Swimmer’s ear is an infection that can develop after spending a lengthy period of time in the water or being exposed to the elements such as wind and rain. The skin that covers the outer ear canal and leads to the eardrum is affected.
According to the University of Iowa, swimmer’s ear is more common among non-swimmers than in swimmers. People who spend a lot of time outside, such as farmers, are more likely to contract the infection.
Acute diffuse external otitis is the medical term for swimmer’s ear.
Bacteria can form colonies in water. Some can enter the ear while swimming in locations with fresh water, for example, and stay there for a long period, especially if the water becomes trapped by wax.
The ear possesses defence mechanisms against infection, but they are most effective when the area is dry. If the ear is wet, bacteria can grow and cause infection.
Ear infections can also be caused by fungi. In North America, however, swimmer’s ear is caused by bacteria in 98 percent of cases.
Swimmer’s ear is responsible for 2.4 million medical visits in the United States each year, according to the Centers for Disease Control and Prevention (CDC).
A doctor can usually cure the infection quickly, and getting treatment early can help you avoid consequences.
Causes
The ear has various defence mechanisms against infection.
Cerumen, often known as earwax, is produced by glands in the ear canal and serves a variety of purposes.
Earwax, for example:
- forms a thin, waterproof film on the skin of the ear canal
- Acids and antibacterial properties are present, which help to fight germs.
- collects debris, dead skin, and dirt and transfers it out of the ear, where it manifests as a waxy clump at the ear canal’s opening.
The ear canal’s shape is also important. From the middle to the outer ear, it dips downward to allow liquid to escape.
When the ear canal’s defences are overwhelmed by an infection or an allergic reaction, external otitis can develop.
Symptoms
External otitis is divided into three categories.
Swimmer’s ear (acute diffuse external otitis)
External otitis is the most prevalent kind of otitis. It affects the entire ear canal and can last up to three weeks.
The rash might spread to the eardrum and outer ear.
The following are some of the signs and symptoms:
- watery or pus-like discharge, which may smell bad
- itching and irritation in and around the ear canal
- tenderness when moving the ear or jaw
- redness and swelling in the outer ear and ear canal
- pain in the area
- scaly skin, which may peel off, in and around the ear canal
- sore and swollen lymph nodes, or “glands,” in the throat
- some hearing loss, if the swelling inside the ear is significant
Other types of external otitis
When a hair follicle in the ear becomes infected, it causes acute localised external otitis. A furuncle is a painful, pus-filled bump that can form in the ear canal. This is a form of furunculosis infection.
Infection, allergies, or a skin condition like dermatitis can all cause chronic external otitis. Symptoms must endure at least 3 months to support a diagnosis, although they can last for years.
Risk factors
The following factors make swimmer’s ear more likely to develop:
- Swimming, particularly in water with high bacteria levels.
- Using a cotton swab to clean, probe, scratch, or scrape the ear canal.
- Wearing a swim hat, wearing a hearing aid, or having a lot of earwax can all cause water to get trapped inside the ear.
- Having eczema, acne, or psoriasis as a skin condition
- Having a tiny ear canal.
Children are especially sensitive to swimmer’s ear.
However, swimmer’s ear affects more than just swimmers. Farmers and other people who spend a lot of time outside are typically affected.
Diagnosis
A handheld equipment called an otoscope will be used by the doctor to check the ear canal.
They’ll look for things like:
- flaky or scaly skin
- damage to the eardrum
- redness
- inflammation
They’ll also inquire about someone’s:
- recent experiences, including swimming and inserting things into the ear, such as cotton swabs
- symptoms
- medical history
If there is a blockage, the doctor may use an ear curette, a tiny instrument for scraping debris out of the ear canal, or a suction device to clean it.
If the eardrum is damaged, the patient will be referred to an ear, nose, and throat specialist, who will determine whether the infection started in the middle ear.
If symptoms do not improve, a sample of debris or discharge may be tested to discover more about the underlying problem.
A doctor may want to rule out cancer or temporal arteritis, a condition in which arteries become damaged or inflamed, if a patient over the age of 50 visits the doctor with ear pain.
Treatment
The treatment for swimmer’s ear is usually simple.
Options include:
Painkillers: For example, acetaminophen (Tylenol) can help with pain.
