Yes, all managed to capitalize on their Olympics success – Phelps with his many endorsements, Spitz in his famous poster displaying his seven Olympic medals, Weissmuller with a career in the movies playing Tarzan and later appearing as TV’s “Jungle Jim.”
Give up? Well, the extensive time they all spent in the water means they all were more susceptible than the average person to swimmer’s ear, an outer ear canal infection that is most often caused by water remaining in the ear after swimming.
Anyone who spends a lot of time in the water – as most Olympic swimmers do when they train for the gold – are more susceptible to swimmer’s ear. When water clogs the ear canal and can’t be extracted, the warm, moist conditions of the ear allow bacteria to thrive. It’s a painful condition that can lead to serious complications if the ear’s membrane has an opening.
What Causes Swimmer's Ear?
Swimmer’s ear is also known by the names acute external otitis or otitis externa. The infection is caused by bacteria that enters the skin inside the ear canal, which can be damaged by poking the ear canal with fingers, cotton swabs or other objects. This breaks the thin skin lining the ear canal and allows harmful bacteria to enter.
If you go swimming before the membrane heals, the result can be an infection that is mild at first but can progress to severe pain, fever and other complications.
The Centers for Disease Control and Prevention estimate that 36 percent of children ages 7 to 17 years old and 15 percent of adults swim at least six times during the year, creating a large number of potential ear infection opportunities. The term for illnesses that result from swimming is recreational water illnesses (RWI), which are the product of bacteria or germs that are ingested or otherwise enter the body by contacting contaminants found in water.
The Ear's Natural Defenses
Swimmer’s ear is usually prevented because the outer ear canals have protections in place to prevent infection. These include glands that produce a wax-like substance to form a water-repellent barrier on the skin inside the ear and discourages bacteria growth and the downslope of the ear canal, which helps to drain any water that gets into the space.
However, these defenses can be overwhelmed under certain circumstances, allowing bacteria to grow, and swimming isn’t the only cause. Excessive moisture in the ear caused by humid weather or heavy perspiration from hot weather can also accumulate in the ear canal. Then, when cleaning the ear or poking at an itch with a finger, the skin breaks, allowing the bacteria present to invade. There are also certain jewelry or hair products that can cause an allergic reaction or skin condition that helps to promote infection.
If someone swims a lot, particularly if it’s in a body of water like a lake that has elevated bacteria, they may be more susceptible to acquiring swimmer’s ear, simply because they are immersing themselves in water that contains more bacteria than the chlorinated water of a pool. Anyone with a narrow ear canal, like children, can more easily trap water inside the ear, and headphone buds or hearing aids inserted into the ear also have a chance of breaking the skin.
Symptoms of Swimmer’s Ear
Swimmer’s ear symptoms start out mild and include itching in the ear canal, redness in the area, fluid drainage and the urge to tug on the ear to clear accumulated fluid.
As the problem progresses, itching can intensify, leading to increased pain and redness, more fluid drainage, potential pus discharge, and a feeling that something is blocking or otherwise standing in the ear. This is typically caused by fluid, debris and swelling in the ear canal. Hearing may be affected at this stage, with most patients reporting that they hear muffled conversation.
The final stage produces severe pain that may extend beyond the ear to the neck, side of the head, or face; a complete blockage in the ear canal, cutting off hearing; swelling and redness in the outer ear, along with swollen lymph nodes in the nearby neck; and a high fever.
The consequences of not treating these conditions promptly are daunting. Temporary hearing loss is the first issue, as the increasing amounts of fluid muffle outside sounds. This will get better once the infection clears. However, if symptoms persist, it may mean the patient is suffering from a rare strain of bacteria, chronic skin allergy, reaction to any ear drops used to battle the infection, or a combination of fungal and bacterial infections.
In rare instances, a swimmer’s ear infection can spread into connective tissues of the skin, creating a deep tissue infection known as cellulitis. When this happens, it can create bone and cartilage damage (known as necrotizing otitis externa) that can affect the bones in the lower part of the skull and the cartilage in the outer ear. Those who have weak immune systems or diabetes are more susceptible, and it is particularly dangerous because the unchecked infection can invade nerves or the brain, potentially creating a life-threatening situation.
Ways to Avoid Swimmer's Ear
Here are a few suggestions to avoid swimmer’s ear:
1) Make sure not to poke your inner ear lining aggressively with a finger, swab or other tool, like headphone ear buds.
2) Clear any water from the ear immediately.
3) Thoroughly dry the outer ear after swimming or perspiring heavily.
4) Take note of any irritations in the ear area. They may be a reaction to hair care products or other conditions that may produce bacteria.
5) Seek medical help. Take any redness or hearing problems seriously. Symptoms, particularly pain, require a doctor’s immediate attention to stem any serious complications.
Diagnosis and Treatment
A doctor will conduct a complete physical examination but also may ask about swimming habits, including recent areas visited. Most cases can be dealt with at the lower levels of examination, but severe complications may require a specialist. The doctor will examine the inner ear with an otoscope, a lighted instrument that will allow an examination of the ear canal to determine its condition. If the ear canal is blocked, a small suction device or scoop may be used to clear debris and allow a better view.
If damage to the eardrum is present (particularly if it appears torn), the doctor may issue a referral to an ear, nose and throat specialist. At that meeting, a sample of ear debris may be taken for laboratory examination to determine the exact bacteria causing the symptoms.
To treat the infection, ear drops that contain antibiotics to fight existing infections, steroids to treat inflammation, acidic solutions to restore the ear conditions to normal, or an antifungal medication to fight fungal infections will typically be used. Oral antibiotics may be used in advanced swimmer’s ear infections.
To fight pain, over-the-counter ibuprofen, naproxen or acetaminophen, sold as Advil, Aleve or Tylenol, will be recommended, although severe pain will usually require a prescribed medication.
During treatment, it is recommended that the patient not swim; travel via airplane; use headphones, earplugs or hearing aids; and avoid getting any moisture in the ear canal while showering or bathing. A cotton ball can usually block the entrance to prevent moisture from intruding while immersed in the water.
With those treatments, swimmer’s ear infections will usually clear up in a few weeks.