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How to Prevent Swimmer's Ear & Other Causes of Ear Pain

A doctor checks a young girl's ear.

Our ears are essential for daily life, constantly collecting and transmitting soundwaves to the brain for interpretation. But hearing isn’t our ears’ only purpose. Properly-functioning ears can also pinpoint a sound’s location, distinguish familiar voices in a crowd, and maintain a person’s balance and equilibrium thanks to the movement of fluid through the inner ear, according to the American Speech-Language-Hearing Association (ASHA). So, when your ears are on the fritz, it’s understandably distressing.

If you're wondering what's causing your ear pain or how to prevent ear problems such as swimmer's ear, hearing loss, or exostosis, this post is for you. Our comprehensive guide to ear ailments contains everything you need to know about caring for your ears in and out of the pool.

Swimmer's Ear

What is Swimmer's Ear?

Also referred to as otitis externa, swimmer's ear is one of the most common water-induced health problems, affecting water-exercisers, triathletes, fitness swimmers, and children alike. The Center for Disease Control and Prevention (CDC) estimates that swimmer's ear patients account for at least 2.4 million doctor visits and nearly 500 million dollars in healthcare costs annually.

A swimmer dons her Speedo goggles.

You might assume that swimmer's ear is the same as a run-of-the-mill ear infection − the kind you had when you were a kid. But middle ear infections are caused by viruses or fluid buildup, whereas swimmer's ear is caused by contaminated water that becomes trapped in the ear, leading to pain, swelling, or discharge. You might also experience swimmer's ear symptoms such as fever, swollen glands, redness in or around the ear opening, or a "full" sensation in the inner ear. If you can move your outer ear without experiencing any pain, you probably don't have swimmer's ear, according to the CDC. But, just like a typical childhood ear infection, swimmer's ear can lead to hearing loss and cartilage damage if left untreated.

Treating Swimmer’s Ear

For swimmer's ear infections that are caught early, treatment is simple, according to the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNSF). All you need to do is keep the ear canals clean and administer ear drops that prevent bacterial growth. Doctors at the AAO-HNSF suggest lying down with the affected ear facing up and dropping solution into the ear until it's full. Remain lying down for a few minutes to allow the drops to be fully absorbed. The AAO-HNSF even advises making your own DIY solution by mixing a 1:1 ratio of white vinegar and rubbing alcohol. The alcohol dries excess water, while the vinegar maintains natural moisture levels. AAO-HNSF notes that most cases of swimmer's ear clear up in about 7-10 days.

Note: If you have a perforated ear drum or ear tubes, do not attempt any treatment without first speaking with your ENT. If your symptoms worsen despite at-home care, immediately seek help from a doctor.

How to Prevent Swimmer’s Ear

Because otitis externa is caused by trapped water, keeping the ear canals dry is key to reducing the incidence of swimmer's ear. The CDC suggests using ear plugs for swimming or bathing. You should also avoid swimming in untreated or unclean water and discontinue the use of Q-tips in the ears. Cotton swabs simply compact dirt and earwax, creating a more hospitable environment for the bacteria that causes ear infections.

Ear Tubes

What Are Ear Tubes?

Ear tubes are tiny cylindrical devices inserted through the ear drum to allow air to flow into the inner ear. Children who suffer from recurring ear infections, speech delays, fluid retention, or behavioral problems are all candidates for ear tubes.

A happy-looking child slides down a red waterslide.

You might also hear them referred to as pressure equalization tubes, myringotomy tubes, or tympanostomy tubes. No matter what you call them, they’re remarkably common. The AAO-HNSF reports that ear tube surgeries are the most routine medical procedure for children aged one to three, with more than 500,000 procedures performed annually.

Can You Swim With Ear Tubes?

The answer is an unequivocal "yes". Though doctors often recommend that children with ear tubes avoid getting water in their ears while swimming or bathing, formal recommendations published in 2013 by the AAO-HNSF suggest that "clinicians should not encourage routine, prophylactic water precautions (use of earplugs, headbands; avoidance of swimming or water sports) for children with tympanostomy tubes." That's because swimming in clean, well-maintained water poses little risk to children with ear tubes. Thanks to the tube's tiny opening and water's surface tension, liquid doesn't simply flow through the tube into the inner ear.

Despite official guidelines, recent research conducted by the Children's Hospital of Pittsburgh indicates that there is a small, but statistically-significant, increase in ear infection episodes among children who don't wear ear protection while swimming. So, if your child will be playing in untreated or unclean water (think: lakes, rivers, blow-up pools), wearing an earband or earplugs for swimming may help to curb the incidence of ear infection. Ear plugs are also ideal for washing your child's hair since soapy water is more viscous and therefore more likely to pass through your child's ear tube.

Ear Plugs for Ear Tubes

If your child will be swimming with ear tubes, any waterproof ear plug will prevent water from entering your child's ear canal. A moldable ear plug is ideal for younger children to manipulate and put in their own ears; pre-shaped varieties are best for older children with ear tubes because they're a bit more difficult to situate in the ear. Moldable plugs are only good for about 5 uses before becoming soiled or losing their malleability while pre-molded ear plugs can be washed and reused time and time again.

