Also known as acute otitis externa, or external otitis, 98 percent of cases of swimmer's ear result from bacteria, such as streptococcus, staphylococcus, or pseudomonas.
Swimmer's ear often occurs after excessive water exposure. The ear has ways of protecting itself from infection, but these work best when they are dry.
Germs and bacteria can easily accumulate in pools and other areas of fresh water. When swimming, water can enter the ear and stay there for a long time, especially if it becomes trapped by wax.
In this environment, bacteria can thrive, and infection can result.
According to the Centers for Disease Control and Prevention (CDC), swimmer's ear is responsible for 2.4 million healthcare visits each year.
Otitis externa is usually easy to treat, and early treatment can prevent complications.
There are three types of external otitis, including swimmer's ear.
Acute diffuse otitis externa, or swimmer's ear
Swimmer's ear can lead to ear pain.
This is a diffuse infection of the ear canal and the most common type of otitis externa. It can last up to 3 weeks, and involves swelling, or inflammation, of the entire ear canal.
A rash can extend to the outer ear and the ear drum.
Signs and symptoms include:
- Redness and swelling, or inflammation of the outer ear and ear canal
- Scaly skin in and around the ear canal, that may peel off
- Watery or pus-like discharge from the ear that may smell bad
- Itching and irritation in and around the ear canal
- Tenderness when the ear or jaw is moved
- Sore and swollen lymph nodes, or glands, in the throat
- Some hearing loss, if the ear is shut by swelling
The American Family Physician estimate that 1 percent of people will experience acute otitis externa each year, and 10 percent will have it at some time.
Other types of external otitis
Acute, localized otitis externa, also known as furunculosis, happens when a hair follicle becomes infected. There may be a painful, pus-filled painful bump in the ear canal.
Chronic otitis externa is the same as acute otitis externa, but it lasts for longer, or at least 3 months, and possibly for years. It can result from allergies or a skin condition such as eczema.
The ear has several features that help protect against infection.
One is cerumen, or earwax, a waxy substance secreted by glands in the canal.
- Creates a thin, waterproof film on the skin of the ear canal
- Deters bacteria because of its acidity and antibacterial activity
- Collects debris, dead skin, and dirt and transports them out of the ear, where they appear as a waxy clump at the opening of the ear canal
The shape of the ear canal is also important. It slopes downward from the middle to the outer ear, so that liquid drains outward.
Otitis externa can develop when the ear canal defenses become overwhelmed, for example, by a bacterial, fungal or viral infection, or an allergic reaction.
Acute otitis externa can result from:
- Swimming, especially in water where bacterial levels are high
- Over-cleaning, prodding, scratching, or scraping the ear canal, for example, with cotton swabs
- Having too much earwax or using a swim cap can increase the risk of water getting trapped
Children and others with a small ear canal can get water trapped more easily.
People who use a hearing aid or other device, or who have excessive amounts of cerumen, or earwax, have a higher risk. This is because water is more likely to get trapped, and because the protective effect of the cerumen is reduced.
Acute external otitis is a common type of ear infection.
The doctor will examine the ear canal using an otoscope, and ask about medical history, symptoms, recent experiences, such as swimming, and whether the person has inserted anything in the ear recently, such as cotton buds or a hearing aid.
The doctor will check for redness, inflammation, flaky or scaly skin, or a combination of these and will check for damage to the eardrum.
An ear curette or suction device may be used to clear the ear canal if there is debris, or if the eardrum is blocked.
If the eardrum is damaged, the doctor will refer the patient to an ear, nose and throat (ENT) specialist, who will check the middle ear to see if the primary infection is there.
If the infection does not improve, the doctor may take a sample of debris or discharge to identify the cause of the infection.
Treatment for swimmer's ear is normally straightforward.
Painkillers such as acetaminophen can relieve discomfort. Examples are paracetamol, Tylenol, or ibuprofen. The doctor may prescribe ear drops, usually consisting of an astringent or acidic acid, a corticosteroid, an antibiotic or antifungal preparation, or a combination.
A specialist may use microsuction to clean the ear. This can make ear drops more effective.
In some cases, an ear wick can help. A soft cotton gauze plug covered with medication is inserted into the patient's ear canal, allowing the medication to enter. The ear wick should be replaced every 2 to 3 days.
One home treatment is to mix a solution that is half rubbing alcohol and half vinegar, and put two drops in each ear. The alcohol will combine with alcohol in the ear and evaporate, removing the water. The acid in the vinegar will stop the bacteria from growing.
Treatment for other types of otitis externa
Chronic otitis externa often results from an allergy or skin condition. A physician will treat the underlying condition first. They may prescribe ear drops with a corticosteroid for 7 days, along with an acetic acid spray.
If the patient does not respond to this treatment, antifungal ear drops may help.
Localized otitis externa, resulting from a pimple, will often burst and heal in a few days without intervention. If the problem remains after a week, a doctor may prescribe antibiotics. If there is severe pain, the doctor may drain it to remove the pus.
Medications can relieve pain.
The following tips can help manage all types of otitis externa:
- Keep the affected part dry by avoiding swimming and using a shower cap when bathing
- Remove any discharge and debris gently, using cotton wool in the outer ear only, without prodding deeply
- A warm towel placed on the ear may relieve pain
Removing any ear plugs, earrings, hearing aids, may eliminate the source of an allergic reaction. Treatment should be sought if there are signs of psoriasis, eczema, or seborrheic dermatitis.
Some ear drops containing neomycin or propylene glycol may trigger an allergic reaction in susceptible individuals.
Otitis externa is not usually serious, and complications are rare.
Untreated, however, the infection can invade deeper tissue, and serious problems can arise.
- Abscess, a pus-filled growth that develops in and around the affected ear
- Cellulitis, if bacteria enter the deep layers of skin
- Stenosis, an accumulation of thick, dry skin in the ear canal that can lead to hearing problems and deafness
- Otomycosis, an infection of the ear canal resulting from a fungal species
In malignant otitis externa, or necrotizing otitis externa, the infection can reach the bone and cartilage of the outer ear, leading to inflammation and damage to the skin and cartilage of the outer ear and bones of the lower part of the skull. It is very painful and can ultimately be fatal.
If the infection spreads to the eardrum, a buildup of pus can cause the eardrum to become inflamed or perforated. This will normally heal within 2 months. The ear must be kept dry, and oral antibiotics may be prescribed.
To prevent ear infections, it is important to avoid swimming in polluted water, and to keep the ears dry.
A close-fitting swim cap can help regular swimmers avoid infections.
Ways of doing this include:
- Drying the outer ear with cotton wool or a towel after swimming or exposure to moisture
- Tipping the head so that the ear faces downward, then pulling the earlobes in different directions or shaking the head can help remove water from inside
- Blowing the ears with a hairdryer, on a low setting, held at a distance of at least one foot from the ear
- For regular swimmers, wearing a swim cap that covers the ears, or specially-designed, well-fitting ear plugs
It is important never to put cotton buds, keys or hairpins into the ear, as this can cause further damage and force unwanted material deeper inside.
Wax travels out of the ear naturally, so cotton buds are only suitable for the outer ear. Wax buildup should be treated by a health care professional.
For some people, substances such as hair sprays or hair dyes may irritate the ear, increasing the risk of otitis externa. To prevent this, gently place cotton balls in the ears before applying them, but without pushing them in too far.
A physician will advise how soon it is safe to swim after an ear infection or treatment.