By Jon Foss, founder, CEO and swim coach and instructor
If your swimmer is complaining of an itchy or sore ear that’s a little red, feels plugged, and hurts more when you pull on the earlobe, you are likely dealing with swimmer’s ear—a subject I, unfortunately, have a lot of personal experience with. In my 31 years of experience as a swim instructor and coach, I have had more than my fair share, from swimming 10 practices a week or teaching 40 hours in the pool. Fortunately, if you catch it early, it’s easy to treat at home. For full disclosure, I am not a doctor, but my father was and he helped treat me. I’ve since learned quite a bit about what causes it and how to treat it, and how NOT to treat it.
Not the same as an inner ear infection
Parents are often familiar with Otitus Interna, the inner ear infection common in toddlers and treated with antibiotics or sometimes tubes in the ears. Good news: swimmer’s ear (or Otitus Externa in medical terms) is very different. It is an infection of the OUTER ear canal, and will only require antibiotics if left untreated. Swimmer’s ear is typically caused by the normal, residential bacteria already found in your ear, rather than dirty water. Normally, these bacteria reside on the surface of the skin in the ear canal, where they are kept in check by the naturally acidic pH of the ear.
But when you swim, a few things can happen:
- Acidity changes: The pH of your ear changes to neutral when pool, bath, ocean or lake water get into it, letting the bacteria grow unfettered.
- Bacteria nestles in: The cells lining the ear may swell with frequent immersion, creating space between the cells the bacteria can enter.
- Water is trapped: Water may get trapped in the ear canal because of its shape or because of earwax buildup, keeping the ear lining wet.
- Abrasions to the ear make things worse: Abrasions can occur if you use a cotton swab to dry the ears or scratch the inside of your ear in some other way.
Next thing you know your ear itches, feels plugged and a slight pull on the earlobe verifies the problem. At this point it is treatable.
Eventually, the ear becomes sore and inflamed, and if left untreated, the swelling can spread to the nearby lymph nodes. At that point, it can cause enough pain that moving your jaw becomes uncomfortable. This can happen as quickly as a couple of days. At this point, the only treatment is antibiotics.
So how does one prevent or care for swimmer’s ear?
- Dry your ears after swimming. This is usually enough for 95% of all swimmers and teachers. A simple hair dryer for 15 seconds per ear is usually enough – small, portable dryers are affordable and effective.
- Try over-the-counter ear-drying drops. These often use a mix of alcohol and mild acidic solution to dry your ear and return the pH to normal levels. A few drops in each ear, allowed to sit for five minutes, is usually enough to do the trick. Keep a tissue handy – drops tend to leak out.
- For advanced infections, get antibiotics. A doctor or clinician can prescribe antibiotic drops or oral antibiotics as needed.
I have noticed that as swimmers get older, their bodies seem to self-correct and swimmer’s ear is no longer a problem. Most high-level swimmers (ages 11 and over) do not use anything in their ears. Their body just gets used to the water and only on a rare occasion do they need treatment.
About ear plugs, ear tubes and ear wax
- In my experience, ear plugs and ear bands are poor at keeping water out. I have tried them on occasion and they never seem to work for me, so I can’t recommend them. Water always slips behind and they tend to irritate the ear tissue.
- Children with PE tubes are more prone to infections. I suspect it is because the use of cotton swabs on children with PE tubes is more common and these may cause surface abrasions that allow the bacteria to take hold.
- If you’re swimming for an extended period of time, the earwax (cerumen) in your ear may build up and cause the external ear canal to become blocked off, increasing the chance of swimmer’s ear. I would suggest an over the counter ear wax removal remedy, rather than cotton swabs.
At the end of the day, all the research suggests the most important factors are keeping the ears dry, maintaining a healthy pH, and allowing any treatment enough time to work. Swimmer’s ear is a nuisance, but nothing more than that when you take the proper steps. I hope this has been helpful, and we’ll see you at the pool!