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Pain in Ear after Swimming – Causes and Treatment

Pain in ear after swimming occurs due to the infection of the external ear. It causes inflammation of the skin that lines the ear canal, the inflammation may sometimes spread to involve the pinna and outer layer of the tympanic membrane. The condition is also called “otitis externa” or more commonly “swimmer’s ear”.

Location of pain

Pain is usually felt in the affected ear that may also travel to the jaw.

Symptoms

The most common symptom experienced due to a swimmer’s ear is an earache. However, symptoms are more distinctly divided based on the acute or chronic infection.

Acute phase:

  • Hot burning sensation in the ear
  • Pain that increases on chewing or moving the jaw
  • Fever
  • Thin serous discharge from the ear initially which then becomes thick and purulent.
  • Swelling of the outer ear may lead to conductive hearing loss.
  • Swelling of regional lymph nodes and tenderness of the involved lymph nodes in severe cases.

Chronic phase:

  • Irritation and desire to itch
  • Scanty or no discharge
  • Crusting
  • Scaling and fissuring of meatal skin
  • Meatal stenosis (hypertrophy of the skin of the ear) in severe cases.

Causes

Following factors are responsible for this condition:

  • Due to swimming: After swimming, the remaining water in the ear creates a moist environment that favors the growth of pathogens.
  • Hotter climate: In a hot and humid environment where excessive sweating causes a change in the pH of the ear from acid to alkaline thus helping in bacterial proliferation.
  • Trauma to the external ear: The skin of the ear can be easily damaged. It can be due to scratching of the ear with hairpins or matchsticks or unskilled instrumentation. It removes the protective ear wax in the ear, allowing germs to enter the ear making it susceptible to infection.
  • Invasion by pathogenic organisms: Common organisms involved include Staphylococcus aureus, Pseudomonas pyocyanin, Bacillus proteus, and Escherichia coli.
  • Allergic sensitization: Sometimes cosmetics, hair products, and jewelry can elicit an allergic reaction and increase the chance of getting a swimmer’s ear. Some dermatological conditions like eczema, psoriasis can do so as well.
  • Secondary to infection of the middle ear: Any infection of the middle ear can spread to the outer ear and cause otitis media.
  • Young age: It is commonly seen in kids as they have a narrow ear canal.

Complications

Sometimes a longstanding case of swimmers ear may result in the below-mentioned complications:

  • Cellulitis
  • Lymphadenitis
  • Conductive hearing loss
  • Osteomyelitis
  • Widespread infections
  • Long-term infection (chronic otitis externa)
  • Bone and cartilage damage (early skull base osteomyelitis)

Diagnosis

  • It is diagnosed clinically based on a detailed history
  • Further examination of the ear using an otoscope may help in formulating a definitive diagnosis.

Prevention

  • Swim wisely
  • Protect your ears from irritants
  • Keep your ears dry and wax-free
  • Avoid scratching your ear
  • Do not put anything in your ear canal
  • Avoid unnecessary exposure to water
  • 3% solution of hydrogen peroxide can be used occasionally to remove ear wax
  • Mineral oil eardrops can be used in case of crusty skin condition for ear protection
  • Use caution after an ear infection or surgery

Treatment

Acute and chronic infection, both are treated differently.

Acute phase:

  • Ear toilet: All the debris in the ear is removed gently and carefully. It can be done by dry mopping, suction, or irrigation of the canal using warm, sterile normal saline.
  • Medicated wicks: Gauze wicks are soaked in antibiotic and steroid preparation which are then put in the patient’s ear. The patient is advised to keep the gauze moist using ear drops
  • Local steroids: To relieve edema, erythema and to prevent itching local steroids like hydrocortisone can be used.
  • Antibiotics: Broad-spectrum systemic antibiotics are used
  • Analgesics: For pain relief analgesics like ibuprofen, acetaminophen or naproxen sodium are typically used.

Chronic phase:

  • Gauze wick: Wicks are soaked in 10% ichthammol glycerine and are inserted into the ear canal to reduce the swelling.
  • Ear toilet: After the swelling has settled, ear toilet can be done easily
  • Topical steroids and antibiotics: To reduce itching local antibiotics and steroid creams are applied.
  • Surgical excision: In case of chronic stenotic otitis externa or medical treatment failure, the bony meatus is widened using a drill and is lined by a split-skin graft.

Home remedies

  • Use earplugs or cotton with Vaseline to plug the ears.
  • Thoroughly dry the ears after showering or swimming.
  • For prevention of infection, a mixture of 50% rubbing alcohol, 25%white vinegar, and 25% distilled water can be used which creates an acidic environment and helps to prevent infection.

When to consult a doctor?

You should consult your doctor, if:

  • You notice an abnormal discharge from the ear.
  • Pain is accompanied by fever.
  • You notice the pain in your throat or other areas as well.

FAQ

How long does it take for the swimmer’s ear to go away?

It is cured within 7 to 10 days provided that you are taking the treatment adequately. Within few days of treatment, pain is relieved.

Is the swimmer’s ear contagious?

It is not contagious thus you don’t need to isolate yourself in fear of spreading the infection.

Can swimming make your ear hurt?

Frequent swimming can make the ear wet and cause infection of the ear. A moist environment is perfect for bacterial growth thus causing pain and swelling of the ear.

Can you go swimming with an ear infection?

It depends on the infection. If the infection has ruptured the eardrum, then going underwater can cause pain in the ear and also worsen the infection.