Swimmer’s Ear – Outer ear infection – Otitis Externa – Ear Wax

Overview

Swimmer’s ear is an infection in the outer ear canal, which runs from your eardrum to the outside of your head. It’s often brought on by water that remains in your ear, creating a moist environment that aids the growth of bacteria.

Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer’s ear by damaging the thin layer of skin lining your ear canal.

Swimmer’s ear is also known as otitis externa. Usually, you can treat swimmer’s ear with eardrops. Prompt treatment can help prevent complications and more serious infections.

Symptoms

Swimmer’s ear symptoms are usually mild at first, but they can worsen if your infection isn’t treated or spreads. Doctors often classify swimmer’s ear according to mild, moderate and advanced stages of progression.

Mild signs and symptoms

• Itching in your ear canal.
• Slight redness inside your ear.
• Mild discomfort that’s made worse by pulling on your outer ear (pinna or auricle) or pushing on the little “bump” in front of your ear (tragus).
• Some drainage of clear, odourless fluid.

Moderate progression

• More-intense itching.
• Increasing pain.
• More-extensive redness in your ear.
• Excessive fluid drainage.
• Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris.
• Decreased or muffled hearing.

Advanced progression

• Severe pain that might radiate to your face, neck or side of your head.
• Complete blockage of your ear canal.
• Redness or swelling of your outer ear.
• Swelling in the lymph nodes in your neck.
• Fever.

When to see a doctor

Contact your doctor if you have even mild signs or symptoms of the swimmer’s ear.

Call your doctor immediately or visit the emergency department if you have:

• Severe pain
• Fever

Causes

Swimmer’s ear is an infection that’s usually caused by bacteria. It’s less common for a fungus or virus to cause a swimmer’s ear.

Your ear’s natural defences

Your outer ear canals have natural defences that help keep them clean and prevent infection. Protective features include:

• A thin, water-repellent, slightly acidic film lines the ear canal and discourages bacterial growth. Earwax (cerumen) is an accumulation of this waxy film, dead skin cells, and other debris that travels to the opening of the ear canal to keep it clean.
• The outer ear, particularly around the opening of the ear canal, helps prevent foreign bodies from entering.

How the infection occurs

If you have a swimmer’s ear, your natural defences have been overwhelmed. The conditions that often play a role in infection include:

• Moisture in the ear canal creates an ideal environment for bacterial growth.
• Exposure to contaminated water.
• Damage to the sensitive skin of the ear canal creates an opening for infection.

Risk factors

Factors that can increase the risk of swimmer’s ear include:

• Excess moisture in your ear canal from heavy perspiration, prolonged humid weather or water remaining in the ear after swimming

• Exposure to high bacteria levels in contaminated water

• Cleaning the ear canal with cotton swabs, hairpins, or fingernails can cause scratches or abrasions.

• Ear devices, such as earbuds or hearing aids, can cause tiny breaks in the skin.

Complications

A swimmer’s ear usually isn’t serious if treated promptly, but complications can occur.

• Temporary hearing loss. You might have muffled hearing that usually gets better after the infection clears.

• Long-term infection (chronic otitis externa). An outer ear infection is usually considered chronic if signs and symptoms persist for more than three months. Chronic infections are more common if there are conditions that make treatment difficult, such as a rare strain of bacteria, an allergic skin reaction, an allergic reaction to antibiotic eardrops, or a skin condition such as dermatitis or psoriasis, or a combination of a bacterial and fungal infection.

• Deep tissue infection (cellulitis). Rarely, a swimmer’s ear can spread into deep layers and connective tissues of the skin.

• Bone and cartilage damage (early skull base osteomyelitis). This is a rare complication of the swimmer’s ear that occurs as the infection spreads to the cartilage of the outer ear and the bones of the lower part of the skull, causing increasingly severe pain. Older adults, people with diabetes, or people with weakened immune systems are at increased risk of this complication.

• More widely spread infection. If a swimmer’s ear develops into advanced skull base osteomyelitis, the infection can spread and affect other parts of your body, such as the brain or nearby nerves. This rare complication can be life-threatening.

Prevention

Follow these tips to avoid a swimmer’s ear:

• Keep your ears dry. After swimming or bathing, tip your head to the side to help water drain from your ear canal. Dry only your outer ear, wiping it gently with a soft towel. You can safely dry your outer ear canal with a blow-dryer if you put it on the lowest setting and hold it at least a foot (about 0.3 meters) away from the ear.

