Swimmer’s ear: Symptoms, causes, and risk factors

Swimmer’s ear is an infection that can occur after spending a long time in the water or outdoors in the wind and rain. It affects the skin that covers the outer ear canal, which leads to the eardrum.

Despite the name, swimmer’s ear is more common in people who are not swimmers, according to the University of Iowa. Individuals who spend a lot of time outdoors, such as farmers, often get the infection.

The medical name for swimmer’s ear is acute diffuse external otitis.

Bacteria can accumulate in the water. While swimming, in areas of fresh water, for example, some can enter the ear and remain for a long time, especially if the water becomes trapped by wax.

The ear has ways of protecting itself from infection, but these work best when the area is dry. If the ear is damp, bacteria can thrive, resulting in infection.

Fungal infections can also occur in the ear. However, in 98 percent of cases in North America, swimmer’s ear results from exposure to bacteria.

According to the Centers for Disease Control and Prevention (CDC), swimmer’s ear is responsible for 2.4 million healthcare visits in the United States each year.

In most cases, a doctor can easily treat the infection, and receiving treatment early can prevent complications.

Symptoms

There are three types of external otitis.

Swimmer’s ear (acute diffuse external otitis)

Swimmer's ear is an infection
Swimmer’s ear is an infection that can happen if water becomes trapped in the ear.

This is the most common type of external otitis. It can last for up to 3 weeks, and it affects the entire ear canal.

A rash can extend to the outer ear and the eardrum.

Signs and symptoms include:

redness and swelling in the outer ear and ear canal

pain in the area

scaly skin, which may peel off, in and around the ear canal

watery or pus-like discharge, which may smell bad

itching and irritation in and around the ear canal

tenderness when moving the ear or jaw

sore and swollen lymph nodes, or “glands,” in the throat

some hearing loss, if the swelling inside the ear is significant

Other types of external otitis

Acute localized external otitis occurs when a hair follicle in the ear becomes infected. A painful, pus-filled bump, called a furuncle, may form in the ear canal. This infection is a type of furunculosis.

Chronic external otitis can result from infection, allergies, or a skin condition, such as eczema. To warrant the diagnosis, the symptoms must persist for at least 3 months, and they can last for years.

Causes

The ear has several ways of protecting itself from infection.

Cerumen, or earwax, is produced by glands in the ear canal, and it performs several functions.

For example, earwax:

forms a thin, waterproof film on the skin of the ear canal

contains acids and antibacterial properties, which combat bacteria

collects debris, dead skin, and dirt and transports them out of the ear, where they appear as a waxy clump at the opening of the ear canal

The shape of the ear canal is also important. It slopes downward from the middle to the outer ear, so that liquid can drain.

External otitis can develop when the ear canal’s defenses cannot cope with an infection or an allergic reaction.

Ear pain
Not only swimmers have this type of ear infection. Working outdoors is one risk factor.

The following factors increase the likelihood of contracting swimmer’s ear:

swimming, especially in water with high levels of bacteria

cleaning, prodding, scratching, or scraping the ear canal with a cotton swab

wearing a swim cap, using a hearing aid, or having a lot of earwax, which can trap water inside the ear

having a skin condition, such as eczema, acne, or psoriasis

having a small ear canal

Children are especially vulnerable to swimmer’s ear.

Not only swimmers get swimmer’s ear, however. It commonly affects farmers and other people who spend a lot of time outdoors.

Diagnosis

The doctor will examine the ear canal using a handheld device called an otoscope.

They will check for:

redness

inflammation

flaky or scaly skin

damage to the eardrum

They will also ask about a person’s:

medical history

symptoms

recent experiences, including swimming and inserting things into the ear, such as cotton swabs

If there is a blockage, the doctor may use an ear curette, a tiny instrument designed for scraping away debris, or a suction device to clear the ear canal.

If there is damage to the eardrum, the doctor will refer the patient to an ear, nose, and throat specialist, who will check whether the infection originated in the middle ear.

If symptoms do not improve, the doctor may test a sample of debris or discharge to learn more about the underlying issue.

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