External otitis is a condition that occurs when the ear canal (the part of the ear that leads from the outer ear to the ear drum) becomes irritated. Risk factors for developing external otitis include swimming, trauma to the ear canal (from scratching or use of cotton swabs), ear devices (hearing aids, ear phones), allergic contact dermatitis (from shampoos, cosmetics, jewelry) and dermatologic conditions like psoriasis. Swimmer’s ear is the name for external otitis that occurs in a person who swims frequently.
Ear wax serves to protect the ear from water, bacteria and injury. Excessive cleaning or scratching at the ear canal to remove wax can cause injury and lead to infection. Swimming on a regular basis can also remove ear wax, cause softening of the skin, alter the pH of the ear canal, and ultimately result in infection. The most common symptoms of swimmer’s ear include pain in the outer ear (especially when the ear is pulled or moved), itchiness of the ear, fluid or pus leaking from the ear, and/or difficulty hearing. If your child has these symptoms and you suspect swimmer’s ear, you should see your healthcare provider.
Your healthcare provider will examine the outside and inside of the ear and may need to clean the ear canal to confirm the diagnosis. Treatment of swimmer’s ear aims to reduce pain and eliminate infection of the ear canal. Most people can be treated with ear drops, but if the infection is severe or there are concerns for a middle ear infection, oral antibiotics may be used.
Ear drops reduce pain and swelling and treat the infection. It is important to apply the ear drops correctly and finish the entire course of treatment even if the pain is better in a few days. Pain from swimmer’s ear can also be treated with over-the-counter acetaminophen or ibuprofen as needed. During treatment, getting the ears wet should be avoided — so no swimming for 7-10 days (competitive swimmers may consider return at 2-3 days if pain has resolved). It is also recommended to place a cotton ball coated with petroleum jelly in the ear canal while bathing. Additionally, avoid wearing ear devices like ear phones or hearing aids while the ear is healing.
To prevent swimmer’s ear, rather than putting something in the ear canal after swimming, shake your ears dry. You may also try blow drying your ears with a hair dryer on a low setting, holding the dryer about 12 inches away from the ear. If you are having recurrent episodes of swimmer’s ear, try using over-the-counter drying drops that contain alcohol and/or acetic acid and consider wearing ear plugs made for swimming. Swimmer’s ear should improve within 36-48 hours with appropriate treatment, so if pain worsens or does not improve in 36-48 hours make sure to follow up with your healthcare provider.
by Jean M. Mullen, MD, FAAP
Dr. Jean Mullen is a board-certified pediatrician and Fellow of the American Academy of Pediatrics. Originally from the east coast, Mullen attended Washington and Jefferson College in Pennsylvania and went on to complete medical school at Temple University School of Medicine in Philadelphia, PA. She interned at St. Christopher’s Hospital for Children before completing her pediatric residency at the University of Maryland Medical Center. Mullen has lived and worked in Gilbert, AZ since 2002. “I love our bright sunny skies and family-friendly community. My favorite pastime is being with my husband and our three children, and I also enjoy spending time with friends, golfing, hiking, skiing and walking our golden doodle.”