Swimmer’s Ear: Everything you need to know about the infection

Swimmer’s ear or external otitis is an ear infection in the outer ear canal. It is caused by bacteria and runs from your eardrum to the outside of the head. The bacteria grow in a moist environment and invade the skin because of the water that remains in your ear. Activities like swimming provide the most favorable conditions for its growth. Apart from swimming if you put fingers, cotton swabs or other objects in your ears, you are running a high risk of getting prone to swimmer’s ear. By poking things into your ear, you damage the thin layer of skin lining your ear canal resulting in the infection.

Causes

As discussed earlier, this infection is caused by bacteria, which is usually found in water and soil. The invasion of this bacteria is however, discouraged by the natural defenses of your ear. Cerumen is a waxy substance which forms a water and bacteria repellant film on the skin inside your ear. All the dirt and debris gets accumulated in the form of earwax which we generally see at the opening of the ear canal. Downward sloping of your canal too helps the water to drain out. However, when this natural defense is broken, it results into swimmer’s ear. Let’s have a look at how and when this can happen:

1. Excessive moisture

Water that remains after swimming, extended humid weather, or heavy perspiration can lead to excess moisture in ear.

2. Abrasions

Skin in the ear canal can get ruptured or scratched because of various factors like cleaning with fingers or sharp objects. This causes abrasions. Wearing headphones or hearing aids too can break the skin.

3. Sensitivity/ Infections

Accessories like jewelry or even hair products can cause allergies or reactions to the skin. Such skin conditions promote infection.

Symptoms

The symptoms for Swimmer’s ear can be broadly categorized into mild, moderate and advanced progressions. While treatment is available for every stage, you are advised to visit the doctor if you experience even the mildest of symptoms.

Mild

1. Itching in the canal
2. Redness inside the ear
3. Draining of clear, odorless liquid out of the ear
4. Mild ache made worse by pulling on outer ear or pushing on the little bump

Moderate

1. Intense itching
2. Increasing pain
3. Extensive redness in ears
4. Drainage of excessive fluid
5. Pus discharge
6. Partial blockage of ear canal or feeling of fullness inside the ear
7. Muffled or decreased hearing

Advanced

1. Spreading of severe pain from ears to face, neck or side of your head.
2. Complete blockage of the ear canal
3. Swelling in lymph nodes in neck
4. Excessive redness or swelling of outer ear
5. Fever

Diagnosis

Consult your doctor as soon as you experience any of the above mentioned symptoms. If the symptoms are mild, doctors can diagnose the problem at your very first visit. However, if the infection is at an advanced stage, you may be asked to go for lab tests based on the doctor’s understanding and evaluation. Initial check-ups will include:

1. Examination of ear canal with otoscope (a lighted instrument). This will include evaluation of swollen, flaky or red ear canal.
2. Examination of eardrum to ensure it is not damaged or torn. If the view of the eardrum is blocked, your doctor will use a small suction device to clear your ear canal of any flake, debris or dirt.

If the severity of the infection is high, further evaluation may be needed which may include:

1. Examination of eardrum if it is torn or damaged. The doctor will refer you to an ENT (ear, nose, and throat) specialist. Since some treatments apt for outer ear infections, are not fit for those of middle ear. Therefore, he will check your middle ear to see if it is infection’s root cause.
2. Taking a sample of discharge or debris from your ear if the infection does not respond to the treatment. This is done to identify the exact micro-organism responsible for your infection.

Treatment

1. Cleaning

To stop the infection and help your ear canal to heal, the doctor will first clean your ear. Once he cleans the ear using a suction device, it will be easier for the eardrops to flow to all infected areas.

2. Treating Infection

Depending on the type and stage of your infection, the doctor will prescribe eardrops that will contain a combination of-

a. Antifungal medication (to fight fungus)

b. Antibiotic (to fight bacteria)

c. Steroid (to reduce inflammation)

d. Acidic solution (to restore ear’s natural anti-bacterial environment)

Your doctor may prescribe additional oral antibiotics if the infection is not responding to the treatment.

3. Treating Pain

Over-the-counter pain relievers, such as ibuprofen, naproxen or acetaminophen may be used by the doctor to ease pain. However, in case of severe pain, stronger medications may be prescribed by him.

While on treatment, avoid these things:

1. Swimming or scuba diving
2. Flying
3. Wearing headphones, hearing aid or an earplug
4. Bathing without covering your ear. Use a cotton wool with petroleum jelly.

Prevention

Follow these tips to prevent the infection:

1. Keeping ears dry: Thoroughly dry your ears (wiping the outer portion gently with a soft cloth) after any water based activity like swimming or bathing to prevent formation of moisture.
2. At home preventions: Before and after swimming you can use one teaspoon (into each ear) of homemade drops. To prepare the drops mix one part of white vinegar with one part of rubbinh alcohol.
3. Swimming wisely: Look for signs alerting about high bacteria count and avoid swimming on that day.
4. Avoiding putting foreign objects in ear: Never use objects like paper clip, hair pin or cotton swabs into your ear. This may deteriorate the conditions by rupturing the eardrum and the skin. Visit your doctor for ear cleaning.
5. Taking precautions after an ear surgery/ infection: If you have had an ear surgery or infection recently, talk to your doctor for proper guidance before going for swimming.

Frequently Asked Questions

1. What are the complications due to swimmer’s ear if not treated promptly?

Here is a list of possible complications:

1. Temporary hearing loss.
2. Long term infection.
3. Deep tissue infection.
4. Bone and cartilage damage
5. More widespread infection.

2. What are the risk factors that can increase your susceptibility to swimmer’s ear?

The risk factors include:

1. Swimming (especially in water with high bacteria count).
2. A narrow canal trapping more water.
3. Excessive production of earwax.
4. Cleaning of ear with harmful foreign objects like pins or cotton swabs.
5. Use oh hearing devices or aids.
6. Allergic jewelry or hair dyes and sprays.