Swimmer's Ear Problems: A Complete Guide to Preventing Otitis Externa (Swimmer's Ear)

What is Otitis Externa

Otitis Externa, commonly known as “Swimmer’s Ear,” is an inflammation of the skin of the ear canal. Its prevalence reaches 10-20% during the summer swim season, making it the most common infectious injury among swimmers.

Pathogenesis

The ear canal is normally a protected environment:

1. Earwax: weakly acidic, containing antibacterial lipids
2. Dryness: low humidity discourages bacterial growth
3. Skin barrier: intact stratum corneum

Swimming disrupts these three lines of defense:

• Prolonged water exposure dilutes earwax
• Humidity in the ear canal rises
• Repeated ear picking creates micro-wounds in the skin

Bacteria (most commonly Pseudomonas aeruginosa and Staphylococcus aureus) or fungi (Aspergillus) take advantage of the opportunity.

Symptom Stages

Stage	Symptoms
Early	Ear itching, mild feeling of fullness
Acute	Ear pain (worse when swallowing or pulling the ear), discharge
Severe	Hearing loss, ear redness and swelling, fever

Characteristic sign: Pulling the auricle or pressing on the tragus noticeably worsens the pain (unlike otitis media).

High-Risk Groups

The following swimmers are at the highest risk:

• Swimming more than 3 times per week
• Open-water swimmers (poorer water quality)
• Those who wear earplugs but do not clean them thoroughly
• Those with a habit of picking their ears
• People with atopic dermatitis or diabetes
• Those with a history of otitis externa

6 Prevention Strategies

1. Drain Water Immediately After Swimming

Right after getting out of the water:

• Tilt your head to one side, hop on one foot 5 times to let the water drain out
• Repeat on the other side
• Gently pat the outer ear opening dry with a towel (do not insert it deep)
• Use a hairdryer on the cool setting at a distance of 30 cm for 30 seconds

2. Preventive Ear Drops (Acetic Acid 2%)

High-risk swimmers can, after swimming:

• Instill 2-3 drops of 2% acetic acid in isopropyl alcohol
• Keep the head tilted for 30 seconds
• The acetic acid restores the acidity of the ear canal, while the isopropyl alcohol speeds up drying

Note: Contraindicated for those with a perforated eardrum.

3. Wear Swimming Earplugs

Suitable for:

• Those with recurrent otitis externa
• Open-water training
• Those with existing dry skin dermatitis of the ear canal

Selection principles:

• Moldable silicone earplugs are better than rigid ones
• Custom-molded earplugs offer the best waterproofing
• For children, choose styles with better buoyancy
• Wash and air-dry after every use

4. Avoid Picking Your Ears

• Do not use cotton swabs (they push earwax deeper)
• Do not use hard objects such as bobby pins or toothpicks
• Earwax is self-cleaning; cleaning the ear canal opening once a month with an alcohol swab is sufficient

5. Open-Water Swimmers: Watch Water Quality

Common open-water risks in Taiwan:

• Water quality deteriorates within one week after rain
• Bacterial counts are high near river mouths and estuaries
• Water quality worsens in summer heat

Recommendations:

• Do not swim in open water within 5 days after heavy rain
• Always shower and clean the ear canal opening after getting out of the water

6. Extra Protection for Those with Allergies

For those with atopic dermatitis or allergic tendencies:

• Apply a thin layer of petroleum jelly around the ear canal opening to form a waterproof barrier
• Use drying ear drops once a week as prevention
• Avoid swim caps that are too tight and rub against the ear canal

Treatment Steps

Early Itching Stage

• Stop swimming immediately for 3-5 days
• Use acetic acid in isopropyl alcohol ear drops 2-3 times daily
• Observe for 48 hours; see a doctor if there is no improvement

Acute Stage (Ear Pain, Discharge)

• Seek medical attention immediately
• Doctors usually prescribe antibiotic ear drops
• Oral antibiotics may be added in severe cases
• Stop swimming for 7-14 days until fully recovered

Chronic Recurrent Episodes

• Get a thorough evaluation from an ENT specialist
• Ear canal discharge culture may be needed
• Confirm whether there is a fungal infection
• Consider custom-molded earplugs for long-term use

Medication Precautions

• Tap the bottom of the ear drop bottle gently to warm the solution to body temperature before use
• Remain lying on your side for 5 minutes after instilling
• Do not wear earplugs while using ear drops
• The full course of treatment is usually 7-10 days; do not stop medication just because symptoms have resolved

When Can You Return to the Water

Only swim again once the following criteria are met:

• Ear pain has completely resolved
• No discharge
• Hearing has returned to normal
• Doctor has confirmed recovery
• The full course of antibiotics has been completed

Recommendations for the early return period:

• Wear earplugs for 4-6 weeks
• Shorten individual training sessions (to within 30 minutes)
• Increase ear canal drying after swimming

Common Myths

Myth 1: Water in the ear will drain out on its own, so no special treatment is needed

Wrong. The ear canal is curved, and water tends to pool deep inside; active draining is necessary to prevent infection.

Myth 2: Earplugs increase the risk of infection

Partially true. Unclean earplugs are a breeding ground for bacteria. Proper use + thorough cleaning of earplugs can effectively prevent infection.

Myth 3: Use a cotton swab to dry out the water

Completely wrong. Cotton swabs push water deeper and scratch the skin; they are the number one thing to avoid with otitis externa.

Special Considerations for Children

Children have narrower ear canals, making them more prone to water retention. Recommendations:

• Parents should help drain water after every swim
• Use child-specific earplugs
• Check immediately if a child is tugging at their ears or seems irritable
• Preschool children should have an ENT check-up every season

Preventing otitis externa is not just about ear care—it is key to keeping your swim training uninterrupted.

Related Reading

• Ear Canal Infection After Swimming: Prevention of Otitis Externa and Post-Swim Ear Care
• Swimmer’s Ear Problems: Prevention of Otitis Externa and Choosing Protective Earplugs
• Swimmer’s Ear (Otitis Externa): Prevention and Proper Management
• ENT Problems in Swimming: Prevention and Management of Otitis Externa and Sinusitis