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The prevalence in swimmers is approximately five times more than that in nonswimmers, with an annual incidence of approximately 1% and an overall lifetime incidence of 10%.2 It occurs mostly during spring and summer, with age peaks at 7–12 years, and decreases after the age of 50 years. Continuous or prolonged exposure to water dissolves oil and wax in the ear canal, which results in dry, fissuring skin, thereby effectively obliterating the ear’s natural defense mechanism against microorganisms. Minor trauma from vigorous or inappropriate ear cleaning could also be an associated cause. Swimmer’s ear presents with a sudden onset of otalgia, pruritis, canal oedema and erythema, and is often accompanied by otorrhea and hearing loss. A classical finding of severe tenderness with movement of the pinna is characteristic of this condition. Furthermore, it can be classified as mild (minimal canal oedema with minor discomfort and pruritis); moderate (partly occluded canal with intermediate pain and pruritis); and severe (completely occluded ear canal with intense pain, fever, erythema and lymphadenopathy). 3 Bacterial causes are responsible for the majority of acute cases. A recent study conducted in South Africa showed that Pseudomonas aeruginosa (33%) and Staphylococcus aureus (24%) were the main organisms responsible for otitis externa. 4

Clinical evidence in the management of swimmer’s ear