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Swimmers Ear

Alternate Names

  • acute otitis externa
  • external canal infection
  • Outer ear

Definition

Swimmer's ear (otitis externa) is an inflammation or infection of the tissues of the outer ear and the external ear canal. The ear canal is the narrow tube that extends from the outer ear to the eardrum.

What is going on in the body?

The ear canal contains glands that produce oil, sweat, and ear wax. Ear wax helps maintain an acidic environment in the ear canal. If the ear canal loses its acidity, bacteria can grow more easily.
Some people, such as individuals with diabetes, have a less acid environment. A wet environment in the ear canal also makes it a breeding ground for bacteria. Water that is left in the ear after swimming or bathing can promote infection.

Risks

What are the causes and risks of the infection?

Conditions that can lead to swimmer's ear include:
  • benign ear growths in the ear canal that do not allow water to drain out effectively
  • chronic otitis externa, or chronic irritation of the ear canal
  • dermatitis due to allergic reactions to hair spray, dyes, or other chemicals
  • dermatitis due to conditions such as psoriasis and eczema
  • lower levels of acidity in the ear wax, such as in people with diabetes
  • using cotton-tipped swabs, which may injure the ear canal or pack the wax tightly
  • very narrow openings into the ear canal, such as in people with Down syndrome
  • water left in the ear after bathing or swimming, which is why it is also called swimmer's ear
Most episodes of swimmer's ear are caused by bacteria. Fungal infections may also occur in the ear canal, although they are less painful. These often do not respond as quickly to antibiotics and may require specific antifungal medicines.

Prevention

What can be done to prevent the infection?

Since water is the most common cause of swimmer's ear, it is important to get all the water out of the ear canal after bathing or swimming. Some measures to keep water from collecting in the ear canal include:
  • inserting antiseptic ear drops that can be purchased over the counter into the ear canal after swimming or bathing
  • inserting oily or lanolin ear drops into the ear canal before swimming or bathing
  • inserting rubbing alcohol into the ear canal after swimming or bathing
  • inserting a vinegar and rubbing alcohol solution (1 part of vinegar and 1 part of rubbing alcohol, mixed together) into the ear canal after swimming or bathing

Diagnosed

How is the infection diagnosed?

Swimmer's ear is diagnosed by examining the outer ear canal. Cultures can be helpful if the infection is not responding to treatments.

Long Term Effects

What are the long-term effects of the infection?

If swimmer's ear is not identified and treated effectively, it can cause complications such as:
  • hearing impairment from scarring or narrowing of the ear canal
  • infection of soft tissues of the face and neck. This complication is seen especially in people with diabetes and in others with impaired immune systems.
  • necrotizing external otitis, which is an infection of the bones of the ear canal and skull

Other Risks

What are the risks to others?

Swimmer's ear is not contagious and poses no risk to others.

Treatments

What are the treatments for the infection?

Swimmer's ear is usually treated with ear drops that contain antibiotics and steroids. One common medicine is hydrocortisone/neomycin/polymixin B. It is also very important to have the ear wax removed. If the infection spreads into the soft tissues around the ear, oral antibiotics may be needed. If the ear canal is particularly swollen, a wick may be inserted to draw the ear drops in.
Antifungal medicines will be prescribed for fungal infections. Over-the-counter pain medicines may be used for discomfort.

Side Effects

What are the side effects of the treatments?

Some people have a neomycin skin sensitivity. This can cause a reaction in the ear canal very similar to poison ivy dermatitis. If the person continues to have itching and a lot of swelling of the ear canal, then the neomycin needs to be stopped. Other treatments that do not contain neomycin may be used.

After Treatment

What happens after treatment for the infection?

Successful treatment completely heals the ear canal.

Monitor

How is the infection monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

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