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Swimmers Ear

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22 Aug, 2018

Swimmer’s ear is a condition where the ear canal (the part from the eardrum to the exit of the outer ear) is infected by bacterial growth because of accumulation of water.  This condition is most common in regular swimmers since some water tends to get trapped in the ears, hence the name “swimmer’s ear”.

 

Causes

This infection is usually caused by bacteria found in water and soil. Viral or fungal infections are rare.

  • Excess moisture inside the ear canal: Prolonged humid weather, excessive sweating or swimming can cause some water to be left inside the ear canal. This moist environment creates a favorable environment for bacterial growth.
  • Sensitivity reactions: Ear jewelry or hair products can cause an adverse allergic reaction, causing infection or inflammation in the ear canal.
  • Abrasions in the ear canal: Inserting objects like cotton swabs, hairpins, earphones, or even your finger too harshly can cause wear and tear in the inner lining of the ear canal. These small cuts or breaks harbor bacteria and cause infection.

 

Symptoms/Presentation

The symptoms are defined based on the three stages of the condition: mild, moderate & advanced, with the severity of symptoms increased from mild stage to the advanced stage.

Mild Symptoms:

  • Ear itching
  • Redness inside the ear
  • Mild pain or discomfort when the outer ear is pulled slightly
  • Presence of a clear, odorless fluid that slowly drains out of the ear

Moderate symptoms:

  • Itching intensifies
  • Increase in pain
  • Extensive redness inside the ear
  • Excessive fluid drainage
  • Discharge of pus
  • Ear canal gets partially blocked by fluid, swelling and debris
  • Reduced or muffled hearing

Advanced symptoms:

  • Severe pain that may spread to your face, neck or side of your head
  • Ear canal gets completely blocked
  • Redness or swelling in the outer ear persists or worsens
  • Swollen lymph nodes in the neck region
  • Fever

 

Diagnosis

The preliminary tests based on the severity of symptoms include:

  • Ear canal examination: An instrument called the otoscope is used to examine the inside of an ear canal. It may appear swollen, red and flaky with ruptured cells. Other debris may also be found
  • Examination of the eardrum: This is carried out in order to make sure that the eardrum (tympanic membrane) isn’t damaged or torn. The doctor may use an ear curette to clean the ear canal in order to properly visualize the eardrum.

Further tests

  • The patient is referred to an ENT (ear, nose & throat) specialist if the eardrum is damaged. The middle ear is also examined to determine if there is any infection. This is very important because some of the medications used to treat the outer ear are not suitable for treatment of the middle ear, as it is very sensitive.
  • The discharge/debris from the outer ear is further sampled and taken for laboratory testing and culturing, in order to identify the microorganism causing the infection.

 

Treatment

The ultimate goal of any treatment therapy is to stop the infection so that the ear canal can heal itself completely over time;

  • Cleaning: Cleaning of the outer ear canal is the first step and very much necessary in order to help eardrops flow to all infected areas. An ear curette (suction device) is used for cleaning by removing clumps of earwax, any discharge or pus, flaky skin and other debris.
  • Medications for infection: Most commonly, ear drops are prescribed that have a combination of the constituents listed below:
    • Antibiotic to fight bacteria
    • Acidic solution to help restore your ear's normal antibacterial environment
  • Steroid to reduce inflammation
  • Antifungal medication against any fungal infection

The ear drops are taken for a course of 10 to 15 days. It is highly advised to complete the course of treatment, even if the symptoms have disappeared, as there is a risk of relapsed infections occurring. If eardrops do not seem to be an effective treatment for your symptoms, oral antibiotics are prescribed.

  • Medications for pain: Over-the-counter pain-relieving drugs, such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others), naproxen sodium (Aleve, others) can be taken to relieve pain or discomfort.

 

Tips to prevent a swimmer’s ear

  • Do not remove earwax.
  • Do not insert any objects like cotton swabs, pins, fingers, sprays, liquids etc. inside your ears.
  • If you swim often, it is advisable to wear earplugs.  However, it can also cause an infection. Hence, consult your doctor first.
  • Ears should be properly dried with a towel or a blow dryer on a low setting after taking a bath or swimming.
  • When your ears get wet, jerk your head from side to side to help water flow out
  • Be careful enough to shield your ears before applying hair dyes or spraying hairsprays or perfumes.
  • Use eardrops made from rubbing alcohol and white vinegar in a ratio of 1:1 before and after swimming.
  • Do not swim in places where there may be a high bacterial content, like ponds and lakes.
  • Do not stop any treatment for swimmer’s ear sooner than your doctor recommends.