Q: Last summer, my ear started feeling itchy and really painful after swimming. How can I avoid it this year?
Swimmer’s ear is an infection of the ear canal that can plague water lovers and anyone else who sweats, showers or simply lives in a humid climate.
Nearly 1 in 10 people will experience a bout of this infection in their lifetime. Summer, unsurprisingly, is prime time for swimmer’s ear. Both children and adults can get swimmer’s ear — and those who are immunocompromised, have diabetes or other underlying conditions are at greater risk of both getting it and having complications.
Not to be confused with the annoying sensation of trapped water in your ear, acute swimmer’s ear will get your attention quickly. “It’s exquisitely painful,” said Dr. Sapna Singh, a pediatrician and chief medical officer at Texas Children’s Pediatrics in Houston. “I’ve seen teenagers come in in tears.” The ear canal can become itchy and swollen and may leak fluid or a smelly discharge.
The good news: With prescription ear drops, most people start to feel better within a few days. Still, doctors recommend keeping water out of your ear canal for a week or more, depending on how severe the infection is.
If not treated, complications can ensue, including chronic swimmer’s ear and, in rarer cases, an infection that spreads beyond the ear canal.
The causes
The combination of moisture trapped somewhere in your ear canal paired with even a small injury can kick-start swimmer’s ear, said Dr. Mallory Raymond, an ear, nose and throat doctor — or E.N.T. — at Mayo Clinic in Jacksonville, Fla. A scratch from a fingernail can be enough to damage the ear canal’s delicate skin and create a gateway for infection.
Bacteria — often found in hot tubs, pools and open water — are the culprit in most cases. Despite the name, you can get the infection without swimming. Dr. Anthony Tolisano, an E.N.T. at Walter Reed National Military Medical Center in Bethesda, Md., often sees cases of swimmer’s ear in his patients who use hearing aids, which can trap small amounts of water.
A primary care doctor can typically diagnose the infection, usually treated with antibacterial ear drops. If you don’t feel better in a week or two, Dr. Tolisano recommends seeing a specialist to rule out other issues.
While less common, fungi can also be at fault, particularly in tropical, humid regions, said Dr. John Cho, an E.N.T. with Hawai‘i Pacific Health in Honolulu — so it’s important to get your ear checked out to make sure you receive the appropriate treatment.
Prevention tips
To avoid swimmer’s ear in the future, prevent water from lingering in your ear canals. But if your ears feel damp or itchy, resist the urge to use a cotton swab, which can create micro-tears or leave cotton fibers in the ear canal.
“Q-Tip is a four-letter word” among E.N.T.s, Dr. Tolisano said. “It feels good, right? But I think that what people don’t realize is how delicate that skin really is.”
Swabbing your ears can also disrupt their natural infection protection: ear wax. “The ears are self-cleaning,” Dr. Cho said. Earwax defends the ear from microbes and debris.
Instead, to safely dry the ear after being in the water, Dr. Raymond said, “my go-to is to use a blow dryer.” She recommends using a low temperature setting and holding the dryer a safe distance — usually at least a foot from your ear.
For people who spend a lot of time in the water, Dr. Raymond suggested rinsing the ear canal with a mix of water, distilled white vinegar and rubbing alcohol when you get out of the water. This will flush out bacteria, restore the ear’s natural pH and help dry it out.
Keeping devices like earbuds clean and removing them regularly — particularly after a sweaty workout — may also reduce the chance of trapped water and subsequent infection. Some limited evidence suggests those who took regular breaks from earbuds and earphones were less likely to get swimmer’s ear than those who wore them for extended periods.
Swimmer’s ear is usually a one-time affair, experts said. But some people, including those with narrow ear canals or conditions like eczema that affect the ear’s skin, can have recurrent cases. Many of Dr. Singh’s infection-prone patients wear earplugs, alone or with swim caps or swim headbands while in the water. For children, she suggested consulting a pediatrician before using earplugs or over-the-counter ear drops.
If you feel discomfort or pain that lasts for more than a few days with preventive measures — or if you’ve received prescription ear drops for swimmer’s ear but you aren’t getting better — contact a physician.
“Extreme pain is always a red flag,” said Dr. Raymond. “That’s a reason to get your ears looked at.”
Cameron Walker is a writer in California covering health and the environment.
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