How to manage and prevent swimmer's ear

This article covers how to prevent, treat and compete with otitis externa – known as swimmer’s ear.

What you need to know about swimmer’s ear and swimming

Symptoms

• Mild: slight irritation in the canal and sometimes a little redness and mild discomfort, on occasions with a slight discharge of colourless fluid
• Moderate: the itching and irritation becomes intense, which may have a pus stained discharge, some pain and redness visible externally. The canal can become partially blocked by the debris which gives a muffled sensation and if the blockage is greater, there may be a degree of hearing loss
• Severe: this requires urgent medical attention if there is temperature (pyrexia), severe pain, complete blockage, large amount of discharge, lymph gland enlargement in the neck or swelling of the outer ear.

Causes

• Like most medical conditions, prevention is better than the cure so that it doesn’t become a recurrent problem.
• If you are a competitive swimmer, you may be more susceptible to develop this condition. This could be due to the prolonged periods of time you spend training in chlorinated water making you more vulnerable to inflammation.
• The cause is an infection, usually bacteria (pseudomonas or staphylococcus aureus). It invades the skin inside the ear which is thin and lines the canal.
• Sometimes the inflammation is caused by a fungus or by an allergy causing a secondary eczema.

Treatment

• Most episodes of otitis externa can be cleared up quickly. This can be within a few days with a topical (directly applied) treatment.
• Swabs sent for testing can help with determining which bacteria is causing the infection and determine antibiotic sensitivity.
• Ear drops usually contain an antibiotic to kill the bacteria, a steroid ear drop to reduce the swelling and inflammation and sometimes an anti-fungal drop to kill primary or secondary fungal infection.
• There are numerous other medications manufactured by pharmaceutical companies such as ‘Otosporin’ or ‘Sofradex’ and the application advice should be followed.
• Oral antibiotics such as flucloxacillin may be necessary if there is inflammation or spreading infection.
• After treatment, a follow up with your doctor can be arranged if necessary to exclude other causes such as a perforated drum.

Tips for preventing swimmer’s ear

These tips are to help you prevent swimmer’s ear whilst taking part in swimming and aquatic sports.

Do:

1. Wear a tight fitting silicon swimming cap. This reduces the amount of water entering your ears. More protection can be achieved by using ear plugs.
2. Shower after your swim and dry both ears as chlorine in water is a drying agent.
3. Clean and sterilise your ear plugs to avoid growth of bacteria.

Try:

1. An alcohol based proprietary preparation such as ‘Ear Calm’ as you may benefit from this. This is applied after swimming and keeps the canal dry, kills bacteria and minimises the risk of infection.
2. To keep ears clear of wax as this can encourage bacteria growth and recurrent infections. If there is a lot of wax in your ear, this can be syringed out by your local practice nurse (now mainly recommended only if other remedies fail) or using a wax dissolving topical preparation such as ‘Cerumol’.

Avoid:

1. Putting objects in your ear such as cotton buds to try and clean wax. The lining of the outer canal (external auditory meatus) can be damaged by this type of trauma.

Be careful:

1. When training in a different pool to what you are used to as you may be more susceptible to infection.

Additional Advice

You can find out general advice about ear infections on the NHS website.

Health Fact Sheets

Swim England’s Health Commission group have developed a range of fact sheets on swimming with particular health conditions, written for competitive swimmers, the general public and to also assist those who support or advise swimmers.

Listed below is the current fact sheet library for people with health conditions.

To view and download fact sheets written specifically for people who support or advise swimmers, head to our Health and Wellbeing pages.