Swimmer’s Ear - Symptoms and Treatment

What do doctors call this condition?

External ear infection, otitis externa

What is this condition?

Swimmer’s ear is an inflammation of the skin of the external ear canal and the folds of skin and cartilage known as the auricle or pinna (this is the part of the ear we see). It may be acute or chronic and is most common in the summer. With treatment, acute swimmer’s ear usually subsides within 7 days. This disorder tends to recur.

What causes it?

Swimmer’s ear usually is caused by bacteria, such as Pseudomonas, Proteus vulgaris, streptococci, and Staphylococcus aureus. Sometimes, swimmer’s ear is caused by fungi, such as Aspergillus niger and Candida albicans. Fungal swimmer’s ear is most common in the tropics.

Occasionally, chronic swimmer’s ear is caused by dermatologic conditions, such as seborrhea or psoriasis.

• Predisposing factors include:
• swimming in polluted water, after which earwax creates a culture medium for the waterborne organism
• cleaning the ear canal with a cotton swab, bobby pin, finger, or other foreign object, which irritates the ear canal and may introduce the infecting microorganism
• exposure to dust, hair care products, or other irritants, which causes the person to scratch the ear, excoriating the auricle and ear canal
• regular use of earphones, earplugs, or earmuffs, which trap moisture in the ear canal, creating a culture medium for infection
• chronic drainage from a perforated eardrum .

What are its symptoms?

A person with acute swimmer’s ear will have moderate to severe pain that is exacerbated by manipulating the external ear, clenching the teeth, opening the mouth, or chewing. Other symptoms may include fever, foul-smelling discharge from the ear, regional cellulitis, and partial hearing loss .

Fungal swimmer’s ear may not cause symptoms, although A. niger produces a black or gray, blotting paper-like growth in the ear canal. In chronic swimmer’s ear, itching replaces pain, and may lead to scaling and skin thickening. Discharge from the ear may also be present.

How is it diagnosed?

Physical exam confirms swimmer’s ear. In acute swimmer’s ear, otoscopy reveals a swollen external ear canal (sometimes to the point of complete closure), periauricular lymphadenopathy (tender lymph nodes in front of or behind the external ear, or in the upper neck), and, occasionally, regional cellulitis.

In fungal swimmer’s ear, removal of growth shows thick red epithelium. Microscopic exam or culture and sensitivity tests can identify the causative organism and determine antibiotic treatment. Pain on palpation of external ear structures distinguishes acute swimmer’s ear from middle ear infection.

In chronic swimmer’s ear, physical exam shows thick red epithelium in the ear canal. Severe chronic swimmer’s ear may reflect underlying diabetes, underactive thyroid, or kidney infection.

How is it treated?

To relieve the pain of acute swimmer’s ear, treatment may include heat therapy to the region around the external ear (heat lamp, heating pad, or hot, damp compresses) and drug therapy with codeine and aspirin or Tylenol. After cleaning the ear and removing debris, the doctor may prescribe antibiotic eardrops (with or without hydrocortisone). If fever persists or regional cellulitis develops, a systemic antibiotic is necessary.

As with other forms of this disorder, fungal swimmer’s ear requires careful cleaning of the ear. The doctor will prescribe a cream to treat swimmer’s ear resulting from candidal organisms. Using slightly acidic eardrops creates an unfavorable environment in the ear canal for most fungi, as well as Pseudomonas. No specific treatment exists for swimmer’s ear caused by A. niger, except repeated cleaning of the ear canal with baby oil.

In chronic swimmer’s ear, primary treatment consists of cleaning the ear and removing debris. Supplemental therapy includes antibiotic eardrops or antibiotic ointment or cream (neomycin, bacitracin, or polymyxin B, possibly combined with hydrocortisone).

For mild chronic swimmer’s ear, treatment may include antibiotic eardrops once or twice weekly and wearing specially fitted earplugs while showering, shampooing, or swimming.

Infections of the outer ear canal may take one of two forms: a localized infection such as a bail or abscess, or a generalized infection that affects the whole lining of the canal. Ear infections can occur after swimming. Persistent, excessive moisture in the ear canal can make the canal more susceptible to infection. Polluted water from lakes and rivers can cause infection by direct contact. Another cause of both localized and generalized infections is scratching inside the ear to relieve itching or while attempting to remove wax.The first symptom of infection may be itching in your ear, usually followed by pain. Sometimes yellowish-green pus seeps from the ear, and this may relieve the pain. If the pus blocks your outer ear canal, you may lose some hearing. When you have this kind of ear infection, any movement of the head may cause pain in your ear.

Infections of the outer ear are most com­mon in young adults. If you do not get treatment for such an infection, it may spread and affect underlying cartilage and bone.

What is the Treatment?

Self-help: Take aspirin and place a warm, clean cotton pad or an electric heating pad over your ear to help relieve pain until you see your physician.

Professional help: The physician will probably look into your ear with an otoscope, and may take a sample of any pus. The sample will be sent to a laboratory to see what has caused the infection. Then the doctor will probably clean your ear with a suction device or a cotton-tipped probe. This usually relieves irritation and pain. Your physician may prescribe any number of drugs in the form of pills, capsules, ear drops or cream. A combination of gentle daily cleaning of the ear and the use of the prescribed drugs should clear up the condition.

Usually, if the condition is not improved by this treatment within three to four days, your physician will take further action. Armed with the results of the laboratory tests, the physician may prescribe an antibiotic that is especially effective against the particular organisms, usually bacteria, causing the infection. If the pain is severe, the doctor may also prescribe a painkiller.

You must keep the infected ear dry. This means no swimming, and wearing ear plugs or a shower cap in the bath or shower.

The infection may recur and need treatment for many months if the microbes causing the infection are fungi, or if you develop an allergy to them. If this happens, your physician will probably prescribe a steroid cream or ear drops.