Swimmer's Ear

Swimmer's ear, also known as otitis externa, is a fungal or bacteria infection of the outer ear that can be very painful, but is rarely serious. The outer ear consists of the earlobe and a short tube leading to the eardrum, which separates the outer and the middle ear. The middle ear is the location of the bones that link the eardrum to the inner ear. Infection of the middle ear is called otitis media, and is a common childhood ailment associated with colds.

Symptoms

Swimmer's ear is experienced initially as an earache, with pain or itchiness in the ear, and tenderness if you (gently) pull the earlobe or press the tagus (the small flap of ear in front of the canal opening). The skin in front or below the ear may become tender as well. As the infection progresses, the ear grows inflamed, and any head movement or touching can be painful. In addition, ear wax and skin debris may be visible in the ear canal and the ear may feel stuffy or full, and minor hearing loss may ensue. In some cases, there is drainage from the ear: bacterial infections generally produce a yellowish pus and there may be an unpleasant smell; fungal infections produce a greyish white excretion.

If these symptoms are present, you can be pretty sure it's swimmer's ear, an external infection, and not otitis media, which is an internal infection.

Causes

Swimmer's ear is caused by water-loving organisms, such as bacteria Pseudomonas aeruginosa. When water becomes trapped in the ear canal, the bacteria (and occasionally fungi) that cause swimmer's ear grow and become an infection. These organisms are often already living in the ear canal, but soar in the presence of water or other foreign liquids that provide ideal environment for breeding and maturation.

This is why swimmer's ear is so common in the summer, when children spend so much time playing in the water. But swimmer's ear can also be caused by:

• persistent moisture in the ear from bathing or living in very humid environment;
• swimming in polluted water;
• skin breakage due to scratching the ear with a foreign object, or from cleaning the ear especially with cotton swabs.

Also, swimmer's ear is sometimes associated with other cold infections, such as a middle ear infection (otitis media) where the infection passes outward. Fortunately, however, since the middle ear gets infected via the tubes leading from the throat, swimmer's ear can't lead to otitis media because the eardrum prevents fungi and bacteria from passing through...

Swimmer's ear usually occurs within a few days of getting contaminated water or placing contaminated objects in the ear, time enough for the organisms to get a foothold and develop into an infection.

Complications

People with swimmer's ear rarely develop complications unless they have diabetes or have a weak immune system. The acidic conditions of earwax in healthy individuals reduce the ability of fungi and bacteria to take hold. In diabetics, earwax can be quite alkaline and may encourage the spread of infections to the surrounding bone.

Self-diagnosis

Swimmer's ear is usually easy to diagnose: if there is pain when you pull gently on the earlobe or press on the tagus, then it may well be a case of swimmer's ear. If there's only mild aching and no drainage, then you may be able to treat it yourself.

Treatment

Many people have found that swimmer's ear can be cured early by carefully putting a few drops of an acidic solution, such as aluminum-based drops, into the ear canal, and then letting it drain out. To help reduce the pain, place a warm (not hot) heating pad over the ear; keep the ear dry while it's healing (use earplugs when showering or bathing); and don't swim or clean the ears until the infection is completely gone.

If you think it's a more serious case of swimmer's ear, consult your local pharmacist who can advise you about the various over-the-counter products that can cure the infection and about an appropriate analgesic (pain-killer) such as aspirin or ibuprofen (e.g., Advil or Motrin).

If, however, you or your child gets recurrent infections or if the infections don't respond to these measures, a visit to your family doctor is in order.

Your doctor will recognize swimmer's ear immediately and will probably begin by prescribing antibiotic eardrops designed to kill the bacteria most likely responsible. If the infection doesn't go away, your doctor will take a sample of the ear's drainage in order to identify the actual bacterium or fungus responsible, prescribe the appropriate antibiotic or fungicide.

Prevention

If you or your child tends to get swimmer's ear from swimming a lot, apply a few drops of an aluminum-based ear product into the ears right after swimming. Ask your local pharmacist about this product.

In addition:

• only swim in water known to be clean or in pools and hot tubs with good chlorine and pH control;
• never insert any object in the ear (e.g., fingers, cotton swabs) that may scratch the ear canal and provide a site for infection;
• use earplugs when swimming if prone to external otitis;
• dry outer ears thoroughly after baths, showers, or swimming.