Ear drops: An astringent or acidic acid, a corticosteroid, an antibiotic prescription, an antifungal preparation, or a combination of these ingredients are commonly found in the suggested drops.
Microsuction: To make the drops more effective, a specialist may employ suction to clear the ear.
Ear wick: This is a delicate cotton gauze plug covered with medication, and a doctor will implant it into the ear canal. The goal is to make it easier for drugs to get into the area. Every 2 or 3 days, the ear wick should be replaced.
Other kinds of external otitis treatment
Chronic external otitis: If the underlying problem is an allergy or a skin problem, a condition will treat it first.
They might tell you to use ear drops and a spray for seven days. Acetic acid will be in the spray, and a corticosteroid will be in the drops. Antifungal ear drops can help if this doesn’t work.
Acute localised external otitis: Without treatment, the pus-filled lump would usually burst and heal in a few days.
Antibiotics may be used if symptoms last longer than one week. The doctor may drain the pimple to remove the pus if there is acute pain. Pain relievers may also be beneficial.
Guideline
The strategies listed below can be used to treat all types of external otitis.
Keeping the ear dry: When bathing, wear a shower helmet and refrain from swimming until the infection has cured.
Gently removing any discharge and debris: Use cotton wool to clear the outer ear solely, under the guidance of a doctor, without pushing deeply.
Applying a warm compress to the affected area: To help reduce pain, place a warm cloth over the ear.
Disconnecting all devices: Hearing aids, earplugs, and earrings can all increase symptoms and cause an allergic reaction.
Checking for side effects: Allergies can be triggered by ear drops containing neomycin or propylene glycol.
Complications
External otitis is usually not a serious condition. Complications are uncommon when a person undergoes treatment.
However, if the infection is not treated, it can spread to deep tissue, resulting in more significant problems, such as:
- An abscess: In or around the affected ear, a pus-filled tumour might develop.
- Cellulitis: Bacteria infiltrate the deep layers of the skin, resulting in a skin infection.
- Stenosis: This happens when thick, dry skin builds up in the ear canal, restricting it and perhaps causing hearing loss.
- Otomycosis: As a result of external otitis, this fungal infection might occur.
External otitis maligna, also known as necrotizing external otitis
If the infection spreads to the outer ear’s bone and cartilage, it can cause inflammation and damage to the lower region of the skull.
The condition is excruciatingly uncomfortable and potentially fatal. Adults with compromised immune systems are the most vulnerable.
A buildup of pus can cause inflammation and perforation of the eardrum if the infection progresses to the eardrum.
In most cases, this will cure within two months. Oral antibiotics may be prescribed by a doctor, and it is important to keep the ear dry.
Prevention
Avoid swimming in contaminated water and keep your ears as dry as possible to avoid ear infections.
The Merck Manual recommends making a solution of equal parts rubbing alcohol and white vinegar and placing two drops in each ear after swimming to dry the ears.
The alcohol will evaporate any retained moisture in the ear, while the vinegar will modify the pH of the ear, preventing bacteria growth.
Other methods of infection prevention include:
- using cotton wool or a cloth, dry the outer ear
- to dislodge retained water, tilt the head with the ear pointed downward and tug the earlobes in different directions, or shake the head
- using a hair dryer on a low setting and holding it at least 1 foot away from the ear, dry the ears.
- earplugs or a swim cap that covers the ears
- after swimming in a chlorinated pool, cleaning the ears with pure water
Never insert cotton swabs or other foreign things inside your ears, such as hairpins. This can cause the problem by forcing the undesirable substance deeper into the ear canal.
Because earwax naturally travels outward, only cotton swabs should be used to remove it from the outer ear. Any wax buildup inside the ear should be treated by a healthcare expert.
Hair sprays and dyes, for example, can irritate the ear, increasing the risk of external otitis. Before using the goods, carefully place cotton balls in the ears to prevent this. Make sure the cotton balls don’t become stuck in your ear canal.
A physician will tell a client when they can safely swim again after treatment for an ear infection.
Sources:
- https://www.aafp.org/afp/2018/0101/p20.html
- https://uihc.org/health-library/otitis-externa-get-rid-swimmers-ear
- https://www.medicalnewstoday.com/articles/178934
- https://www.cdc.gov/healthywater/swimming/swimmers/rwi/ear-infections.html
- http://www.aafp.org/afp/2012/1201/p1055.html
