Summer time swimming season could also be over, however you may nonetheless get swimmer’s ear – and you do not even have to go within the water

Both children and adults are susceptible to the ear infection known as “swimmer’s ear.” Kay Blaschke/Stock4B-RF via Getty Images

Many forms of ear infections strike children and adults alike, but among the most common is acute otitis externa, also known as swimmer’s ear.

About 10% of Americans will experience swimmer’s ear during their lifetimes. Adults are affected more commonly, and children only rarely, generally ages 5 to 12.

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But you don’t have to be swimming to get swimmer’s ear. Go out jogging or walking, or do yardwork on a hot day, and moisture from perspiration can drip in your ear. However, the occurrence increases fivefold in swimmers – thus the reason the condition came to be called “swimmer’s ear.” It also occurs more frequently in tropical climates because of humidity and higher temperatures.

As doctors who specialize in ear problems, we are actively involved in research and clinical treatment for children and adults struggling with ear, nose and throat problems. Practicing in the state of Florida, we’ve certainly seen our share of patients with swimmer’s ear.

If left untreated, swimmer’s ear could cause temporary hearing loss along with bone and cartilage damage.

Causes and symptoms of swimmer’s ear

Swimmer’s ear is an infection in the external ear canal, the tube leading from the ear opening to the eardrum. Typically, swimmer’s ear occurs only in one ear, and sometimes the eardrum itself is affected. Moisture trapped in the canal leads to a break in the skin barrier and creates an opening for certain bacteria types to enter or existing ones to overgrow.

One of these culprits is the bacterium Pseudomonas aeruginosa, which is present in soil and water throughout the world. These bacteria favor moist areas, such as sinks, toilets, inadequately chlorinated swimming pools and hot tubs, as well as outdated or inactivated antiseptic solutions.

If you have the infection, you’ll know it. Symptoms generally appear a few days after infection. The main symptom of swimmer’s ear is severe pain and discomfort. It’s particularly noticeable when the outer ear is tugged, or by touching the tragus – that’s the small bump at the front of your ear. Other symptoms include itchiness inside the ear, redness, swelling and drainage. A feeling of fullness, or the perception of a plugged ear, may also occur, along with disturbed balance and temporary hearing loss.

Predisposition to swimmer’s ear

Numerous factors can predispose someone to swimmer’s ear. They include a narrow ear canal, and skin diseases such as eczema or psoriasis. In addition, individuals wearing ear plugs, ear buds or hearing aids may be at an increased risk. Diabetics may also be more prone to the infection.

Swimmer’s ear can also come from something getting stuck inside the ear, excessive ear cleaning or contact with chemicals in hair dye or hairspray.

An illustration showing inflammation and narrowing of the ear canal. ttsz/iStock via Getty Images Plus

Diagnosis and treatment

Swimmer’s ear is diagnosed after a health care provider has gathered a thorough history and examined the inside of the ear. The ear canal will typically look red, swollen and moist. There is also a possibility of fluid drainage or the appearance of scaly, shedding skin. Depending on the degree of swelling, the eardrum may be hard to see. A sample of fluid may be removed from the ear and sent to a lab to look for bacteria or fungus.

Eardrops are commonly used to treat swimmer’s ear. These drops often contain antibiotics to kill the infection and steroids to stop the swelling.

One such eardrop is Ciprodex. It contains ciprofloxacin, an antibiotic, and dexamethasone, a powerful steroid. Patients will need to place about four to five drops in the infected ear canal twice a day for seven to 10 days.

Another commonly prescribed drop is Floxin, which contains an antibiotic but not a steroid. It is commonly prescribed in less swollen but still infected ears.

Other drop preparations include Cortisporin, which contains a commonly used combination of neomycin and polymyxin B, as well as hydrocortisone. However, neomycin is also damaging to the inner ear, so doctors nowadays often turn to Ciprodex or Floxin.

In some cases, the ear canal is too swollen for drops to reach the infected area, so the physician may place a wick or stent in the ear canal to keep it open. This will usually be left in place for three to five days until removed by the doctor, although occasionally the wick falls out once the swelling subsides. Usually, after 10 days the infection is resolved and the ear canal skin returns to normal.

Don’t try to get the water out with a Q-tip.

Managing a persistent infection

Sometimes swimmer’s ear may not resolve after seven to 10 days of treatment with eardrops. Oral antibiotics are typically recommended if the infection has spread beyond the ear canal or in patients with poorly controlled diabetes. Hospitalization for swimmer’s ear is rarely necessary; however, complications that can occasionally lead to hospitalization include fever, worsening discharge, extensive narrowing of the ear canal or failure of previous treatments.

