Medical Monday - Swimmer's Ear

What is swimmer's ear?

Swimmer's ear (otitis externa) is an inflammation or infection of the ear canal, the passage that leads from the outer ear to the eardrum. This condition is called swimmer's ear because it commonly occurs in people who have been swimming. But other people can get it too.

What causes swimmer's ear?

You can get swimmer's ear when bacteria or fungus grows in your ear canal. This happens when water, sand, or other small debris irritates the delicate skin in the ear canal. Other things that can irritate the ear canal include hearing aids, lots of ear cleaning, and eczema of the ear canal.

Swimmer's ear is more likely if you have a very narrow or hairy ear canal; live in a warm, humid climate; have little or no earwax; have lots of ear infections; or have eczema or dry skin. If you have had swimmer's ear in the past, you are more likely to get it again.

What are the symptoms?

Swimmer's ear can be very painful. The pain can get worse when you touch the earlobe or another part of the outer ear or when you chew. Other symptoms can include itching, a feeling of fullness in the ear, and a yellowish or brownish discharge from the ear. Your ear canal may be swollen. In severe cases, the outer ear can be red and swollen too. 

If you think you have swimmer's ear, call your doctor to find the best way to treat it.

If you have diabetes or take medicine that suppresses your immune system, swimmer's ear can cause severe problems. Call your doctor right away.

How is it treated?

Follow these tips when treating swimmer's ear:

• If your doctor prescribed ear drops, use them as directed.
• Talk with your doctor before putting anything in your ear.
• Avoid getting water in the ear until after the problem clears up.
• Use a hair dryer to carefully dry the ear after you shower.
• Take an over-the-counter pain medicine like acetaminophen (such as Tylenol), ibuprofen (such as Advil or Motrin), or naproxen (such as Aleve). Read and follow all instructions on the label. Do not give aspirin to anyone younger than 20. It has been linked to Reye syndrome, a serious illness.

Some home treatment can help swimmer's ear. But it is important to see a doctor first. If your doctor says it is okay, you can try the following:

• If your ear is itchy, try nonprescription swimmer's ear drops, such as Star-Otic or Swim-Ear. Use them before and after swimming or getting your ears wet.
• To ease ear pain, apply a warm washcloth or a heating pad set on low. There may be some drainage when the heat melts earwax.
• Do not use a heating pad when you are in bed. You may fall asleep and burn yourself.
• Do not use a heating pad on a child.

In severe cases, the ear canal should be carefully cleaned out by an ear specialist. Occasionally, if the ear canal is very swollen, a wick with antibiotic drops will be placed in the ear canal.

Do not use ear candles. They have no proven benefit, and they can cause harm.

How can you prevent swimmer's ear?

You may be able to prevent swimmer's ear.

• Do not scratch or clean the inside of the ear with cotton swabs, bobby pins, your fingernails, or other objects.
• Avoid prolonged use of earplugs and in-ear headphones. Like cotton swabs, these can cause irritation and itching and can plug the ear with wax.
• Keep soap, bubble bath, and shampoo out of the ear canal. These products can cause itching and irritation.
• Keep your ears dry.
• After you swim or shower, shake your head to remove water from the ear canal.
• Gently dry your ears with the corner of a tissue or towel, or use a hair dryer on its lowest setting. Hold the dryer several inches away from the ear.
• Put a few drops of rubbing alcohol or rubbing alcohol mixed with an equal amount of white vinegar in your ears after you swim or shower. You can also use over-the-counter drops, such as Star-Otic or Swim-Ear, to help prevent swimmer's ear. Wiggle the outside of the ear to let the liquid enter the ear canal, and then tilt your head to let it drain out.
• Do not swim in dirty or polluted water.

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.

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.

Call a health care practitioner immediately in any of these situations:

• Pain is not controlled with over-the-counter medicines that are taken as recommended on the label. Any pressure on the outer ear may cause great pain, so it is often difficult to lie down with the affected side against a pillow. Many people with swimmer's ear have trouble sleeping until they get medical attention.

• The person feels dizzy.

• The person has any signs of facial weakness or double vision.

• The person has diabetes or some other condition that prevents the immune system from functioning normally.

Swimmer's ear, in general, is not an emergency. However, the person should go to the emergency department at the hospital if they are experiencing symptoms of swimmer's ear and have diabetes, are running a fever, are experiencing dizziness or facial weakness, or have a history of prior ear surgery.

For more information visit these sites:

http://www.emedicinehealth.com/slideshow_anatomy_of_an_ear_infection/article_em.htm

http://www.emedicinehealth.com/swimmers_ear/article_em.html