Swimmer's Ear Costs U.S. Half a Billion Yearly

Study Finds Each Minor Infection Costs a Patient About $200 to Treat

Medically Reviewed by Laura J. Martin, MD on May 19, 2011

May 19, 2011 -- Swimmers often regard inflammation of the external ear canal, known as swimmer's ear, as an inevitable, minor nuisance. But a new study finds that the problem adds substantially to health care costs and the number of annual doctor visits.

"For swimmer's ear, there are 2.4 million health care visits and it costs half a billion dollars in health care costs each year," says Emily Piercefield, MD, DVM, an epidemiologist with the CDC who co-authored the report.

That doesn't include lost time from work and school activities, she tells WebMD.

The condition is often preventable, she says, by following simple hygiene measures and other tips.

The research is published in the Morbidity and Mortality Weekly Report.

Swimmer's Ear: By the Numbers

The new study is believed to be the first report to describe the overall number of cases in children and adults and the costs associated with the condition.

Swimmer's ear, known to doctors as acute otitis externa, is an inflammation of the external ear canal. Bacterial infection is the typical cause. The symptoms include pain, tenderness, redness, and swelling of the ear canal. There can also be discharge from the ear.

Piercefield and her team used databases such as the National Ambulatory Medical Care Survey and a database of emergency room visits. They used an insurance claim and payment database to estimate costs.

The $200 cost per infection was for those who didn't need to be hospitalized. Less than 3% of visits to the emergency department for swimmer's ear during 2007 ended in hospital admission.

Among other findings:

  • One in 123 Americans visited a doctor in 2007 for swimmer's ear.
  • From 2003 to 2007, children ages 5 to 14 had the highest annual visit rates for swimmer's ear, but more than 50% of visits were by adults 20 and older.
  • Cases peaked during summer swimming season, not surprisingly. June, July, and August are peak months.

Swimmer's Ear: Stopping It

Swimmers can reduce their risk of the infection, Piercefield says. Being aware of risk factors is one way.

"Risk factors are frequent swimming," she says. "The longer you are in the pool and more frequently, those increase your risk. If you are in a warm, humid environment, that increases your risk."

Infection can set in, she says, when bacteria accumulate in the water sitting in the ear canal. Keeping the ears dry is the goal.

Among the ways to help prevent the condition:

  • Keep your ears as dry as possible while swimming. Use a bathing cap, ear plugs, or custom-fitted swim molds.
  • Dry ears thoroughly after a shower or a swim.
  • Keep objects out of your ears. This includes cotton-tip swabs.
  • Leave earwax alone. It protects the ear canal from infection. If the wax is interfering with hearing, see your doctor.
  • Ask your doctor about using a homemade mixture of equal parts of rubbing alcohol and white vinegar after swimming. This remedy is not recommended for those with damaged eardrums, ear ventilating tubes, ear infection, or ear drainage.
  • Be sure the pool you swim in is properly disinfected. You can use pool test strips to check or ask the pool operator.

Swimmer's Ear: Perspective

The statistic of 2.4 million visits a year for swimmer's ear is surprising, says Thomas J Balkany, MD, Hotchkiss Professor and director of the University of Miami Ear Institute.

He reviewed the report for WebMD. "In my clinical experience, this appears to be a high number," he says.

He does agree that swimmers can reduce their risk.

He also recommends the 1-1 rubbing alcohol and white vinegar treatment, under certain conditions. "Don't use anything in the ear unless a doctor has told you the ear is normal," he says. Those with ear tubes or a possible hole in the eardrum should not use the mixture, he says.

For others, the remedy can help, he says. The alcohol has a drying effect, and the vinegar is acidic enough to change the environment of the ear canal so bacteria have a difficult time growing.

How to tell if you may need attention for swimmer's ear? "Place your index finger in the opening of the ear canal and your thumb behind the ear. Firmly but gently move the cartilage back and forth," Balkany says. If that hurts, he says, it could be swimmer's ear.

The typical treatment is antibiotic ear drops.

Show Sources


Piercefield, E. Morbidity and Mortality Weekly Report, May 20, 2011, vol 60: pp 605-609.

Emily Piercefield, MD, DVM, epidemiologist, Division of Applied Sciences, CDC.

Thomas Balkany, MD, Hotchkiss Professor and director, University of Miami Ear Institute; chairman emeritus, department of otolaryngology, University of Miami Miller School of Medicine.

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