• Swim wisely. Don’t swim in lakes or rivers on days when warnings of high bacteria counts are posted.

• Protect your ears while swimming. Wear earplugs or a swimming cap while swimming to keep your ears dry.

• Protect your ears from irritants. Put cotton balls in your ears while applying products such as hair sprays and hair dyes.

• Use caution after an ear infection or surgery. If you’ve recently had an ear infection or ear surgery, talk to your doctor before swimming.

• Avoid putting foreign objects in your ears. Never attempt to scratch an itch or dig out earwax with items such as a cotton swab, paper clip, or hairpin. Using these items can pack material deeper into your ear canal, irritate the thin skin inside your ear or break the skin.

What to do about earwax

Earwax usually moves to the opening of the ear canal, where you can gently wash it away with a damp cloth. It’s best to leave it alone and let the earwax do its job.

If you have an excess of earwax or it’s blocking your ear canal, you can do two things rather than dig it out. See your doctor or use an at-home cleaning method. Follow these steps for safe at-home cleaning:

• Soften the wax. Use cerumol or waxsol drops in your ear canal.
• Use warm water. After a day or two, when the wax is softened, use a rubber bulb syringe to gently squirt warm water into your ear canal. Tilt your head and pull your outer ear up and back to straighten your ear canal. When finished irrigating, tip your head to the side to let the water drain out.
• Dry your ear canal. When finished, gently dry your outer ear with a towel or blow-dryer.

Diagnosis

Doctors can usually diagnose a swimmer’s ear during a medical consultation. If your infection is advanced or persists, you might need further evaluation.

Initial testing

Your doctor will likely diagnose the swimmer’s ear based on the symptoms you report, the questions he or she asks, and a physical examination. Your doctor’s initial evaluation will usually include:

• Examine your ear canal with a lighted instrument (otoscope). Your ear canal might appear red, swollen, and scaly. There might be skin flakes or other debris in the ear canal.

• Look at your eardrum (tympanic membrane) to be sure it isn’t torn or damaged. If the view of your eardrum is blocked, your doctor will clear your ear canal with a small suction device or an instrument with a tiny loop or scoop on the end.

Further testing

Depending on the initial assessment, symptom severity, or the stage of your swimmer’s ear, your doctor might recommend an additional evaluation.

In addition:

• If your eardrum is damaged or torn, your doctor will likely refer you to an ear, nose, and throat specialist (ENT). The specialist will examine the condition of your middle ear to determine if that’s the primary sites of infection. This examination is important because some treatments intended for an infection in the outer ear canal aren’t appropriate for treating the middle ear.

Treatment

The goal of treatment is to stop the infection and allow your ear canal to heal.

Cleaning

Cleaning your outer ear canal is necessary to help eardrops flow to all infected areas. 

Medications for infection

For most cases of swimmer’s ear, your doctor will prescribe eardrops that have some combination of the following ingredients, depending on the type and seriousness of your infection:

• Acidic solution to help restore your ear’s normal antibacterial environment.
• Steroids to reduce inflammation.
• Antibiotics to fight bacteria.
• Antifungal medication to fight infection caused by a fungus.

Ask your doctor about the best method for taking your eardrops. Some ideas that may help you use eardrops include the following:

• Reduce the discomfort of cool drops by holding the bottle in your hand for a few minutes to bring the temperature of the drops closer to body temperature.

• Lie on your side with your infected ear up for a few minutes to help medication travel through the full length of your ear canal.

• If possible, have someone help you put the drops in your ear.

• To put drops in a child’s or adult’s ear, pull the ear up and back.

If your infection is more advanced or doesn’t respond to treatment with eardrops, your doctor might prescribe oral antibiotics.

Medications for pain

Your doctor might recommend easing the discomfort of the swimmer’s ear with over-the-counter pain relievers, such as ibuprofen. 

If your pain is severe or your swimmer’s ear is more advanced, your doctor might prescribe a stronger medication for pain relief.

Helping your treatment work

During treatment, do the following to help keep your ears dry and avoid further irritation:

• Don’t swim or go scuba diving.
• Don’t wear an earplug, a hearing aid, or earbuds before the pain or discharge has stopped.
• Avoid getting water in your ear canal when showering or bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a shower or bath.

For more information,

https://www.mayoclinic.org/diseases-conditions/swimmers-ear/symptoms-causes/syc-20351682