Swimmer’s Ear Overview

Swimmer’s ear (also called otitis externa) is a painful condition of the visible or outer portion of the ear and ear canal (outer ear).

The ear canal is a cylinder-shaped structure that extends from the outer part of the ear, above the ear lobe, all the way to the eardrum (tympanic membrane). The typical size of the canal is about 2.5 centimeters in length and 7-9 millimeters in width.

The main function of the ear canal is to protect the ear from infection and entry of foreign objects. This function is accomplished by the length of the canal, making it difficult for objects to enter. In addition, the outer portion of the canal produces ear wax (cerumen) that helps trap debris entering the ear, and it also produces an acidic environment that may be harmful to bacteria entering the ear. There is also hair in the ear canal which provides an additional barrier against debris entering the ear.

All ages are affected equally, but children and teenagers are prone to develop this type of ear infection. This is a popular infection in swimmers and divers – hence the name “Swimmer’s Ear”. The infection affects 10% of the population every year.

Most of the time, swimmer’s ear is easy to recognize and cure with home care.However, if necessary, a visit to a health care inspection is recommended. The condition often occurs during the summer with exposure of the ear to water while swimming, and Water from a bath or shower can trigger the condition as well.

People with diabetes or those whose immune systems are weakened can develop a more worrisome form of the disorder that might require hospitalization for intensive medical treatment.

Swimmer’s Ear Causes

The skin lining the ear canal and outer ear serves as a barrier against infection from bacteria and fungi. The ear is protected against infection because the lining is slightly acidic. The lining is also a physical barrier that protects against excessive moisture.Picture of the Ear Structure
Any break in the skin lining can lead to infection, allowing bacteria or fungi to invade the outer ear.
The barrier can become broken and lead to an infection in the following ways:

  • When you attempt to clean your ears with cotton-tipped swabs or other objects inserted in the ear, the skin lining of the ear canal may break. This can also remove the protective ear was from the ear canal.
  • Excessive moisture in the ear canal from showering or swimming also alters the acidic environment of the ear canal, and allows for the invasion of bacteria or fungi. This is the reason this condition happens mainly in the summer months, and hence, is called swimmer’s ear.
  • Ear plugs, hearing aids, headphones, and other devices that may be inserted into the ear canal may increase the risk of swimmer’s ear.
  • Chemicals such as hair dyes, bleaches, and shampoos may irritate the ear canal and alter its protective properties. An infection can result.

Generally, any inflammation of the outer ear canal, such as infections, allergies, or skin conditions, can lead to swimmer’s ear.

The most common bacteria responsible for outer ear infection are Staphylococcus aureus and Pseudomonas aeruginosa. Other bacteria are less common. In minority of cases (less than 10%), a fungus is the cause of swimmer’s ear.

Swimmer’s Ear Symptoms

  • The most common symptom of swimmer’s ear is pain. Pain gradually begins over a day or two. The pain almost always involves only one ear. The pain is especially intense when the ear is touched or pulled.
  • The ear canal may itch.
  • The outer ear may be red, and in severe cases the ear canal may be swollen shut.
  • The ear may drain. This drainage may be clear, white, yellow, or sometimes bloody and foul smelling. Some fluid may crust at the opening of the ear canal.
  • With severe swelling or drainage, the person may have trouble hearing.
  • Ringing in the ear (tinnitus) and dizziness or vertigo may also be present.
  • Fever is generally not present. If there is a fever, it is not usually high.

Exams and Tests

The doctor can easily make a diagnosis of swimmer’s ear after taking a brief history and performing a limited physical examination. Pain produced by gently pulling on the ear as the doctor attempts to examine the ear canal is a likely sign of swimmer’s ear.

  • The doctor may look at the ear canal with a lighted scope called an otoscope. With this, the ear canal can be seen to be swollen, red, and sometimes coated with a whitish material called an exudate.
  • The doctor may examine the drainage from the ear under a microscope to determine if bacteria or fungi are causing the infection. This allows the doctor to prescribe either an antibacterial or an antifungal medicine.
  • X-rays and blood tests are rarely needed.

Self-Care at Home

  • Avoid any further trauma to the ear. Do not attempt to remove visible debris or drainage from the ear.
  • Apply heat to the ear to control the pain at home. Warmth from a heating pad may provide some relief. Fold a towel in half and place it between the heating pad and the ear. Limit the use of the heating pad to short periods. The folded towel should help prevent accidental burning of the ear if the heating pad is too hot.
  • If the person is not allergic to these, try a variety of over-the-counter pain medicines such as aspirin, ibuprofen (such as Advil), or acetaminophen (such as Tylenol).
  • Nonprescription ear drops are not usually strong enough to cure the problem. Such drops are useful only for prevention of episodes after water exposure. Ear drops used for treatment of the condition must be obtained with a prescription from a doctor.

