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  • Writer's pictureDr. Koralla Raja Meghanadh

Swimmer's Ear (Chronic Otitis Externa)

Updated: Apr 1



Swimmer’s ear or chronic otitis externa is a mild, continuous, long-standing infection in the ear canal often seen in swimmers. It can be a recurrent disease in swimmers.


This infection occurs when water enters the ear canal, creating a moist environment ideal for bacteria and fungus to grow for a few hours until it dries. It affects swimmers due to their constant water exposure and its chemicals.

Swimmer's ear or swimmer ear - symptoms, causes, diagnosis, treatment, prevention

Note: Swimmer’s ear is a type of Otitis Externa, which is chronic in nature. Many sources on the internet use Otitis Externa and Swimmer’s ear as synonyms. That’s not true. Otitis Externa translates to Ear infection in the external ear. Other types of Otitis Externa include Bacterial Otitis Externa, Otomycosis(Fungal Otitis Externa or Fungal ear infection), etc.


Is Swimmer’s Ear Fungal or Bacterial?

Swimmer’s ear infection can be bacterial, fungal, or both. Many times, it is both bacterial and fungal.


Symptoms of Swimmer Ear

The symptoms of swimmer’s ear are the same as the otitis externa symptoms, which are usually mild:

  1. Pain in the ear

  2. Itchiness or irritation in the ear

  3. Pus from the ear. Yellow-colored watery discharge from the ear


What Causes Swimmer’s Ear Infection?

As the name indicates, a swimmer’s ear infection is primarily caused by swimming. Particularly in individuals who engage in the activity regularly, water can enter the outer ear, and some of it may remain trapped in the ear canal for an extended period, sometimes for 2 to 3 hours or even longer.


The water in the swimming pool has chlorine and other chemicals. These chemicals will stay in our ears along with the water and irritate the thin skin in the ear canal. The irritation will prompt us to try clearing the ear. The ear canal’s skin becomes delicate during this time due to the longstanding wetness. Our attempts to clean the canal can easily result in skin rupture. This ruptured skin can quickly become infected due to chemicals, bacteria, and fungi. So, a swimmer’s ear can be bacterial, fungal, or both.


How is Swimmer’s Ear Diagnosed?

The complaints or symptoms mentioned above, like itching, pain, and irritation, are mentioned by the patient. These symptoms are generally mild and recurring.


When a doctor looks into the ear, we can confirm the diagnosis by observing

  1. Swelling of the ear canal skin

  2. Edema of the skin

  3. Pus discharge


Additionally, the patient’s history with a swimming pool further confirms the diagnosis.


Swimmer’s Ear Treatment

Treatment for swimmer’s ear typically involves antibiotics and external cream application that contains both antibiotics, antifungal, and a mild steroid.


Antibiotics are prescribed orally and as a cream application, but antifungal treatment is typically limited to cream application.


There is no need for oral antifungal medication since the swimmer’s ear is primarily a cutaneous superficial opportunistic infection of the ear canal’s skin.


Home Remedies for Swimmer’s Ear

You can use any of the below two home remedies for swimmer's ear. But, if a person has perforation in the eardrum, home remedies can lead to unnecessary complications like facial paralysis, vertigo, tinnitus, hearing loss, etc.


You can use one of the below home remedies for chronic otitis externa or swimmer's ear at your own risk.


White Vinegar

You can prepare the ear drops using the below formula.

1 portion of white vinegar (5% acetic acid) + 4 portions of drinking / RO / distilled water

Rubbing alcohol

The alcohol percentage should be less than 70%. This can be used as ear drops.


We would suggest an ENT consultation over home remedies for any ear infection due to the complex nature of the ear.

What are the Complications of Swimmer’s Ear?

If a swimmer’s ear patient scratches their ear with a sharp object, the risk of spreading the infection increases. This infection can extend to the middle and external ear and even affect the outer cartilage. In such cases, stronger medication may be required.


While a swimmer's ear usually doesn't cause additional issues, a severe infection may intensify pain and itching.


Use of self-prescribed antibiotic ear drops

In most cases, a swimmer's ear can have a fungal infection. When antibiotic ear drops are used without a prescription, the infection can worsen ten times overnight.


How to Prevent Swimmer’s Ear?

The most effective way to prevent swimmer's ear is to take steps to keep water out of the ear canal. Additionally, here are some tips that help you in preventing swimmer’s ear:

  1. Wearing earplugs while swimming

  2. Avoiding the use of cotton swabs or other objects to clean the ear canal

  3. Avoid scratching your ears

  4. Don’t use antibiotic ear drops or any other ear drops without a prescription.

Following these tips can significantly reduce your risk of developing a swimmer’s ear and maintain ear health.


Takeaway

If you experience symptoms of a swimmer's ear after swimming, please consult an ENT doctor, as we might not understand the condition.


Swimmer's ear can be fungal, bacterial, or both. So, an ENT will diagnose and prescribe treatment accordingly. Wrong treatment can worsen the situation and result in unnecessary complications.


If you are swimming, to prevent this condition, please take the precautions mentioned above.



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