Swimming can be a delight for children and for parents. Although water in the ear from swimming or bathing is not associated with most types of ear infections (even for children with tubes!), it can cause one kind of ear infection as well as exquisite pain.
Swimmer’s ear is an infection of the skin that lines the ear canal. A waxy, water-resistant coating usually protects this skin. Bacteria normally live on the surface of the skin with no ill effect.
If there is a break in the skin’s normal barrier, these bacteria can slip inside the skin, causing an infection called external otitis or swimmer’s ear. This is different from otitis media. What creates a gap in the protective barrier of the skin? If the ear remains wet for long, moisture penetrates the water-resistant layer and the skin becomes prune-like in the same way that one’s fingers and toes become soft and wrinkled when they remain in water. Bacteria can easily move into this soft skin. Tiny scratches in the ear canal (usually from sticking a finger or some other object into the ear) also leave the skin vulnerable to infection. The skin can even be breached as a result of the ear’s becoming extraordinarily dry, causing the skin to crack. Ironically, swimmer’s ear can be the result of spending time in desert conditions.
Preschool and school age children get swimmer’s ear more than anyone else. Babies and toddlers are usually spared from swimmer’s ear, even if their ears get wet. Adolescents and adults are at risk. Children with eczema or seborrhea are at higher risk than their peers. Swimmer’s ear is more common in people who swim in pools than in people who swim in lakes. Perhaps this is because the chlorine in swimming pools disproportionately kills the gentle, beneficial bacteria in the ear canal, giving the aggressive bacteria freer reign.
People with swimmer’s ear usually complain of an itchy and/or painful ear. The pain can be quite severe. The ear is particularly sensitive to the ear lobe’s being moved up and down. The earwax may appear soft and white, and there may be a small amount of clear discharge. Sometimes hearing is decreased during swimmer’s ear. Rarely the infection can become quite severe.
Swimmer’s ear will usually disappear within 2 to 3 days of treatment.
It may be diagnosed from the history and/or the physical exam. With severe infections, cultures may be necessary to identify the specific bacteria or virus involved.
Early or mild swimmer’s ear can sometimes be treated with a few drops of white vinegar placed in both ears provided that the ear drums are normal and intact. Put the vinegar in one ear and leave it for about five minutes before turning that ear down in order to drain the vinegar solution. Repeat this twice a day for three days. Some doctors recommend a similar solution using rubbing alcohol and white vinegar.
If the symptoms worsen or persist for over three days, prescription antibiotic drops may be necessary. They are effective the great majority of the time. Some prescription drops also contain topical steroids which can rapidly help pain and swelling in the ear. Sometimes oral pain medicines are also necessary. Rarely, oral or even IV antibiotics are needed.
The first step to prevent swimmer’s ear is to make sure the ears get dry after being in the water. Turning the head and gently pulling the ear in different directions helps to drain water out of the ear. Try drying the opening of the ear very carefully as far as you can reach with a towel.
If swimmer’s ear becomes a recurrent problem in children with normal, intact ear drums, you can put a few drops of rubbing alcohol into the ears each time they become wet to facilitate drying. Another good option is instilling a few drops of white vinegar. The acetic acid inhibits the growth of bacteria in the skin. Controlling seborrhea or eczema can be helpful for affected children.
External otitis; otitis externa