Swimmer's Ear

by Susan Eicher, M.D.

Now that the end of summer is approaching, most of us are increasing the frequency and intensity of training in preparation for the final races of the season. In addition to predisposing ourselves to acute and overuse injuries, we are also at risk for a variety of disorders that are associated with frequent exposure to heat, humidity, and water. External otitis, or swimmer's ear, is an inflammation of the ear canal that commonly occurs in swimmers and divers but also occurs with daily hair washing, showering, and exposure to hot, humid conditions. Although external otitis is usually a self-limited disorder that is easily treated and only temporarily disrupts training, repeated or chronic infections of the ear canal can have long-term, potentially serious consequences and are best avoided through prevention.

The primary factor responsible for initiating external otitis is the presence of moisture within the ear canal. This leads to breakdown of the lining of the canal and increases its susceptibility to infection. Frequent exposure to water also decreases the amount of cerumen, or wax, in the canal, which normally provides a water-repellent, acidic barrier to infection. Traumatizing the ear canal with Q-tips or other objects also increases the likelihood of developing infection.

Although we cannot avoid heat, humidity, and water exposure during training, several measures can be undertaken to help prevent external otitis. Commercially available drops such as Swim Ear can be used after swimming and showering, but less expensive and equally effective substitutes include 70% isopropyl alcohol (one type of rubbing alcohol) or 70% isopropyl alcohol acidified with white vinegar (1:1 mixture). Instillation of alcohol helps dry the ear canal, and the addition of dilute acetic acid lowers the pH of the ear canal, discouraging growth of the bacteria that commonly cause external otitis. Other preventive measures include avoiding trauma to the canals, such as cleaning with Q-tips. Using ear plugs while swimming may have some theoretical benefit by keeping the ears dry and maintaining the protective cerumen layer, but they are generally unnecessary.

If external otitis does develop, it is important to seek prompt medical attention. Typical symptoms and signs include pain, especially with manipulation of the ear, redness, swelling, and discharge. Occasionally, the degree of swelling and discharge can impair hearing. In terms of treatment, antibiotic-steroid drops are usually effective as long as there is not an allergy to one of the components, and it is important to keep the ears dry until pain and swelling have subsided. Fortunately, with proper ear care, these infections and their adverse effects on health and training usually can be avoided.

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