As the weather warms and schools inch toward summer break, kids will be flocking to pools, lakes, and beaches to cool off and make a splash. While swimming is a great way to get physical activity and beat the heat, between the high temperatures, humidity, and all that time in the water, there lies an increased risk of developing otitis externa, aka swimmer's ear.

What is Swimmer's Ear?

Swimmer's ear is an infection that occurs when water or moisture becomes trapped in the outer ear canal for an extended period of time. This damp environment provides the perfect breeding ground for bacteria (and sometimes fungi) to breed and grow. Additionally, a protective coating of ear wax normally helps guard the ear canal against infections. However, swimming can disrupt this natural defense, washing away the wax and leaving ears vulnerable. The prolonged wetness and a compromised protective barrier set the stage for bacterial overgrowth and inflammation deep within the ear canal.

But, swimmer's ear can be caused by more than just swimming. Any damage to the skin of the ear canal can result in an infection. Scratching the ear canal, cleaning the ear with cotton swabs, or inserting objects like bobby pins or paper clips can all harm the ear lining, leading to otitis externa. Even dry skin or eczema can increase the chances of developing this condition.

What are the Symptoms?

Swimmer's ear can cause multiple symptoms such as itching of the ear canal, redness and swelling of the skin of the outer ear or ear canal, purulent drainage from the ear canal, pain when touching the ear (especially pulling on the lobe), or moving the jaw (including actions like talking or chewing), and changes in hearing. While a low-grade fever may occur in some cases, other signs or symptoms associated with upper respiratory infections are typically not present with otitis externa.

What are Potential Complications?

Swimmer's ear infections usually aren't serious. Still, if left untreated, they can lead to complications such as temporary hearing loss, chronic infection, deep tissue infection, bone and cartilage damage, and even life-threatening infections that can spread to the brain or cranial nerves.

What are School Nurse Interventions?

If, after assessment, otitis externa is suspected, students should be referred to their primary care providers for further evaluation. Treatment often involves prescription eardrops, which commonly contain a combination of either acetic acid or an antibiotic with an inflammation-soothing corticosteroid. In cases with significant swelling, providers may place a wick in the ear canal to help the eardrops reach deeper into the canal—adherence to school policies and medication administration best practices when drops are to be administered in school. OTC pain medications or warm compresses (heating pad set on low) can ease pain and discomfort if ordered, permitted, and not contraindicated.

Finally, as pool season gets underway, school nurses can advocate for prevention measures that protect students' ears by providing information sessions or health office communications for students and parents about the importance of ear care, particularly concerning swimming and water activities. Moreover, developing and distributing materials on how to properly dry ears, the dangers of using cotton swabs inside ears, and the significance of using ear protection during swimming can help reduce the incidence of painful swimmer's ear infections.

Through education, recognition of symptoms, and prompt referrals, the tide can turn against swimmer's ear, ensuring it doesn't dampen summer spirits.