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Swimmer's Ear

Definition :
Water normally flows into and out of your ears without causing any problems. You can nearly always shower, bathe, swim, and walk in the rain without a problem — which is remarkable, considering how large and deep an opening your ear provides. You're protected by your ear's shape, which tips fluid out, and by its lining, which has acidic properties that protect against bacteria and fungi.

When your ear is exposed to excess moisture, however, water can remain trapped in your ear canal. The skin inside becomes soggy, diluting the acidity that normally prevents infection. A cut in the lining of the ear canal also can allow bacteria to penetrate your skin. When this happens, bacteria and fungi from contaminated water or from objects placed in your ear can grow and cause a condition called swimmer's ear (acute otitis externa, or external otitis).

Swimmer's ear is an infection of your outer ear and ear canal. It can be associated with a middle ear infection (otitis media) if the eardrum ruptures.

Usually, self-care steps can relieve the symptoms of swimmer's ear. However, a severe case of swimmer's ear will require a trip to your doctor.

Causes :
Causes of swimmer's ear may include :
  • Persistent moisture in your ear from swimming, bathing or living in a humid environment
  • Exposure to an infectious organism from swimming in polluted water
  • Skin breakage caused by scratching or rubbing your ear with a foreign object (such as a cotton swab or pencil), or attempting to clean earwax (cerumen) from your ear canal
  • Bacteria growth fostered by hair sprays or hair dyes in your ear

Risk Factor :
Swimmer's ear is common in children and in young adults. You may be at increased risk of infection if a skin condition, such as eczema, causes you to scratch your ears excessively. Earwax buildup or blockage also may increase your risk by trapping water in your ear and increasing the likelihood that you'll cut the skin while cleaning your ear.

Other ear problems also may increase your risk of swimmer's ear, including small ear canals that don't drain well and chronic middle ear infections that moisten and perforate the eardrum.

If you're an older adult or have an underlying medical condition, such as diabetes, your immune system may be impaired, increasing your risk of swimmer's ear. If you have poorly managed diabetes, you're at increased risk of developing severe, painful swimmer's ear that may be difficult to treat.

When to seek medical advice :
Make an appointment with your doctor if you have pain or swelling in your ear or drainage from your ear. Swimmer's ear is not usually an emergency, but it's important to see a doctor right away if you have any signs or symptoms of swimmer's ear and have an underlying disease that may impair your immune system.

Your doctor will examine the inside of your ear and, if indicated, refer you to a doctor who specializes in the care of ear, nose and throat disorders (otolaryngologist).

Call your doctor immediately if an infection that's already being treated produces new signs or symptoms, especially fever, redness of the skin behind your ear, or increased drainage from or severe pain in or around your ear.

Symptoms :
Signs and symptoms of swimmer's ear usually appear within a few days of exposure to contaminated water, and may include :

  • Severe pain on moving your outer ear (pinna, or auricle) or pushing on the little "bump" (tragus) in front of your ear.
  • Pain or discomfort in or around your ear. Usually only one ear is involved.
  • Itching of your outer ear.
  • Swelling in your ear or lymph nodes in your neck.
  • Feeling of fullness or stuffiness in your ear.
  • Pus draining from your ear.
  • Decreased or muffled hearing.

Swimmer's ear may also cause your outer ear to appear red with scaly or flaking skin.

Dignosis :
To examine the inside of your ear, your doctor may use a lighted instrument (otoscope). The inside of your ear and your ear canal may appear red and swollen. Your ear canal may also appear scaly, with flaking skin. If you have drainage from your ear, your doctor may culture a sample to determine if the cause of the infection is bacteria or fungi.

Complication :
Swimmer's ear usually isn't serious, but complications can occur if it isn't treated. Complications may include :

  • Temporary hearing loss. You may experience muffled hearing, but this usually goes away when the infection is gone.
  • Recurrent outer ear infections (chronic otitis externa). Swimmer's ear may not respond to treatment or may keep coming back in some people. This can lead to infection in the surrounding skin (cellulitis).
  • Bone and cartilage damage (necrotizing otitis externa). An outer ear infection that spreads can cause inflammation and damage to the bones and cartilage at the base of your skull, often causing increasingly severe pain. Older adults and people with diabetes are at increased risk. An older term for this is malignant otitis externa; however, this condition has nothing to do with cancer (malignancy).
  • More widespread infection. If swimmer's ear develops into necrotizing otitis externa, the infection may spread and affect other parts of your body, such as the brain or cranial nerves. This severe infection can be life-threatening.

The goal of treating swimmer's ear is to clear up the infection. Treatment may include :

  • Cleaning. Clearing your outer ear and ear canal of any drainage and flaky skin allows topical medications to work more effectively. Your doctor may perform this procedure with a suction device or a cotton-tipped probe. To prevent further irritation or injury, don't clean inside your own ear unless your doctor instructs you to do so.
  • Topical medications. Your doctor may prescribe eardrops containing antibiotics to fight infection and corticosteroids to reduce itching and inflammation. Use eardrops liberally (four to five drops at a time) to penetrate the end of your ear canal. If your ear canal is swollen, your doctor may insert a special wick into your ear to allow the drops to reach the end of your ear canal.
  • Oral medications. In some cases, doctors suggest using oral medications in addition to topical treatments. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin, others), may help ease severe ear pain. Ask your doctor which over-the-counter pain medication is best for you. Always take NSAIDS with food.
  • Lifestyle modifications. Don't swim, fly or scuba dive during treatment for swimmer's ear. For the most effective treatment results, water should be kept out of the ear. Talk to your doctor about your bathing habits.

Follow these tips to avoid swimmer's ear :

  • Keep your ears dry. Dry your ears thoroughly after exposure to moisture from swimming or bathing. Dry only your outer ear slowly and gently with a soft towel or cloth. Never insert your finger or any other object into your ear.
  • Swim wisely. Avoid swimming in polluted water.
  • Use earplugs. Some earplugs are designed specifically to keep water out of your ears when swimming.
  • Practice self-care. Mix 1 part white vinegar with 1 part alcohol to make an effective eardrop to use before and after swimming. Pour 1 teaspoon of the solution into each ear and let it drain back out. This mixture may help prevent the growth of bacteria and fungi that can cause swimmer's ear.
  • Avoid putting foreign objects in your ear. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. Using these items can pack material deeper into your ear canal and irritate the thin skin inside your ear.
  • Protect your ears. Avoid substances that may irritate your ear, such as hair sprays and hair dyes. Or put cotton balls in your ears when applying these products.
  • Use caution after ear infection or surgery. If you already have an ear infection or have recently had ear surgery, talk to your doctor before you swim.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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