Swimmer’s ear (otitis externa) is a condition caused by inflammation or infection of the outer ear canal. In a diving environment, this is usually caused when prolonged exposure to wet conditions changes the natural acidity and flora in the ear canal, allowing opportunistic bacteria or fungi to grow and become pathogens. Warm and humid environments and excessive cleaning of the ear canal can predispose a person to otitis externa.
- Swimmer’s ear affects one in 200 Americans every year and is a chronic problem in 3 to 5 percent of the population.
- Swimmers, surfers and other people who are exposed to wet and warm conditions are at increased risk.
The main symptoms are ear pain, warmth and itching — often in the ear canal . Occasionally, the pinna (the cartilaginous external part of the ear) may show signs of inflammation with redness, swelling and pain. If left untreated, swelling can increase to include nearby lymph nodes and produce enough pain that movement of the jaw may become uncomfortable or painful.
- Pain, warmth and itching in the ear canal
- Pain when moving the jaw or when gently pulling on the earlobe or pushing on the pinna
- Muffled hearing (transient, usually a sign of concomitant middle ear compromise)
- Discharge from the ear canal is possible if initial symptoms are neglected for a few days
Management & First Aid
Swimmer’s ear is often self-diagnosed. Professional medical diagnosis is often clinical as well, not requiring more than an ear exam with an otoscope. With proper treatment, symptoms often resolve within a few days, rarely taking longer than a week.
- Do not neglect the initial itching or mild pain, as it may progress overnight.
- Seek a professional medical evaluation. Although diagnosing swimmer’s ear is straightforward, proper treatment requires a prescription of otic antibiotic drops.
- Once you have symptoms, do not introduce any preventative drops or preparations.
Keep your ears clean and dry. Although it might be tempting to keep your ears clean using cotton swabs or similar, the best way to avoid problems with your ears is to not mess with them. Wash your ears with regular soap when you take a shower and don’t insert anything in them. Under normal circumstances, this is all we need.
Your ears produce a waxy substance that is hydrophobic to prevent moisture retention and acidic enough to prevent bacterial growth. Excessive moisture — as is common with frequent diving — can cause an emulsification of the natural ear wax, which can change the environment in the ear canal to make it more susceptible to infections.
- Dry your ears with a towel after swimming, showering or diving. Tilting your head and pulling your earlobe in different directions while your ear is facing down might help eliminate water.
- A hair dryer could be used to carefully dry the ear after a shower. Be careful to ensure the air is not too hot, hold it at least a foot (about 30 centimeters) away from the ear.
- Refrain from putting objects (such as cotton swabs or ear wax removal tools) in the ear canal. This can cause ear wax (cerumen) impaction and can damage the skin in the ear, potentially increasing the risk of infection.
- Excessive debris or cerumen may trap water in the canal.
- If you think you have an excess of buildup ear wax, consult your doctor and allow a medical professional to do a proper cleaning. Remember that cleaner is not necessarily better. Washing the ear canal excessively will change the acidity of the ear canal, and a less acidic environment is a common cause of opportunistic pathogen growth that could lead to an ear infection.
- Talk to your doctor about whether you should use any alcohol-based ear drops after swimming or diving.
Prognosis & Returning to Dive
Prognosis is generally good if the condition is addressed promptly. Upon determination by your physician that the infection has resolved, you may return to diving.
WARNING: Continuing to dive with unresolved swimmer’s ear will perpetuate the condition that caused an infection in the first place, allowing pathogens to prolong and worsen the infection.