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CDC Reports Swimmer's Ear is Expensive Public Health Issue


Swimming --- a great exercise, a source of fun, an escape from summer heat – may result in swimmer’s ear.

Swimmer's ear is not only painful but according to the CDC an expensive public health issue. This week’s MMWR report from the CDC states swimmer’s ear results in 2.4 million doctor visits annually in the United States, each visit costing an average of $200, that's almost $500 million in U.S. health-care costs each year.

Swimmer’s ear, acute otitis externa (AOE), is inflammation of the external auditory canal most often caused by bacterial infection. Symptoms include pain, tenderness, redness, and swelling of the external ear canal, and occasionally, purulent exudate.

In all fairness, swimmer’s ear (AOE) is not caused by swimming, but is associated with water exposure (e.g., swimming, bathing, and excessive sweating) and warm, humid environments.

The CDC report is based on analysis of 2003--2007 National Ambulatory Medical Care Survey (NAMCS) data, and ED estimates by using 2007 Nationwide Emergency Department Sample (NEDS) data. Only visits resulting in a diagnosis of AOE without concurrent otitis media were included in the analyses.

The analysis showed that in 2007, an estimated 2.4 million U.S. health-care visits (8.1 visits per 1,000 population) resulted in a diagnosis of AOE.

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The report found ambulatory care visit for AOE was most common among children aged 5--9 years (18.6%) and 10--14 years (15.8%). Adults are not immune, as 52.8% of these visits were in those aged ≥20 years.

Treatment for the early stages of swimmer's ear include careful cleaning of the ear canal and use of eardrops that inhibit bacterial or fungal growth and reduce inflammation. Mildly acidic solutions containing boric or acetic acid are effective for early infections. Oral antibiotics are rarely needed but should be used when AOE is persistent or when otitis media is also present.

The peak incidence of AOE is summer months, so the report is timely. Prevention is key.

The best prevention measures include reducing exposure of the ears to water (e.g., using ear plugs or swim caps and using alcohol-based ear-drying solutions).

The CDC suggests these tips to prevent swimmer's ear:

  1. Keep your ears as dry as possible, by using a bathing cap, ear plugs or custom-fitted swim molds when swimming.
  2. Dry your ears thoroughly after swimming or showering.
  3. Do not put objects in your ear canal (including cotton-tip swabs, pencils, paperclips or fingers).
  4. Do not try to remove ear wax. Ear wax helps protect your ear canal from infection. If you think your ear canal is blocked by ear wax, consult your doctor or health-care provider rather than trying to remove it yourself.
  5. Ask your doctor about using commercial, alcohol-based ear drops, such as Swim-Ear Drying Aid Drops. Or you can make a homemade ear drop solution by mixing equal amounts of rubbing alcohol and white vinegar.
  6. If you have ear tubes, damaged ear drums, outer ear infection or ear drainage (pus or liquid coming from the ear), you should not use alcohol drops.

It’s time to see a doctor if your ears are itchy, flaky, swollen or painful or if you have drainage from your ears.

Estimated Burden of Acute Otitis Externa --- United States, 2003—2007; CDC MMWR, May 20, 2011 / 60(19);605-609
Otitis Externa: A Practical Guide to Treatment and Prevention; Robert Sander, MD; Am Fam Physician. 2001 Mar 1;63(5):927-937.