Surfer's Ear

What is Surfer's Ear (Exostosis)?

People who surf, water-ski, kayak, or sail are prone to bony growths in the ear known as exostoses. Exostoses can form anywhere on the body, but those found in the ear are commonly referred to as "Surfer's Ear" due to the high number of cases within the surfing community. These abnormal growths in the ear canal are caused by prolonged exposure to cold water and wind. Though they may go unnoticed at first, symptoms begin to manifest as the exostoses develop. As the growths enlarge, the ear canal narrows, causing earwax and water to become trapped and hearing to become impaired. This trapped water may lead to recurring ear infections, if left uncorrected.

A surfer in a wetsuit shreds a wave.

Surfer's Ear Symptoms and Treatment

Once growths form in the ear, there is no way to reverse the problem and medical intervention may be necessary to restore hearing and healthy ear function. Though most surgery candidates are in their mid- to late-thirties, anyone can develop bony ear growths with enough exposure to cold water and wind, according to doctors at the California Ear Insitute.

Medical procedures to remove exostoses are traditionally performed by making an incision behind the ear and using a drill to enlarge the ear's opening. Modern practices replace the use of a drill with a chisel to broaden the ear canal. This method is less abrasive and less likely to result in hearing loss. The minimally-invasive chisel method also promotes faster healing, allowing watersports-enthusiasts to get back to the water more quickly, according doctors at the Palo Alto Medical Foundation (PAMF).

Ear Plugs For Surfer's Ear

Because the growths are exacerbated by exposure to cold water and air, simply keeping the ear canals warm reduces the risk of exostoses. Dr. Douglas Hetzler, an ENT specialist at the PAMF, points out that "prevention of the growth of the exostoses is aided by wearing earplugs and/or a neoprene hood when surfing or swimming in the ocean."

Though any ear plug will do, Doc's Pro Plugs are specifically designed to protect against irritation from cold water and wind. In fact, the company's founder, Dr. Robert Scott, was an avid surfer himself and designed them with this exact purpose in mind. And, because Doc's design doesn't breach the ear canal, they're safe to wear if you've just undergone an exostosis-removal procedure.

Hearing Loss

What is High Frequency Hearing Loss?

Musician's Ear, also known as high frequency hearing loss or noise-induced hearing loss, affects 1 in 10 Americans, according to the American Hearing Research Foundation (AHRF). This damage diminishes a person's ability to decipher normal speech and may require the assistance of a hearing aid.

A carpenter measures a board.
Copyright: kzenon / 123RF Stock Photo

What Causes Hearing Loss?

Though it's commonly thought that hearing loss is age-related and inevitable, the AHRF points out that the real offender is excessive noise and that many cases of hearing loss can be prevented with the use of ear plugs or ear muffs. The World Health Organization (WHO) indicates that hearing can be permanently damaged by exposure to noise levels of 85dB for 8 hours or exposure to 100dB for as little as 15 minutes. WHO also reports that at least 1.1 billion young people are currently at risk of losing their hearing, either partially or entirely, thanks to the ubiquity of cell phones and portable music players: "[A]mong teenagers and young adults aged 12-35 years, nearly 50% are exposed to unsafe levels of sound from the use of personal audio devices and around 40% are exposed to potentially damaging levels of sound at entertainment venues."

In the case of musicians, instruments that produce high frequencies, such as violins and violas, are more likely to cause hearing damage than lower-frequency instruments such as pianos or trombones. And, due to instrument positioning, musicians often accrue more hearing loss in the left ear than the right. Though the moniker calls out musicians specifically, high frequency hearing loss is also common among construction workers, motorcyclists, and people who work regularly with power tools.

High Frequency Ear Protection

If you work in a factory, an airport, or a machine shop, you're probably already aware that the Occupational Safety and Health Administration (OSHA) strictly governs work place noise levels. The latest OSHA standards, laid out in their “Hearing Conservation Program” require several provisions for working environments where the noise level meets or exceeds 90dB. For instance, employees are entitled to free access to at least one style of ear plug and one style of earmuff, compulsory training in the proper use of ear protection, and a yearly hearing test. If the annual hearing test indicates a 10dB (or more) high-pitch hearing loss, the employer must inform that employee and require them to wear ear protection at 85dB or above. In general, no workplace noise above 140dB (that's louder than a rock concert) is ever permitted.

As the Mayo Clinic points out, damage to your hearing can't be reversed. The best solution is to take preemptive measures to curb or eliminate hearing loss before it happens. That means reducing the volume and duration of exposure or wearing ear plugs or ear defenders whenever you're taking part in noisy activities like going to a concert, mowing the lawn or shooting a gun. When selecting ear plugs, seek a pair with a high dB rating. They're designed to attenuate noise levels that reach the ear without deafening you entirely.

This article is an informational resource and should not be construed as medical advice. Always speak with your ENT doctor or family physician before making any health-related decisions.


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