronic infection. Certain circumstances make chronic infections more likely. These include an allergic reaction, a rare bacteria strain, or a combination of fungal and bacterial infections.

On rare occasions, swimmer’s ear can also develop into deep tissue infection (cellulitis). This occurs when the infection spreads to the connective tissues and deeper layers of the skin.

Another rare complication is bone and cartilage damage (or skull base osteomyelitis). When the ear infection spreads to the cartilage in your outer ear as well as your lower skull, it can cause acute pain. If you have diabetes, a weakened immune system, or you’re elderly it’s often easier for the infection to take root in this way.

Widespread infection starting from the ear is a rare complication, but it has happened.

Prevention

To prevent the development of swimmer’s ear there are a few things you can do:

Always dry your ears and ensure you tip your head to one side, then to the other, following a swim or a bath. This will allow any water in your ears to drain out. You should only do this with your outer ear, if you wish to dry your inner ear you can use a hairdryer set to its lowest setting. Just make sure you hold it a foot from your head at least.

Provided you’re sure your eardrum isn’t perforated, you can treat your ears using preventative eardrops that reduce the risk of infection. These are usually made of 1 part rubbing alcohol and 1 part vinegar, a solution promoting dryness and preventing the growth of fungi and bacteria. Simply pour about 1 teaspoon of the mixture into each ear following swimming, then allow it to drain out.

Swim wisely and avoid lakes or rivers when there is a warning of high bacteria counts.

You can protect your ears while swimming using earplugs or a swimming cap.

Keep irritants out of your ears by putting cotton balls inside them if you’re drying your hair or using hair sprays.

Be careful following ear surgery or an infection. If you’re recovering from either, ask your doctor before you swim.

Never use foreign objects to attempt to clean or scratch your ears. It’s more likely to pack any material inside further into your ear.

If you have earwax and wish to remove it, the easiest way to do so is to gently wash it away with a damp cloth when it moves to the opening of your ear canal. It will do this naturally, so it’s better to leave earwax alone and let it do its job.