Swimmer's Ear (External Otitis)

Swimmer's Ear (Outer Ear Infection)

External otitis or "swimmer's ear" in children and adults is an infection of the skin covering the outer ear and ear canal. The ear infection can be short-term (acute) or chronic, which lasts for a long period.

Acute external otitis (acute swimmer's ear) is a common bacterial infection caused by Streptococcus, Staphylococcus, or Pseudomonas bacteria. Usually, bacterial ear infections in children and adults are transmitted through excessive water exposure from swimming, diving, surfing, kayaking, or other water sports. When water collects in the ear canal (frequently trapped by wax), the skin can become soggy, which is an incubator for bacteria to collect and grow. Cuts or abrasions in the lining of the ear canal (for example, from cotton swab injuries) also can expose the ear canal to a bacterial infection.

Why do ears itch?

Itchy ears can drive a person crazy. It can be the first sign of an infection, but if the problem is chronic, it is more likely caused by chronic dermatitis of the ear canal. Seborrheic dermatitis and eczema can both affect the ear canal. There is no cure for this problem, but it can be made tolerable with the use of steroid drops and creams. People with these problems are more prone to acute infections as well. The use of ear plugs, alcohol drops, and non-instrumentation of the ear is the best prevention of infection. Other treatments for allergies may also help itchy ears.

Young children often will put foreign objects into their ears by accident or while scratching or trying to clean their ears. Often, children who put objects in their ears also have a swimmer’s ear (external ear infection). Do not try to remove objects stuck in the ear because it can be difficult. Call your pediatrician to have the object safely removed. Usually, this can be done in the office, but sometimes, general anesthesia may be necessary to remove the lodged object if it is stuck deeply in the ear or if the child or adult is uncooperative.

Insects or bugs can be trapped in the ear, for example, small gnats can be caught and stuck in the earwax. Often, bugs and insects can be washed out with warm water. Larger insects or bugs may not be able to turn around in the narrow canal. If the insect or bug is still alive, first kill it by filling the ear with mineral oil. This will suffocate the insect, and then see your doctor to have it removed.

The signs and symptoms of swimmer's ear in children and adults include the following:

• The first symptom of infection is the ear feeling full, and it may itch.
• The ear canal swells, and fluid or pusses may come from the ear.
• A swimmer's ear is very painful, especially with movement of the outside portion of the ear.
• The ear canal can swell shut, and the side of the face can become swell.
• A sense of fullness in the ear
• The lymph nodes of the neck may enlarge, making it difficult or painful to open the jaw.
• People with swimmer's ears may experience some temporary hearing loss in the infected ear.

Other signs and symptoms of an outer ear infection in children include severe pain when the ear is moved, touched, or itched, and irritability. Outer ear infections in children also can be caused by middle ear infections (otitis media) or objects placed in the ear.

Chronic (long-term) swimmer's ear is otitis externa that persists for longer than four weeks or that occurs more than four times a year. This condition can be caused by the following:

• Bacterial infection
• A skin condition (eczema or seborrhea)
• Fungal infection (Aspergillosis)
• Chronic irritation (such as from the use of hearing aids, insertion of cotton swabs, etc.)
• Allergy, chronic drainage from middle ear disease, tumors (rare)
• It may simply follow from a nervous habit of frequently scratching the ear

In some people, more than one factor may be involved. For example, a person with eczema may subsequently develop black ear drainage. This would suggest accompanying fungal infection.

The standard treatments and preventative measures, as noted in the next sections, are often all that is needed to treat even a case of chronic otitis externa. However, in people with diabetes or those with suppressed immune systems, chronic swimmer's ear can become a serious disease (malignant external otitis). Malignant external otitis is a misnomer because it is not a tumor or cancer, but rather an aggressive bacterial (typically Pseudomonas) infection of the base of the skull.

Swimmer's ear is a treatable condition that usually goes away quickly with appropriate treatment. Usually, a swimmer's ear can be easily treated with antibiotic eardrops. However, regardless of the cause, moisture and irritation will prolong the healing of the infected ear.

Natural and home care for swimmer's ear includes measures such as:

1. Remove water from the ears after swimming or water exposure.
2. Keep the ears dry. While showering or swimming use an earplug (one that is designed to keep water out), or use cotton with Vaseline on the outside to plug the ears.
3. Scratching the inside of the ear or using cotton swabs should be avoided. This will only aggravate the irritated skin, and in most situations will make the condition worse.
4. A hearing aid should be left out as much as possible until swelling and discharge stop.
5. Follow your doctor's instructions for the use of medications and do not stop using the medications until instructed to do so by your doctor. Use of a wick may be necessary for antibiotic treatment if the ear canal is very swollen.
6. A homemade ear drip mix of 50% rubbing alcohol, 25% white vinegar, and 25% distilled water can be used to slightly acidify the ear canal and can be used for the prevention of infections as well as mild infection caused by bacteria or fungus.
7. Treatment for swimmers’ ears in children includes antibiotics, pain medications, and sometimes, antihistamines to reduce itching. Your doctor can determine whether your child's ear pain is due to a swimmer's ear or another condition.

The doctor may advise using a wick to administer medication while the ear canal is swollen. Chronic swimmer's ear may require more intensive treatment. A swimmer's ear typically does not have any long-term or serious complications.

Prevention tips for swimmer's ear infections include:

• Decrease exposure to water. If you are prone to infections, it's recommended that you use an ear plug when you bathe or swim. Swimmer's ear drops or alcohol drops (Swim-EAR®) used in the ear after water exposure followed by drying the ear with a hair dryer held at arm's length will often help keep the ear free of moisture
• Do not insert instruments, scratch, or use cotton swabs in the ears.
• Try to keep the ear free of wax. This may require visits to the doctor to have your ears cleaned.
• Do not attempt to put anything into the ear canal (such as a swab) to try to remove earwax that is deep within the ear canal.
• If you already have an ear infection, if you have a hole in your eardrum, or if you have had ear surgery or ear tubes, first consult your doctor before swimming and before you use any type of eardrop.
• An easy and inexpensive eardrop solution can be made by mixing equal parts of rubbing alcohol and white vinegar (50:50 mixture). This solution will increase the rate of evaporation of water in the ear canal and has antibacterial properties. Using this solution to rinse the ear before and after water exposure can serve as a protective measure against infection.
• Mineral oil eardrops can be used to protect the ear from water when a dry crusty skin condition exists.
• A 3% solution of hydrogen peroxide can be used for occasional ear cleaning to help remove earwax that can cause water to build up in the ear. Apply using an ear dropper (about half full). The solution will fizz slightly. Turn your head to the side and pull back on the top of your ear so that the solution fills the ear canal. Afterward, make sure to use one of the methods described above for drying the ear.
• You can also use a hair dryer on a low setting to dry the ear canal. This also can be done after using the drying eardrops.