Open water swimming: ears to good health

As we head into the peak season for triathlon and open water swimming, it’s time to talk about ears. “Pardon?” I hear you ask. “What’s that got to do with swimming?” Well, let me explain with a query I received at the end of last season from a budding triathlete called Lorna. Lorna had just completed her first year in triathlon, having competed in several open-water events. While she had performed very well, it turned out that she ended up suffering with several bouts of really bad earache, which had become progressively worse over the season. This recurrent earache was diagnosed by Lorna’s GP as a condition called ‘swimmer’s ear’. What was concerning Lorna was that while her ears were okay at the time of writing, she was worried about suffering future episodes and wanted to know what she could do to help prevent it from coming back.

Swimmer’s ear

Although it has a relatively low profile as a sports health issue, swimmer’s ear - more correctly known as ‘otitis externa’ - is actually quite a common problem in both competitive swimmers and those who swim or play regularly in open water. Otitis externa is an inflammation of the outer ear canal - the tube between the skin surface of the external ear and the eardrum. Typical symptoms include redness and swelling of the skin of the ear canal and itchiness, especially in the early stages. As it progresses, the ear can become sore and painful. There may also be a discharge, or increased amounts of earwax, and if the ear canal becomes blocked by swelling or secretions, hearing can be affected.

Otitis externa is usually caused by an infection, which may be fungal or bacterial. A bacterial infection is more likely to result in a localised problem, such as an inflamed spot or boil in the ear canal, but can cause more widespread inflammation of the tissues. Otitis externa may also develop in skin conditions such as eczema or dermatitis, where there's no infection but generalised inflammation of the skin.

Anyone can develop otitis externa and it often follows localised trauma to the skin of the ear canal - for example, if objects are placed in the ear, or if the canal is scraped by a cotton-tipped bud in an attempt to remove earwax. Constantly getting the ears wet can also damage the normal immune defences in the ear leading to infection (hence the term swimmer's ear). Studies also indicate that once you’ve suffered one episode of otitis externa, you’re more likely to suffer a subsequent episode.

Swimmers are particularly at risk of otitis externa. The reasons for this are several-fold and include the fact that both swimming pool and sea/lake water disrupts the normally slightly acidic environment of the ear canal. The acidity of these waters is typically fairly neutral (around a pH of 7.0). However, the natural pH of the ear canal is around 5.0-5.5 – around 40-100 times more acidic. There’s good reason for this natural acidity; studies show that an acidic environment is a powerful inhibitor of bacterial growth. In addition to the disruption to acidity, water residues in the ear canal after swimming increases moisture and humidity, which also help to promote bacterial growth. Then of course, there’s the possibility of bacteria entering the ear canal from the water itself. This is particularly an issue in open waters (which are not chlorinated) and where bacterial counts maybe very high, especially in waters subject to pollution episodes (eg run-off from drains or agricultural land following periods of heavy rainfall).

Solutions

Although otitis externa can usually be easily treated with antibiotic eardrops, prevention is much better than cure, especially as once you’ve suffered one episode of otitis externa, you’re more likely to suffer a subsequent episode. The first prevention strategy is to use a barrier to protect the ear canal. This can be achieved by wearing a tight-fitting cap that that completely covers your ears whenever you swim, and plugging the ears with cotton wool coated in Vaseline. Another useful strategy is to dry any water in your ears after swimming using a hairdryer on a low setting. You can then follow up with an acidifying ear spray product (such as ‘Earcalm’), which temporarily enhances the ear canal’s natural acidity, inhibiting any bacterial growth.

Open-water swimmers should also take sensible precautions by trying to ensure that they swim in clean water. Data on the water quality in lakes and rivers in the UK can be found online through the Environment Agency’s website, which also provides details on sea water quality at various beaches in England and Wales: environment.data.gov.uk/index.html. Many other countries and states have similar online databases covering your area that are searchable. Bear in mind however that both inland and sea water quality can take a big dip after heavy rains, which causes run off from the surrounding land.

Finally, it’s worth adding that you should never insert cotton wool buds or other objects into your ears. Wax works its way out naturally and cotton buds should only be used to sweep around your outer ear (pinna). Also, if you’re an in-ear headphone user, make sure you keep the ear buds clean and that the buds are soft and comfortable, and fit well without the need to push them too far into your ears.

Of course, ensuring good ear health isn’t the only concern for open-water swimmers and triathletes; tummy upsets other infections and injuries can all take their toll on swimmers. These are topics we have covered at length in recent Sports Performance Bulletin articles, some of which are listed below. So ‘listen’ to our advice, check out our articles and stay fit and well this summer!

Andrew Hamilton, Sports Performance Bulletin editor