Swimmer’s ear, or otitis externa, refers to inflammation of the ear canal. Inflammation can be caused by infection, allergic reaction, or dermatologic condition. However, bacterial infection is the most common cause of otitis externa. It’s estimated that 10% of people develop external otitis in their lifetime.
As with other ear infections, swimmer’s ear is most common in children ages 5-14. The condition is usually associated with swimming in pools during the summer months. However, adults can also get otitis externa, which may be associated with instrumentation of the ear canal with a finger or Q-tip.
How Can I Prevent Swimmer's Ear?
Fortunately, the ear has natural defense mechanisms to protect the ear canal — the most important of which is ear wax (cerumen). Ear wax creates an acidic environment in the ear canal which inhibits bacterial and fungal growth, repels water, and traps fine debris. However, breakdown of this skin-cerumen barrier — through long periods of water exposure or with excessive use of Q-tips — puts the ear canal at risk for infection.
Dr. Kingsley’s Preventative Tip
Wear earplugs while swimming for long periods of time to keep water out of the ears, and avoid using Q-tips to reduce the risk of infection.
What Causes Swimmer’s Ear?
Staph bacteria are the most common bacteria to inhabit the external ear, and the most common bacteria that causes external ear infection is Pseudomonas. Fungal infection accounts for only 2-10% of swimmer’s ear cases and typically occurs after bacterial infection treatment or in patients who use hearing aids.
Other less common causes of external ear inflammation include allergic reactions to things such as jewelry or chemicals in cosmetics or shampoos. The allergic response can also cause swelling, redness, and itching, which may require treatment with antihistamine medications or steroids.
Another possible cause of inflammation could be from dermatologic conditions such as eczema and psoriasis, which can present as rashes in and around the ear.
Both these causes of inflammation can predispose the ear canal to a secondary bacterial infection.
What Are the Symptoms of Swimmer's Ear?
Swimmer’s ear symptoms can range from mild to severe. Severe swimmer’s ear can be quite painful because the ear canal swells, causing almost complete occlusion and spreading the infection to surrounding areas. The most common symptoms of swimmer’s ear include:
- Ear pain
- Ear canal discharge
- Hearing loss
- Swollen neck glands
- Tenderness or pain when the ear is touched
Swimmer’s Ear vs. Middle Ear Infection
Do you have swimmer’s ear or a normal ear infection? Swimmer’s ear differs from middle ear infection (otitis media) in several ways:
- The location of pain in a middle ear infection is usually deep-seated and close to the eardrum. With swimmer’s ear, the pain is external in the ear canal or the ear lobe. Children may exhibit this by pulling or tugging on their ear. Note that swimmer’s ear causes increased pain when pulling on the ear lobe.
- Sinus congestion or runny nose are associated with middle ear infection but not swimmer’s ear.
- Systemic symptoms like fever, decreased appetite, diarrhea, or vomiting usually occur with middle ear infection. Swimmer’s ear usually presents with localized symptoms like external itching and ear canal drainage.
How Is Swimmer's Ear Treated?
It’s important to visit your doctor in the early stages of the disease to start treatment as soon as possible. Once bacteria have broken the protective barrier of the skin, swimmer’s ear is unlikely to go away on its own. At this point, antibiotics can treat the bacteria and prevent complications.
Swimmer’s ear treatment depends on the severity of condition. Ear drops are the mainstay of treatment, but the following methods may be used depending on the patient:
- Mild swimmer’s ear: We use topical preparations of acetic acid and hydrocortisone (an acidifying agent and a steroid) to inhibit bacterial growth and reduce inflammation.
- Moderate swimmer’s ear: We use topical antibiotics and steroids to treat staphylococcus aureus and pseudomonas aeruginosa bacteria. Cipro HC (ciprofloxacin-hydrocortisone) and Cortisporin (neomycin-polymyxin B-hydrocortisone) are good first-line agents.
Severe swimmer’s ear: We use topical therapy and oral antibiotics. Oral antibiotics are used to treat deep-tissue infection, as local therapy cannot penetrate deep enough. Ciprofloxacin or Ofloxacin are recommended to treat S. Aureus and P. aeruginosa.
Complications of Swimmer's Ear
One severe complication of swimmer’s ear is malignant external otitis (also called necrotizing external otitis), which is a potentially fatal complication. This is common in older diabetic adults or other immunocompromised individuals. It occurs when the infection spreads from skin to bone and marrow spaces of the skull base. To prevent this severe complication of swimmer’s ear, make sure to seek treatment early while the symptoms are mild and easily treatable.