The season of sunshine and fun is here. Summer means pool parties, evenings on the lake and beachfront getaways. When annoying ear pain gets in the way of all the festivities, many are quick to assume it’s a case of swimmer’s ear. Often, that is an accurate diagnosis, but if ear discomfort coincides with summertime allergies or a cold, an ear infection could be a culprit.The root causes of swimmer’s ear and ear infections are different, and so are the treatments. Determining whether ear pain is the result of swimmer’s ear or an infection can be difficult. Misdiagnosing ear pain can cause the problem to persist longer than necessary. Here’s what you need to know.

Causes of Ear Pain

Swimmer’s ear (otitis externa) occurs when water from an external source such as a swimming pool, river or lake gets trapped in the ear canal and becomes infected. This is usually caused by bacteria in the water, but fungal infections are not unheard of.

Ear infections (otitis media), on the other hand, are caused by internal inflammation resulting from a cold or allergy. In this case, the Eustachian tube of the middle ear becomes blocked or swollen and naturally-occurring fluid in the ear gets trapped behind the eardrum thereby becoming infected.  

Symptoms

It can be challenging to determine whether ear pain is the result of an external factor or an underlying infection, especially when dealing with a younger patient. Pain associated with swimmer’s ear will be felt more profoundly on the exterior of the ear. A patient will feel pain by touching the outside of the ear and may be more prone to tugging or touching the outer ear.

Depending on whether the water-borne irritant is bacterial or fungal, the patient’s symptoms may present differently. If the underlying cause of the swimmer’s ear was a fungus, the ear may be more itchy than painful. 

Patients with an ear infection will report “deeper” pain, and hearing loss is more common because of the infection’s proximity to the eardrum. And, while drainage is more typical of swimmer’s ear, it can be a symptom of either condition. Similarly, redness and swelling are associated with both swimmer’s ear and ear infections. However, a fever is a good indicator that you’re dealing with an ear infection.

Treatment

Swimmer’s ear is usually a mild condition easily treated with over-the-counter ear drops. For those interested in home-remedies, a one-to-one mixture of white vinegar and rubbing alcohol should do the trick. Acetaminophen or Ibuprofen may be used to manage pain.

Sometimes, the pain of swimmer’s ear may become severe enough to require a visit to your physician to get a prescription for an antibiotic ear drop. In these cases, the infection has likely spread to surrounding tissues. An ear wick may be necessary to stent or open the ear canal to allow drop to reach the affected area. A prescription pain medication may also be prescribed.

Ear infections, unlike swimmer’s ear, cannot be treated with ear drops. Oral medication is necessary to treat the underlying issue, whether it’s a cold or a seasonal allergy, causing the blockage or swelling of the Eustachian tube. Infections caught early may respond to an over-the-counter decongestant or nasal spray, but, depending on the persistence of the infection, a prescription antibiotic may be necessary.

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Susceptibility and Prevention

Traits such as the anatomy of the ear, narrowness of the ear canal or a propensity to produce a lot of cerumen (ear wax) can make a person more likely to suffer from swimmer’s ear. Preventable behaviors such as the use of cotton swabs in the ears can exacerbate a susceptibility to swimmer’s ear.

For patients who suffer from recurring bouts of swimmer’s ear, using ear plugs while swimming is a good idea. These can be found at most pharmacies. For some patients, swimmer’s ear can be a particularly stubborn and persistent problem. Custom earplugs made to fit a person’s specific ear canals may make the most sense in these cases.

If you think you or your child may have swimmer’s ear or an ear infection that is not responding to basic care, make an appointment with your ENT or primary care doctor to discuss your care options. 

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