Maybe it starts with a grumpy child holding their ear. Perhaps your first thought is an ear infection. But with broiling summer days coaxing families to beaches and pools, it may be something else.
Swimmer's ear, a common summer ailment that occurs when water becomes trapped in the ear canal, could well be the culprit. The number of cases peak in the summer with 44 percent of all reported incidents of swimmer's ear occurring in June, July or August.
Though painful, the condition is usually harmless.
"Most people think of swimmer's ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," said Michael Beach, associate director for healthy water for the U.S. Centers for Disease Control. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection."
Identifying Swimmer's Ear
Unlike ear infections, swimmer's ear, also known as acute otitis externa affects the outer ear and results in inflammation and infection. It is known as swimmer's ear because the most common source of infection is trapped water followed by the spread of bacteria, according to the American Academy of Otolaryngology. Though ears normally contain bacteria, trapped water can prompt bacteria in the ear canal to multiply.
However the illness can develop following baths or showers, soaking in hot tubs, or in other moist environments. Swimming in polluted water also can cause the illness. Those that live in the warmer and more humid climates tend to be at a higher risk. Residents of the southern United States have reported the highest number of infections.
Wax usually helps protect ears from infection. But swimmer's ear can develop in those with a buildup of of ear wax or in individuals who excessively clean their ears with cotton swabs because dirt and bacteria may become lodged in the ear. Less common causes of swimmer's ear include hair spray or hair dye that may have entered the ear, a cut in the skin of the ear canal or skin conditions such as eczema or psoriasis.
Swimmer's ear is usually characterized by a painful feeling of fullness in the ears, itchiness, drainage, fever, reduced hearing, redness, and pain and swelling in the area surrounding the ear including the side of the face and the lymph nodes. Hearing usually returns to normal after the infection has gone away.
In most cases it is distinguishable from a middle ear infection by tugging on the ear lobe, which is generally painful in the case of swimmer's ear. Deeper ear infections do not typically cause pain and swelling to the visible outer portions of the ear.
It can affect both children and adults equally. Though common in children over the age of 5, about half of all cases occur in adults.
"We see it more in older children," said Dr. Sancak Yuksel, an assistant professor in the department of otorhinolaryngology at The University of Texas Health Science Center at Houston Medical School.
"Usually parents can see it's swollen, and they might not be able to touch it because of pain and swelling so you will need to see a physician," Dr. Yuksel said, noting that white discharge from the ears may be noticeable in some cases.
In most cases the illness is minor and goes away within a few days of treatment, but for those with other disorders such as diabetes, it can be serious and dangerous.
"In diabetic patients the infection can affect them like a malignant disease, and progress to the bones leading to paralysis and other complications, but that is rare," Dr. Yuksel said.
Each year there are about 2.4 million doctor visits related to swimmer's ear equating to about $500 million in health care costs, according to the U.S. Centers for Disease Control and Prevention.
The CDC estimates that patients with swimmer's ear who did not require hospitalization spent about $200 for each incident.
In 2007, one in every 123 Americans visited their doctor as a result of swimmer's ear. The number of doctor's visits were highest for children between the ages of 5 and 14 between 2003 and 2007. Yet more than half of reported infections occurred in adults over the age of 20.
In all likelihood, the illness is far more common because many who suffer from swimmer's ear decide not to see a doctor, and those with chronic bouts may first attempt to treat it with over the counter medications.
Preventing Swimmer's Ear
There are many ways to cut your risk of developing swimmer's ear. The easiest way is simply to keep your ears as dry as possible and free of moisture while swimming and bathing, such as by wearing a bathing cap. Wearing ear plugs can also helps eliminate the risk.
Putting drops into the ears consisting of 50 percent rubbing alcohol and the remainder vinegar before swimming can help reduce the chance of developing swimmer's ear.
After swimming, tilt your head to ensure water does not remain inside the ear canal. It may be necessary to tug on the earlobe and move your head into several positions to ensure the water is removed. Then take time to towel dry ears. A blow dryer on a low setting held a few inches away from the ears also can be used, according to the American Academy of Otolaryngology — Head and Neck Surgery.
Also, avoiding cleaning ears with cotton swabs because the process can push dirt and wax deep into the ear and create conditions ripe for swimmer's ear.
There are no known risk factors for the illness, though those with narrower ear canals may be more susceptible. Others may be more prone because of the specific shape of their ear canals, and may suffer from chronic episodes of swimmer's ear.
"There is not much data on why some people are most prone," Dr. Yuksel said.
Treating Swimmer's Ear
Doctors will examine the inside of the ears to diagnose the illness, generally looking for redness and inflammation or shedding skin. In some cases a physician may take a sample of the discharge from the ears to test it for bacteria or fungus.
Most cases of swimmer's ear can be easily healed with prescription antimicrobial ear drops, which contain antibiotics. The pain usually subsides within 24 hours of beginning treatment, though patients typically are asked to continue treatment for up to two weeks.
Over the counter pain relievers or use of a warm compress may aid with the pain, and corticosteroids may be used to reduce itching and inflammation. Doctors may suggest vinegar drops in some cases.
Parents can first try over the counter drops for swimmer's ear, "but once it's swollen, usually the drops won't reach that part of the ear," Dr. Yuksel said.
In some cases, doctors may need to clear any discharge with suction so that subsequent treatment with drops can be successful. Treatment is needed to avoid spreading the infection, and also to ensure it does not impact your hearing long term.