Among the precautions you can take to prevent swimmer’s ear: Keep the ear canal dry. Tip your head to one side to help the water drain. Use a soft towel or cloth, or gently use a hair dryer near it. If the self-cleansing mechanism of the ear canal is impaired, then the ear canal should be cleansed by a physician.

Since most bacteria prefer a pH-neutral environment, reducing the pH in the ear canal can prevent bacterial overgrowth. A homemade liquid tincture can be mixed from a solution of half rubbing alcohol and half distilled white vinegar. The alcohol combines with the water in the ear and then evaporates. This removes the water while the acidity of the vinegar keeps bacteria from growing.

Two to three drops are usually sufficient and can be applied as a preventive measure soon after the ear has been exposed to moisture. This liquid solution is not a replacement for medical treatment of an actual ear infection and is meant to be used only in people who are prone to such infections because of prolonged or frequent exposure to moisture.

Also, it is important to differentiate swimmer’s ear from a middle ear infection, the most frequent reason for the use of antibiotics in children under age 5. Middle ear infections are usually associated with a viral upper respiratory infection, and they are more often seen during fall and winter, when influenza and cold viruses are more prevalent.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

The most physically active cities in the U.S.

The Most Physically Active Cities in the U.S.

The Most Physically Active Cities in the U.S.

Photo Credit: insta_photos / ShutterstockAs COVID-19 cases decline again, many public health restrictions are lifted, and more of life returns to normal, one interesting question for the months and years ahead is how the pandemic will permanently affect people’s habits and lifestyle.One example is fitness and physical activity. With many gyms, pools, and other recreational facilities closed or operating at limited capacity in 2020, the early COVID-19 pandemic raised concerns that lockdowns would decrease levels of physical activity. One study conducted early in the pandemic found that overall physical activity for adults was significantly lower than prior to the pandemic. Meanwhile, many at-home fitness products and services that boomed during the pandemic now face an uncertain future; while some consumers may be returning to their old gyms, others may simply be losing interest.The questions of whether and how much people are exercising post-pandemic are important because maintaining adequate levels of physical activity is a key component of individual and public health. Experts have identified a number of benefits associated with a physically active lifestyle, including reduced blood pressure, improved mood and energy levels, and better sleep. Physically active people are at lower risk for heart disease, type 2 diabetes, and even some types of cancers. The Center for Disease Control (CDC) found that a lack of physical activity contributes to 10% of all premature deaths in the U.S.



Physically active cities report lower rates of adverse health conditions

Physically active cities report lower rates of adverse health conditions

Additional data from the CDC appears to confirm how physical activity is associated with a reduction in other potential health risks. According to CDC data, the share of adults in each city who report being physically active has negative correlations with the share of adults reporting chronic health problems like obesity, diabetes, and high cholesterol. There are strong negative correlations for the incidences of obesity and diabetes, while the incidence of high cholesterol shows a more moderate relationship.

Western states have the most physically active adults

Western states have the most physically active adults

The share of adults who report engaging in physical activity also varies widely across states, with highly active states found in several regions of the country. Leading states for physically active adults include Colorado (80.9%), Washington (80.6%), Minnesota, (80.3%), and Vermont (79.8%). In contrast, states in the South show lower levels of physical activity. Southern locations like Mississippi (61.2%), Oklahoma (65%), Kentucky (66.6%), and Louisiana (67.5%) report the lowest levels of activity among their residents. While many of the most active states have excellent natural resources suited to active outdoor lifestyles, a more likely explanation is each state’s income levels. Research has found a correlation between higher levels of income and physical activity, and many top states have higher typical incomes than their less active peers. At the local level, many of the most active cities are found in these same active states, including metros like Seattle, Denver, and Minneapolis.The data used in this analysis is from the Centers for Disease Control and Prevention’s PLACES: Local Data for Better Health. To determine the most physically active locations, researchers at ChamberOfCommerce.org calculated the share of adults who self-reported engaging in leisure-time physical activity such as running, calisthenics, golf, gardening, or walking for exercise. For context, researchers also included statistics on obesity, high cholesterol, diabetes, and depression.Here are the most physically active cities.

