By Barbara Jenkins, Au.D., BCABA, and Arvin K. Rao, M.D.

Frequent swimming and surfing—especially in cold water—can leave your ears prone to certain conditions. But an ounce of precaution can provide an ocean of protection. Here’s how. 

Swimmer’s Ear

When you swim frequently, earwax is washed from the ear, leaving it dry, unprotected, and vulnerable to infection. Chlorinated water can be especially drying to the skin.

But don’t think that swimming in untreated water is going to protect you. Oceans, lakes, and streams are teeming with organisms that are usually benign in a healthy ear but that can create havoc in an irritated ear.

If you use a cotton swab to clean your ears, take extra note. Your ear canal’s skin is so fragile that even brushing against it with the swab could cause microscopic irritations that may then promote the growth of infection more quickly and severely.

Add to this humidity and perspiration and you’ve created a breeding ground for any microbe lucky enough to make its way in. This is the perfect formula for a painful bout of otitis externa, or swimmer’s ear.

Otitis externa may or may not cause hearing loss, depending on its severity. Once corrected, your ear, and your hearing, should be as good as new.

People sometimes get confused and believe an outer ear infection is the same as a middle ear infection (otitis media). Remember that the ear canal is actually part of the outer ear, not the middle ear. Only indirectly would swimming cause a middle ear infection, such as if there is a hole in the eardrum or if someone has an allergy to something in the water, leading to inflammation. 

Swimmer’s ear can start off as an irritating itch but can progress into a painful inflammation that may, if left untreated, completely plug your ear. If you have any persistent itching in your ears, see your physician sooner rather than later.  

Your doctor may irrigate your ear first, then prescribe antibacterial, analgesic, or antifungal ear drops. The treatment may take weeks, depending on the severity or the tenacity of the infection. (The antibiotic medication typically used to treat middle ear infections are not very effective here.) 

Surfer’s Ear

Surfer’s ear is a different issue altogether. When exposed to cold water consistently over time, the ear canal may form bony growths. Scientists don’t quite know why the growths form; it’s theorized that the body is trying to protect the ear from wind and cold water. Although benign, they can grow so large as to completely block the ear canal and cause hearing loss. 

This condition is medically referred to as exostosis. Someone with exostosis is more likely to get otitis externa because the growths prevent debris and water from naturally escaping, thus increasing the chances for infection.

Exostosis is called surfer’s ear because half of surfers eventually get these bony growths. But it is not limited to surfers. Anyone who frequents colder waters, whether it be a pool or natural waters, is susceptible.  

Surfer’s ear usually goes unnoticed until it causes an outer ear infection or becomes so large as to cause hearing loss. Your doctor may notice the bony malformations slowly growing over time. Generally, no action is taken until the growths become large enough to restrict your hearing or cause a chronic infection of the ear canal. In this case they may have to be surgically removed. 

Prevention 

It is much easier to prevent outer ear conditions than to treat them, so before you jump into the pool or lake, follow these tips.

Check for earwax buildup. If you have had previous problems with swimmer’s ear, visit your physician or audiologist to evaluate your ear canals for excessive earwax buildup. Although earwax is necessary for conditioning your ear, a buildup (sometimes due to cotton swab use) can trap water and debris. Your audiologist can also check for small holes or perforations in your ear.

Use an ear conditioner. If you swim more than twice a week it’s a good idea to get an ear conditioner (which is not the same as earwax drops). An ear conditioner is a product that acts like a facial for your ears. It prevents the skin in your ear canal from excessive drying, usually using aloe and other natural oils.

Use an ear dryer. These small, battery-operated devices are calibrated to dry the ear safely and effectively after each swim. They are usually available at pharmacies in summer, but any hearing care professional should have some on hand as well.

Wear swim plugs. If you frequent colder water, have a hole in your eardrum, or middle ear tubes in your ears, consider swim plugs (earplugs for swimming). They are available over the counter or custom fit. Do not use cotton balls to plug your ear canals. Yes, some people do! They are ineffective when wet and can be pushed into the ear canal by water pressure.

Stop the swab. Not only will using cotton swabs increase the chances of skin abrasion, you will also push any wax you can’t remove deeper into your ear. Earwax is created in the outer one-third of the ear canal. Using a swab prevents its natural removal and creates a barrier that can trap debris and water inside.

See a physician when needed. Visit your doctor at the first signs of itching or pain in your ear, or hearing loss. Ear problems are easier to treat the sooner they are detected. Don’t self-treat or hope it will go away. If you’ve had symptoms for more than two days, it’s time to see your doctor.

Now retired, Barbara Jenkins, Au.D., BCABA, was Colorado’s first board-certified doctor of audiology. Arvin K. Rao, M.D., is a board-certified otolaryngologist also in Colorado.

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