"Swimmer’s Ear" (Otitis Externa) Prevention

Swimmer's ear (also known as otitis externa) is an infection of the outer ear canal that can cause pain and discomfort for swimmers of all ages. In the United States, swimmer’s ear results in an estimated 2.4 million health care visits every year and nearly half a billion dollars in health care costs (1). The good news is that there are a few simple steps swimmers can take to prevent swimmer’s ear.

 

To help ensure a healthy and pain-free swimming experience, follow the tips below.

Swimmer’s Ear Prevention Tips

DO keep your ears as dry as possible.

•Use a bathing cap, ear plugs, or custom-fitted swim molds when swimming to keep water out of your ears.

DO dry your ears thoroughly after swimming or showering.

•Use a towel to dry your ears well.

•Tilt your head to hold each ear facing down to allow water to escape the ear canal.

•Pull your earlobe in different directions while your ear is faced down to help water drain out.

•If you still have water in your ears, consider using a hair dryer to move air within the ear canal. ◦Be sure the hair dryer is on the lowest heat and speed/fan setting.

◦Hold the hair dryer several inches from your ear.

DON’T put objects in your ear canal (including cotton-tip swabs, pencils, paperclips, or fingers).

DON’T try to remove ear wax. Ear wax helps protect your ear canal from infection.

•If you think your ear canal is blocked by ear wax, consult your health care provider rather than trying to remove it yourself.

CONSULT your health care provider about using commercial, alcohol-based ear drops or a 1:1 mixture of rubbing alcohol and white vinegar after swimming.

• Drops should not be used by persons with ear tubes, damaged ear drums, outer ear infection, or ear drainage (pus or liquid coming from the ear).

CONSULT your healthcare provider if your ears are itchy, flaky, swollen, or painful, or if you have drainage from your ears.

ASK your pool/hot tub operator if disinfectant and pH levels are checked at least twice per day—hot tubs and pools with proper disinfectant and pH levels are less likely to spread germs.

 

But wait. Why doesn’t every kid get an ear infection following every cold virus?


The answer to this question lies in the length, shape, and stiffness of the eustachian tube.


Short, wide eustachian tubes allow more bacteria to travel than long, narrow ones do. And floppy tubes can seal shut with help from sticky mucus that accompanies viral infections. This results in bacteria becoming trapped in the middle ear space with no chance for escape back to the mouth.


These genetically-determined eustachian tube qualities are also the reason children “outgrow” their frequent ear infections. What’s really happening is their short, wide, floppy eustachian tubes are growing into long, narrow, rigid ones.


Once bacteria arrive in the middle ear, they reproduce like crazy and overwhelm the tiny space. The body’s immune system kicks in, destroying the bacteria and creating thick pus. The pus pushes on the ear drum, causing pain receptors to fire and, if there’s enough pressure, causing the ear drum to rupture with pus pouring out the external ear canal.


So that’s why ear infections occur. Not from hat deficiencies or bath water, but from a combination of genetics, viruses, and mouth bacteria

And so we find ourselves in the position of not wanting to over-treat or under-treat. To this end, most of us take a middle road. If the symptoms seem mild, we encourage parents to wait a few days to see if the infection will resolve on its own. However, if the symptoms are severe or the infected child is very young or has an underlying medical condition, we prescribe an antibiotic.


Where do ear tubes fit into the picture?


When ear infections become a recurrent problem, a surgeon can insert a small plastic tube through the ear drum. This provides an exit route for bacteria. Instead of becoming trapped, the microbes can move through the tube, into the external ear canal, and become skin bacteria.


How about preventing ear infections in the first place? That’s a more difficult task. As we discussed in our previous installment, ear infections are caused by a combination of ear anatomy, mouth bacteria, and viral upper respiratory infections. You can’t alter the first two. You can the third, but it means taking your child out of daycare, preschool, or any other place where kids and viruses hang out.