The most physically active small and midsize US cities

The most physically active small and midsize US cities

15. Long Beach, CA

15. Long Beach, CA

Photo Credit: Ingus Kruklitis / Shutterstock

  • Share of adults who are physically active: 75.3%
  • Share of adults who are obese: 27.5%
  • Share of adults with high cholesterol: 27.2%
  • Share of adults with diabetes: 10.5%
  • Share of adults with depression: 15.5%



14. Charlotte, NC

14. Charlotte, NC

Photo Credit: digidreamgrafix / Shutterstock

  • Share of adults who are physically active: 76.8%
  • Share of adults who are obese: 29.5%
  • Share of adults with high cholesterol: 29.2%
  • Share of adults with diabetes: 10.7%
  • Share of adults with depression: 20.8%



13. Oakland, CA

13. Oakland, CA

Photo Credit: cdrin / Shutterstock

  • Share of adults who are physically active: 77.2%
  • Share of adults who are obese: 27.6%
  • Share of adults with high cholesterol: 27.3%
  • Share of adults with diabetes: 10.8%
  • Share of adults with depression: 16.3%



12. Virginia Beach, VA

12. Virginia Beach, VA

Photo Credit: Alexandr Junek Imaging / Shutterstock

  • Share of adults who are physically active: 77.4%
  • Share of adults who are obese: 30.4%
  • Share of adults with high cholesterol: 29.0%
  • Share of adults with diabetes: 8.9%
  • Share of adults with depression: 19.4%



11. Albuquerque, NM

11. Albuquerque, NM

Photo Credit: turtix / Shutterstock

  • Share of adults who are physically active: 77.4%
  • Share of adults who are obese: 27.8%
  • Share of adults with high cholesterol: 25.5%
  • Share of adults with diabetes: 9.4%
  • Share of adults with depression: 19.0%



10. San Jose, CA

10. San Jose, CA

Photo Credit: Uladzik Kryhin / Shutterstock

  • Share of adults who are physically active: 77.7%
  • Share of adults who are obese: 22.0%
  • Share of adults with high cholesterol: 25.5%
  • Share of adults with diabetes: 9.3%
  • Share of adults with depression: 13.6%



9. Raleigh, NC

9. Raleigh, NC

Photo Credit: Farid Sani / Shutterstock

  • Share of adults who are physically active: 78.1%
  • Share of adults who are obese: 30.5%
  • Share of adults with high cholesterol: 28.9%
  • Share of adults with diabetes: 9.6%
  • Share of adults with depression: 20.9%



8. Austin, TX

8. Austin, TX

Photo Credit: ShengYing Lin / Shutterstock

  • Share of adults who are physically active: 78.5%
  • Share of adults who are obese: 25.2%
  • Share of adults with high cholesterol: 30.5%
  • Share of adults with diabetes: 9.5%
  • Share of adults with depression: 19.3%



7. San Diego, CA

7. San Diego, CA

Photo Credit: Lucky-photographer / Shutterstock

  • Share of adults who are physically active: 78.6%
  • Share of adults who are obese: 22.6%
  • Share of adults with high cholesterol: 27.3%
  • Share of adults with diabetes: 8.9%
  • Share of adults with depression: 17.8%



6. Portland, OR

6. Portland, OR

Photo Credit: Bob Pool / Shutterstock

  • Share of adults who are physically active: 79.8%
  • Share of adults who are obese: 25.9%
  • Share of adults with high cholesterol: 25.8%
  • Share of adults with diabetes: 7.4%
  • Share of adults with depression: 25.6%



5. Colorado Springs, CO

5. Colorado Springs, CO

Photo Credit: photo.ua / Shutterstock

  • Share of adults who are physically active: 80.1%
  • Share of adults who are obese: 24.4%
  • Share of adults with high cholesterol: 28.8%
  • Share of adults with diabetes: 7.2%
  • Share of adults with depression: 20.1%



4. Denver, CO

4. Denver, CO

Photo Credit: Nicholas Courtney / Shutterstock

  • Share of adults who are physically active: 80.9%
  • Share of adults who are obese: 22.0%
  • Share of adults with high cholesterol: 26.2%
  • Share of adults with diabetes: 7.7%
  • Share of adults with depression: 18.4%



3. San Francisco, CA

3. San Francisco, CA

Photo Credit: Bogdan Vacarciuc / Shutterstock

  • Share of adults who are physically active: 80.9%
  • Share of adults who are obese: 16.1%
  • Share of adults with high cholesterol: 26.8%
  • Share of adults with diabetes: 9.1%
  • Share of adults with depression: 14.5%



2. Minneapolis, MN

2. Minneapolis, MN

Photo Credit: Checubus / Shutterstock

  • Share of adults who are physically active: 81.1%
  • Share of adults who are obese: 27.5%
  • Share of adults with high cholesterol: 25.7%
  • Share of adults with diabetes: 8.8%
  • Share of adults with depression: 22.8%



1. Seattle, WA

1. Seattle, WA

Photo Credit: Jeremy Janus / Shutterstock

  • Share of adults who are physically active: 84.7%
  • Share of adults who are obese: 22.1%
  • Share of adults with high cholesterol: 27.3%
  • Share of adults with diabetes: 7.4%
  • Share of adults with depression: 23.5%



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