Swimmer's ear (otitis externa)is an inflammation or infection of the outer ear canal, and is distinguished both in location and cause from the inner ear infections (otitis media) common in infants and toddlers.

What causes it?

It is often caused by a variety of common organisms, including some types of bacteria and fungi. However, it can also have purely physical causes. When it occurs among swimmers, three elements are usually present:

• the ear canal is alkaline, rather than acid,
• the ear canal is damp or wet, &
• an infectious agent is present.

Explanations

Swimming in pools almost always provides the first two conditions, since pools are wet (!) and usually slightly alkaline. The ear itself provides the third condition, since many of the organisms often involved in ear infections are already normally present in the ear canal, at least in small quantities.

Voila': your swimmer has met all the minimum requirements for an infection

But, since some of the causative organisms (esp., some varieties of Psuedomonas) are quite resistant to most pool sanitizers, swimmers often get an extra helping from some pools, including some that are otherwise well sanitized. And, of course, many natal waters, will have some of these organisms are almost always present.

• Dry your ears after swimming;
• Use ear drops after swimming; &
• If you are particularly susceptible, use ear drops before swimming, as well.

Children may not be able to effectively do the "head-shake" maneuver sometimes needed to remove the water: drops are a good idea for them. And, some individuals are MUCH more susceptible, for a variety of reasons, than others.

While ear infections often occur subsequent to swimming in well sanitized pools, when 20% or more of a swim team gets infections simultaneously, there is a good chance that one of the pools they have recently swum in is badly sanitized.

And, keep in mind that if you've (or your child) has had multiple cases of otitis externa, REGULAR preventative use of non-irritating ear drops can work wonders, and should be a part of your swimming routine. Drops and swimsuits should go together!

What kind of drops should you use?

Rubbing alcohol is often recommended for use as ear drops. However, rubbing alcohol burns or stings at best, especially on young swimmer's skin, and may hurt like the devil if the ear canal is already slightly inflamed or irritated. (Some other, less common, types of alcohol are NOT irritating, and are used in commercial ear drops.)

Lest drastic -- and possibly more effective -- is a mixture of 1/2 vinegar and 1/2 hydrogen peroxide. Once the peroxide is added, the mixture is perishable, so don't mix more than you'll use in a week or so. The peroxide can lose its strength rather quickly once mixed. Vinegar alone is a good preventative since it restores the ear canals acidity.

A laboratory wash bottle, filled with this mixture, and used routinely on swim team members (line 'em up, squirt it in!) is cheap and seems to eliminate problems almost completely. But check with parents: there are some bizarre sensitivities out there -- and some bizarre parents!

But, please be careful. Don't jab the bottle nozzle in some wiggly kid's ear! You may want to trim and round the nozzle so it's less 'pointy'. And, though this mix doesn't irritate most peoples ears, it feels pretty AWFUL in EYES! Having the kids hold a towel over their eyes, as you squirt, is a good idea.

Even better, in my personal experience, are the commercially available Star-otic drops. Although I'd had problems finding these in recent years, my local Eckerds is now carrying them, and my pharmacist checked, and said that they are a regular Eckerd's product now. So, if your Eckerd's doesn't have them, they can probably get them easily.

When should I go to the doctor?

The obvious and legally acceptable answer is: ask your doctor.

However, my non-medical opinion is: if your ear really hurts a lot, has a discharge or pus, or if you have a fever, you should go. Also, if you have had problems in the past with serious ear infections, you should probably hustle down to his office, sooner rather than later.. A bad infection can be a real mess.

Revised 4/8/99 - BMP