Swimmer’s Ear (Otitis Externa)

What is Swimmer’s Ear?

Swimmer’s ear is an inflammation of the ear canal and eventually the earlap, occurring in people who often have wet ears. It occurs mostly in children and teenagers who spend a lot of time in water, but also in persons who sweat a lot or have skin diseases.

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Swimmer's Ear is Common in Children

Picture 1.Swimmer’s ear commonly occurs in children

Symptoms of Swimmer’s Ear

Common symptoms are (1):

  • Ear itch
  • Pain, especially when pressing upon the ear ‘tag’ or pulling the ear-pad, or during chewing
  • Feeling of fullness in the ear
  • Decreased hearing, noises in the ear
  • Ear canal and ear-pad swelling, redness and skin scalding
  • Pus draining from the ear canal
  • Swelling of lymph nodes around the ear

Usually only one ear is involved.

In severe cases with fever, dizziness, or general headache, you should visit a doctor promptly.

Causes and Risk Factors for Swimmer’s Ear

The predisposition for swimmer’s ear is constant ear moistness. Moist skin in ear canal may then be inflamed due to physical or chemical irritation or due to infection by bacteria like staphylococci, streptococci, or pseudomonas, or by fungi. Swimmer’s ear may also develop from folliculitis in the ear canal. Middle ear infection may spread into the outer ear canal through a perforated eardrum.

Risk factors for swimmer’s ear are (2):

  • Frequent swimming or diving, especially in polluted water
  • Persisting moistness in the ear from bathing or living in moist climates
  • Narrow ear canal
  • Use of earphones or hearing aids
  • Having swimmer’s ear, ear injury or surgery in the past
  • Vigorous ear cleaning using cotton buds, impacted earwax, foreign objects
  • Hair sprayers, dyes and shampoos which irritate the skin of ear canal
  • Skin diseases: eczema, seborrhea, psoriasis, allergies
  • Poorly controlled diabetes, cancer, blood diseases (hemophilia), weak immune system
  • Corticosteroids, chemotherapy

Swimmer’s ear most often occurs in school children, but it may also appear in adults. It is not common in infants and toddlers.

Diagnosis of Swimmer’s Ear

Diagnosis is made by ear examination performed by a doctor of general practice. Only in severe cases an ear doctor (ENT) is needed. In severe cases with ear drainage, a sample of pus can be sent to a microbiological laboratory to find the exact cause.

Home Treatment and Remedies for Swimmer’s Ear

In mild cases, and when one can be quite sure that the eardrum is not perforated, swimmer’s ear can be treated at home. During an infection, ears should be kept dry by avoiding swimming, and using shower caps during showering. Using cotton balls during infection is not appropriate.

Outer ear (earlap) should be regularly dried with a towel. Ears can be dried using a hair drier from an arm length distance, after you have set it at ‘warm’ position (never at ‘hot’).

Burow’s solution, a mixture of aluminium sulfate and acetic acid, is an effective remedy against both bacterial and fungal external otitis. Mineral oil ear drops can be used in skin diseases causing dry ears, thus protecting them from water.

Home made ear drops from equal parts of white vinegar and ‘rubbing alcohol’may be used in mild infection. They should be stored in an eardrop bottle and heated to body temperature before using, to prevent dizziness. Ear drops should reach the end of the ear canal and they should be allowed to stay there for at least 2-3 minutes to take effect.

Pain killers like Aspirin, acetaminophen or ibuprofen may be used. Warm (not hot) pads placed over infected ear may reduce pain, but they should be not used in children.

CAUTION:Ear candles should not be used in swimmer’s ear since they may cause burns and eardrum rupture (1).

Treatmet by a Doctor

In severe cases, or when other skin diseases are involved, treatment of swimmer’s ear should be done by a doctor. Treatment may include ear canal cleaning, topical antibiotic ointments or ear drops, corticosteroids, or (only in resistant cases) oral antibiotics. Pain killers may be prescribed. Swimmer’s ear can be usually treated in 7-10 days.

Sometimes, a “wick” needs to be placed in the ear canal to keep it open and to enable administering ear drops. Periodic suctioning of the ear canal may also be needed to keep ear canal open.

Complications of Swimmer’s Ear

Possible complications are:

  • Temporary hear loss
  • Repeated infections
  • Ear cartilage damage
  • Eardrum rupture and middle ear infection
  • Malignant external otitis

Swimmer’s ear is not contagious (1).

Prevention of Swimmer’s Ear

The following preventing measures may apply for all, but mostly for individuals prone to get repeated ear infections.

1. Keeping Ears Dry

Use ear plugs or Vaseline coated cotton balls while swimming or showering. To remove trapped water from ears, grab the lower part of ear-pad, pull it down and tilt the head to allow any water to pour out. Dry the ears using a hair drier. Do not use cotton buds to dry the ear canal. Most ear doctors nowadays do not recommend cleaning the ear canal at all. Only clean your ear-pad.

Prevention Ear Inflammation and Infection

Avoid irritant shampoos, hair sprays and dyes. Before and after swimming and after showering use ear drops, either from pharmacy or home made. This will prevent an ear infection.

Chronic Swimmer’s Ear?

Chronic swimmer’s ear can be caused by a bacterial infection, eczema, seborrhea, fungi, chronic irritation (hearing aids, cotton swabs), allergy, chronic drainage from middle ear disease, tumors (rare), or frequent ear scratching.

Malignant External Otitis

Malignant external otitis is a bacterial (usually Pseudomonas) infection of the base of the skull (1). It can develop if bacteria invade the bones inside the ear canal. Brain nerves and brain may get affected. It is mainly seen in poorly controlled long-term diabetes, HIV,  or impaired immune system, and it can be life dangerous. Symptoms include ear pain with sudden facial paralysis, hoarseness, and throat pain. Treatment is with antibiotics.

References:

  1. Swimmer’s ear  (cigna.com)
  2. Risk factiors for swimmer’s ear  (cigna.com)
About Jan Modric (249 Articles)
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  • Unless an infection is left untreated, swimmers ear is quite temporary.
    Most children outgrow the activity and move on to more adult pastimes.