Medical Treatment

Medications are generally aimed at symptom relief as well as a cure for swimmer’s ear. The main steps to treat swimmer’s ear can be listed as the following:

  • Clean the ear thoroughly
  • Treat inflammation and infection
  • Control pain
  • Obtain sample of any drainage and culture it (to see if any bacteria grows)
  • Avoid factors that may promote inflammation or infection

If there is a large amount of drainage or debris in the ear, the doctor will clean out the ear canal before medicine is placed in the ear.

  • The ear canal may be cleaned out using a wire or plastic loop instrument or under direct vision using a suction device.
  • After cleaning the ear, the doctor may place a foam wick in the canal. This allows antibiotic or antifungal ear drops or both to be placed onto the wick. The wick swells up inside the ear canal, thus holding the medicine in place against the lining of the skin.
  • Oral pain medicines are generally prescribed if over-the-counter medicines are not strong enough. Oral antibiotics are not often prescribed unless the infection is severe.

Topical Remedies

Topical remedies or swimmer’s ear drops are generally directed toward the treatment of inflammation and infection and are classified into the following:

  • acidifying agents,
  • antiseptics,
  • anti-inflammatory agents, and
  • antibiotics.

Acidifying Agents
Acidifying agents are effective because the common bacteria responsible for outer ear infection cannot survive in a very acidic environment. Examples include acetic acid, hydrochloric acid, salicylic acid, boric acid, sulfuric acid, and citric acid solutions.

Antiseptic Agents
Antiseptic agents work by potentially killing the offending bacteria. Some of these antiseptic solutions are alcohol, gentian violet, m-cresyl acetate, thimerosal, and thymol. Most of these are typically applied into the ear canal by an ear specialist (otolaryngologist).

Anti-inflammatory Agents
Anti-inflammatory agents help with inflammation and may reduce pain. Some studies have shown that the combination of anti-inflammatory and acidifying agents was superior to acidifying agents alone in reducing the duration of symptoms and providing relief for swimmer’s ear. Anti-inflammatory steroids such as hydrocortisone (Acetasol HC, Vosol HC) or dexamethasone (Ciprodex) are usually found in products in combination with antibiotics, acidifying agents, and antiseptics.

Many topical antibiotics are available for treatment of swimmer’s ear (otitis externa). Again, these are usually found in combination with the other three groups to increase the effectiveness of treatment.

Oral or intravenous antibiotics are generally not used in the treatment of swimmer’s ear. However, they may be appropriate in cases of severe infection in people with diabetes or those with weakened immune systems. They may also be used if applying topical ear drops is not possible due to severe swelling and closure of the ear canal.

Less commonly, outer ear infection may be related to a fungal infection (otomycosis). Typically, this condition is suspected in people who do not respond to the usual treatment for swimmer’s ear, those in highly tropical climates, or in people with multiple previous infections. Fungal infection can also cause more itching and less pain than bacterial infections. The examination of the ear may reveal a white, mold-like appearance.

The treatment of fungal outer ear canal infection also focuses on the combination of topical antiseptics, acidifying agents, anti-inflammatory agents, and anti-fungal medicines. Clotrimazole (Lotrimin, Mycelex) and miconazole (M-Zole, Micatin, Lotrimin) are the most commonly used anti-fungal medications used to treat fungal ear infections.

The Eardoc will assist with pain but is not a treatment for swimmer’s ear, also called Otitis Externa. the Eardoc is best for Otitis Media, ear infections and fluids drainage from the ear.

Prevention of ear infection

  • Use of shower caps while bathing and earplugs while swimming will help keep water out of the ear canal.
  • The best earplugs are often soft balls of special wax. The wax can be purchased at most pharmacies. Simply roll a small ball of wax in your hands and press it into the outer ear.
  • Homemade ear drops also help prevent swimmer’s ear after water exposure.
  • Make a 50:50 mixture of white vinegar and rubbing alcohol for use after swimming or exposure to water. Apply 3-4 drops in each ear canal after swimming. This helps dry the canal and maintain the acidic environment of the ear canal.
  • Avoid placing objects in the ear that can scrape or scratch the skin of the canal because this may cause an infection

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