Monday, July 25, 2011

How To Prevent Swimmer’s Ear

Nothing refreshes on a scorching hot summer day quite like a plunge into a swimming pool or one of the glistening lakes that dot the Canadian landscape.

The down side for some people is that a head-dunking and water-filled ears could set them up for the irritating and painful condition known as swimmer’s ear.

A recent report by the U.S. Centers for Disease Control & Prevention found that one in 123 Americans went to the doctor in 2007 with swimmer’s ear.

Because the outdoor swimming season is shorter in Canada, the prevalence is perhaps lower here for this form of earache formally known as otitis externa, characterized by an inflammation of the outer ear and ear canal.

“It’s called swimmer’s ear just because it tends to be quite common in the summer months in particular when kids usually do a lot of swimming,” said Dr. Moshe Ipp, a pediatrician at Toronto’s Hospital for Sick Children.

“When you’re in the water for hours on end you wash away the sort of oily wax bits in the ear, and then water sits in that external canal because kids don’t dry their ear, and you have the sort of change in the acidity — it becomes a little bit more neutral alkaline, and bacteria can then get in.”

By contrast, the childhood ear infections that we more commonly hear about affect the middle ear — closer to the ear drum.

Michele Hlavsa, chief of the CDC’s healthy swimming program, said swimmer’s ear is often caused by a bacteria called pseudomonas, or by staph.

Water can wear down the ear wax and skin in the outer ear canal, she said in a phone interview from Atlanta.

“Our ear wax actually has an antimicrobial property to it, so it helps us fight infections, but when we have water sitting in our ears, bacteria can grow in the ear and then cause infections.”

Those affected might have itchiness inside the ear, redness or swelling of the ear, she said.

“You can have pain when you tug on the ear — that’s the real hallmark of swimmer’s ear. If you tug on your earlobe, it causes an intense pain, and also sometimes people with swimmer’s ear have pus that drains out of the ear.”

Ipp said water is one of the main causes, but other factors could include the use of cotton swabs which can injure the lining of the ear canal and set the scene for an otitis externa.

“Various chemicals could probably do that as well, such as hair shampoo, or whatever. Anything that disturbs that environment will give you an external ear infection.”

Bathing caps, shower caps or ear plugs will stop water from getting into the ear canal for those who are susceptible to the condition.

Otherwise, in terms of prevention, both Hlavsa and Ipp said that drying the ears with a towel is important — but never, ever use cotton swabs.

Hlavsa said a hair dryer can help.

“We recommend putting the hair dryer on the lowest heat setting and lowest speed setting for the fans, and holding it several inches from the ear,” she said. “Because the point is really just to circulate air within the ear canal, it’s not to evaporate the water. It’s more to ventilate the ear.”

She’s heard reports of people hitting their heads against things to encourage water to drain, but doesn’t suggest this head-banging approach.

“We recommend tilting the head down so each ear faces the ground, and pulling on the earlobe to help kind of drain the water out,” she said.

Ipp said special over-the-counter ear drops are available at pharmacies for those who are prone to swimmer’s ear.

“After the kids have been swimming the whole day, you just put a few drops in each ear, and what it does is it restores the normal pH into the external canal, and prevents any bacteria or fungi for that matter from establishing themselves. It’s an antiseptic.”

A homemade solution that some people suggest is a 50-50 mixture of vinegar and rubbing alcohol, he said, adding that a couple drops in each ear after swimming will restore the normal pH, and the alcohol dries out the ear canal a bit.


The CDC cautions that these preventative drops should not be used by people with ear tubes, damaged ear drums, outer ear infections or pus or liquid coming from the ear.

If someone does get an infection, a doctor needs to make a diagnosis and would normally prescribe antibiotic ear drops, Ipp said.

“Sometimes they need an oral antibiotic as well, not always, but if it’s so inflamed or so clogged up in the ear canal that you can’t get the drops in, you need to give them an antibiotic by mouth.”

Relief should come within a few days, but if it doesn’t the patient would need to be seen again. A visit to an ear, nose and throat specialist might be required — especially if the ear canal is jammed full of pus and debris from the infection.

The specialist might have to put an ear wick into the ear. It’s like a little bit of gauze with ear drops on the end of the gauze, Ipp explained.

The CDC report found about 2.4 million doctor visits per year for swimmer’s ear. Rates of doctor visits were highest in children aged five to 14.

“For our health-care system, it’s only like $200 a pop, but when you’re talking about 2.4 million cases, you’re talking about a pretty expensive condition,” the CDC’s Hlavsa said.

She has recommended to American swimmers that they buy test strips and check pH levels before they get into a pool because proper levels mean germs are less likely to be spread.

“There’s nothing like an angry mom to say, ‘This is not acceptable, this needs to change.’ Public health inspectors, at least in the U.S., only visit pools once, twice, three times a year. I don’t know how it works in Canada, but you know the pool inspector’s not there every day.”

Thanks to

Kathy Dowsett
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