Swimmer’s Ear – Risk factors, Complications, and Treatment.

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 after swimming, creating a moist environment that aids bacterial growth. 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. The most common cause of this infection is bacteria invading the skin inside your ear canal. Usually you can treat swimmer’s ear with eardrops. Prompt treatment can help prevent complications and more-serious infections.

Pathophysiology

Otitis externa typically affects the external auditory canal – the part of the ear via which sound waves travel to reach the tympanic membrane.

Any interruption in wax formation (e.g. repeated water exposure), trauma to the canal (e.g. cotton buds) or blockage (e.g. debris) can disrupt the external auditory canal’s protective mechanisms, and lead to pathogen overgrowth and inflammation.

The skin becomes erythematous, swollen, tender, and warm, leading to debris and discharge accumulation. The narrowing of the canal, in combination with the accumulation of debris, leads to further entrapment of pathogens and propagating the infective process.

The most common causative pathogens are Pseudomonas Aeruginosa (around 40%), S. Epidermidis, S. Aureus, and anaerobes. In rarer cases, it can be due to a fungal infection (typically Aspergillus spp.).

Causes

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

Your ear’s natural defenses

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

• Glands that secrete a waxy substance (cerumen). These secretions form a thin, water-repellent film on the skin inside your ear. Cerumen is also slightly acidic, which helps further discourage bacterial growth.

Cerumen also collects dirt, dead skin cells and other debris and helps move these particles out of your ear, leaving the familiar earwax you find at the opening of your ear canal.

• Cartilage that partly covers the ear canal. This helps prevent foreign bodies from entering the canal.

How the infection occurs

If you have swimmer’s ear, your natural defenses have been overwhelmed. Conditions that can weaken your ear’s defenses and promote bacterial growth include:

• Excess moisture in your ear. Heavy perspiration, prolonged humid weather or water that remains in your ear after swimming can create a favorable environment for bacteria.
• Scratches or abrasions in your ear canal. Cleaning your ear with a cotton swab or hairpin, scratching inside your ear with a finger, or wearing ear buds or hearing aids can cause small breaks in the skin that allow bacteria to grow.
• Sensitivity reactions. Hair products or jewelry can cause allergies and skin conditions that promote infection.

Risk factors of Swimmer’s Ear

The following factors increase the likelihood of contracting swimmer’s ear:

• Swimming, especially in water with high levels of bacteria
• Cleaning, prodding, scratching, or scraping the ear canal with a cotton swab
• Wearing a swim cap, using a hearing aid, or having a lot of earwax, which can trap water inside the ear
• Having a skin condition, such as eczema, acne, or psoriasis
• Having a small ear canal
• Children are especially vulnerable to swimmer’s ear.

Not only swimmers get swimmer’s ear, however. It commonly affects farmers and other people who spend a lot of time outdoors.

What Are the Symptoms of Swimmer’s Ear?

Signs and symptoms of swimmer’s ear may include:

• Itching inside the ear (common)
• Pain inside the ear that gets worse when you tug on the outer ear (common)
• Sensation that the ear is blocked or full
• Drainage from the ear
• Fever
• Decreased hearing
• Intense pain that may spread to the neck, face, or side of the head
• Swollen lymph nodes around the ear or in the upper neck
• Redness or swelling of the skin around the ear

What are the complications of swimmer’s ear?

If left untreated, swimmer’s ear may cause other problems such as:

• Hearing loss from a swollen and inflamed ear canal. Hearing usually returns to normal when the infection clears up.
• Ear infections that keep coming back
• Bone and cartilage damage
• Infection spreading to nearby tissue, the skull, brain, or the nerves that start directly in the brain (cranial nerves)

Diagnosis of Swimmer’s Ear

Doctors can usually diagnose swimmer’s ear during an office visit. If your infection is advanced or persists, you might need further evaluation.

Initial testing

Your doctor will likely diagnose swimmer’s ear based on symptoms you report, questions he or she asks, and an office examination. You probably won’t need a lab test at your first visit. Your doctor’s initial evaluation will usually include:

• Examining 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.
• Looking 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 additional evaluation, including sending a sample of fluid from your ear to test for bacteria or fungus.

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 site 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.
• If your infection doesn’t respond to treatment, your doctor might take a sample of discharge or debris from your ear at a later appointment and send it to a lab to identify the microorganism causing your infection.

Treatment and Medications

Treatment for swimmer’s ear is usually straightforward. Options include:

• Painkillers: Acetaminophen (Tylenol), for example, can relieve discomfort.
• Ear drops: The recommended drops usually contain an astringent or acidic acid, a corticosteroid, an antibiotic medication, an antifungal preparation, or a combination.

• Microsuction: A specialist may use suction to clean the ear, making the drops more effective.
• Ear wick: This is a soft cotton gauze plug covered with medication, and a doctor will insert it into the ear canal. The aim is to help medicine to enter the area. A person should replace the ear wick every 2 or 3 days.

Treatment for other types of external otitis

Chronic external otitis: If the underlying problem is an allergy or skin issue, a physician will treat this condition first.

They may instruct a person to use ear drops for 7 days, as well as a spray. The spray will contain acetic acid, and the drops will contain a corticosteroid. If this does not work, antifungal ear drops can help.

Acute localized external otitis: The pus-filled bump will often burst and heal in a few days without treatment.

If symptoms persist for longer than 1 week, a doctor may prescribe antibiotics. If there is severe pain, the doctor may drain the pimple to remove the pus. Painkillers can also help.

How can I avoid getting swimmer’s ear?

The best way to avoid an infection is to keep your ear canal dry! Here are some tips to keep your ears dry and healthy:

• Dry your ears well with a towel after swimming or bathing.
• Tilt your head to drain water from your ears. Pull on your earlobe to straighten out your ear canal and let the water out.
• If your ears still seem wet, try using a hair dryer on low and hold it several inches from your ear until your ears feel dry.
• Wear earplugs if you swim a lot. Your audiologist can make molds that fit your ears. You can also use a swim cap to keep your ears dry.
• Don’t put anything in your ears! Cotton swabs, fingernails, and pointed objects can scratch your ear canal. This can make it easier to get an infection.
• Earwax helps protect our ears from infection. Ask your doctor how to safely remove earwax if you think you have a problem with wax buildup.