Preventing Swimmer's Ear In Adults

Introduction

Swimmer's ear is the infection of your outer ear, which is a pathway between your eardrum and the opening of your ear. It is also called otitis externa.^1,2 Swimmer's ear is often the result of water getting into your ear and staying for long periods.⁵ This moisture makes the environment conducive to the growth of pathogens which cause this infection. Bacteria are the most commonly implicated, however, viruses and fungi are also implicated. Anyone could come down with a swimmer's ear but it is often seen in children.

Swimmer's ear is different from otitis media (infection of the middle ear), which usually follows an episode of the common cold in children. It is also important to note that a swimmer's ear cannot be spread from one person to another.

Putting objects, cotton swabs and fingers into your ears could damage the lining of your outer ear and put it at risk of getting infected. Otitis externa can be treated with antibiotic ear drops. 

Without treatment, the infection will usually not go on its own. Hence, prompt and adequate treatment is required to prevent more serious infections from spreading to the base of the skull and middle ear and also cause other severe complications.

Causes of swimmer's ear in adults

Swimmer's ears are usually caused by bacteria. Less commonly, fungi and viruses are also causative factors.

The ear has some natural defences against infection. These are:

Ear wax

A thin waxy film is made up of debris that enters the ear canal, and dead skin cells. It is water-repellent, acidic and has antibacterial properties. This prevents the growth of bacteria in the ear canal.⁴

The anatomical structure of the ear

The shape of the ear makes it slightly difficult for foreign objects to get into the ear canal. This is a protective mechanism against infectious and dangerous agents.

Once these protective mechanisms are overwhelmed, it's easy to get a swimmer's ear. Cleaning your ears way too much with buds can make you lose ear wax which should protect your ears. Also, too much water in your ears can affect the function of your ear wax. 

Risk factors for swimmer's ear include:

Excess moisture in the ear canal

Prolonged periods of moisture in the ear, especially if it's contaminated water, can lead to a swimmer's ear. After swimming, the water that gets into the ear, if not cleaned off, can create an enabling environment for bacteria to thrive and cause ear infections. 

Swimming in contaminated water

When you swim in contaminated water, you are exposed to high levels of bacteria which can cause your swimmer's ear.

Use of earbuds and other objects to clean the ears

When you use earbuds to clean your ears, they could cause scratches and erosions on the skin of your ear canal and allow bacteria to infect your ears. Also putting fingers and objects (like pens, paper clips, bobby pins) in your ears can make you develop swimmer's ear easily.

Chemicals

The chemicals in shampoos, hairsprays and other hair products are harsh on the ear. They damage the ear lining and increase your risk of having an ear infection.

Hearing aids

Use of hearing aids can increase your risk of getting swimmer's ear especially if they are contaminated by infectious substances. Also, they could rub away the protective ear wax or even scratch your skin, thereby increasing the risk of having swimmer's ear.⁴

Skin conditions

Having skin conditions like eczema and psoriasis can make you prone to ear infections.³ Sometimes, ear jewellery could irritate the skin in some people and increase the risk of having swimmer's ear.²

Age

While anyone can have swimmer's ear, it is more common in young children and early teenagers than in adults.² One reason is due to the narrow ear canals of children that make it easier to trap water and difficult to drain, hence constituting a favourable environment for bacteria to thrive.

Symptoms

The symptoms of swimmer's ear include:

1. Pain in the ear especially when the outer ear is pulled or has pressure put on it. The pain could get worse if treatment is delayed and may even spread to involve the side of your face
2. Itching in the ear
3. Redness and swelling in the ear
4. Discharge from the ear (Foul-smelling yellow-to-green pus oozing out of your ear)
5. Blocked ear (More like a feeling of fullness in the affected ear)
6. Difficulty hearing
7. Enlarged lymph nodes of the ear and neck
8. Fever (which is an important sign of an ongoing infection)

Preventive measures

Avoiding exposure to contaminated water

You should avoid swimming in polluted water as it could be infested with bacteria which can cause you an ear infection if it gets into your ears. Take note of posted warnings when the bacterial load is high in lakes or rivers and stay clear.⁵

Protect your ears while swimming

To avoid exposing your ears to water containing infectious agents that can cause swimmer's ear, you should do the following:

• Use bathing caps when you shower
• Plug your ears with ear plugs or ear-fitting moulds before you swim
• Make sure to clean earplugs properly before using them
• Be sure to plug your ears when you wash your hair with hair products. You do not want them getting into your ears

Keeping ears dry after swimming

• Dry your ears properly with a towel
• Tilt your ears right and left to let go of trapped moisture
• Pull your ears in all directions so that water in your ear canal can flow out 
• You could consider using a hair dryer. This should be set at the lowest and held about 0.3 meters from the ear
• Before using ear-drying drops to dry your ear after swimming, be sure to consult your healthcare provider because you don't want to use them if your eardrums are punctured or if you have an ear infection

Avoid putting foreign objects in the ear

Don't use objects like cotton buds, paper clips, pencils or keys to clean your ears. 

Do not try to clean the ear wax in your ears

Ear wax has the protective role of preventing the growth of infectious agents in your ears. However, if you think you could be having wax impaction due to excess wax collection in your ears, you can make use of wax softeners or consult your healthcare provider for further advice.

Caution after ear surgery or infection

If you've just had ear surgery or recently just completed treatment for an ear infection, you should avoid water.

Treatment

Over-the-counter ear drops

Most of the OTC ear drops for swimmer's ear focus on drying out the ear quickly rather than treating the infection. They contain Isopropyl alcohol and glycerin. Alcohol combines with water in the ear and makes it evaporate faster.

Prescription ear drops

Eardrops are typically used to treat swimmer's ear. They usually contain a combination of corticosteroids which help to calm down the inflammatory process going on and then antibiotics; which fight against the infections responsible. Antifungal eardrops are also available for swimmer's ear caused by fungi. They could contain acetone sometimes.

Usually, the eardrops are used 3 to 4 times daily for 5 days. The prescription also varies depending on your doctor's recommendation. You'd feel your symptoms improve within 24 hours of using the eardrops usually but they'll be gone in 2 to 3 days.

Pain relievers

Pain relievers are very useful in managing the symptoms of swimmer's ear. They don't cure it though. If you feel high discomfort, you should inform your doctor who would recommend some OTC pain relievers to address the pain you might be feeling.  Common painkillers are paracetamol, ibuprofen or naproxen.

Antibiotics

Usually, your doctor will recommend antibiotics in eardrop forms which could come as single antibiotics or combined with steroids. An example is Ciprofloxacin eardrops. Your doctor may also prescribe oral antibiotics like Amoxicillin.²

Summary

Swimmer's ear is a very common infection of the ear. It is usually caused by bacteria but fungi and viruses could also be responsible. Treatment is required as it doesn't resolve on its own and could cause severe complications. Eardrops are commonly used to treat swimmer's ear, whether they are antibiotics, steroids or analgesics. Preventive measures include using ear plugs while swimming and drying your ears properly to avoid having swimmer's ear.