Swimmer's Ear (Otitis Externa)

What Is It?

Otitis externa is an infection of the ear canal caused by bacteria or fungi. It often is called swimmer's ear because it is associated with frequent swimming. Prolonged exposure to water, which may contain certain bacteria, makes the skin of the ear canal swollen and more likely to get infected. Summer humidity also changes the skin of the ear canal, increasing the possibility of infection.

While swimmer's ear is most common in the summer, it can happen any time of the year. People with skin conditions such as eczema and seborrhea may be more prone to infections. Others who are more likely to develop swimmer's ear include people who: 

• Suffer trauma to the ear canal, usually when trying to clean the ear with a cotton swab or other instrument  
• Have small ear canals that do not drain well enough on their own  
• Have drainage of pus from chronic middle ear infections with perforation of the eardrum 
• Frequently use earplugs or hairspray 
• Frequently get water in their ears from showers, baths or shampoos

Symptoms

Symptoms of swimmer's ear include: 

• Itching of the ear canal  
• Redness of the skin of the outer ear or ear canal  
• Drainage from the ear canal, often yellow or green or possibly cheesy  
• Pain, when touching the ear or moving the jaw while chewing or talking  
• Decreased hearing

Diagnosis

Swimmer's ear usually is diagnosed by examining the ear with a special viewing tool called an otoscope. The doctor looks for: 

• Swelling or redness of the skin of the external ear canal  
• Draining fluid or debris in external ear canal  
• Tender lymph nodes near the ear

In rare cases, a culture of the drainage is necessary. For a culture, a sample of the draining fluid is treated in a laboratory to see what bacteria or fungi grow. Your doctor also may examine the eardrum to look for signs of middle ear infection. 

Expected Duration

With treatment, symptoms usually improve within 1 to 3 days and go away completely in 7 to 10 days. The problem can return, especially if you don't take steps to prevent getting water in the ear canals repeatedly.

Prevention

To help prevent swimmer's ear: 

• Keep your ear canal dry. Limit your time exposed to water. 
• To keep water out of your ears while showering, use a ball of cotton covered with a layer of petroleum jelly. 
• If you get water in your ears, dry them thoroughly. First, turn your head to the side and pull the earlobe in different directions to help the water run out. Gently dry the opening to the ear canal. Then use a hair dryer briefly on its lowest setting held at arm's length to dry the rest of the canal. 
• Do not use cotton swabs to clean your ears because they can cause trauma to ear canals, making them more susceptible to infection. In addition, swabs usually push wax deeper into the ear canal, and water can get trapped behind wax buildup. 
• Do not use earplugs unless they are designed specifically to keep water out because water gets trapped behind most earplugs. They also tend to push wax back into your ear canal. 
• Make your own preventive eardrops by mixing equal parts white vinegar and rubbing (isopropyl) alcohol. The vinegar restores the natural acidity of the ear canal, making it less susceptible to infection while the alcohol dries out the ear. Use three to four drops in each ear after swimming. 

Treatment

Swimmer's ear usually is treated with prescription eardrops. The most commonly used drops combine either acetic acid or an antibiotic with a corticosteroid to calm the inflammation. There are multiple commercial combinations available. 

Drops usually are placed in the ear canal three or four times per day for about five days. Follow the instructions on your prescription. 

In the past, the most commonly prescribed topical treatment was a combination of neomycin, polymixin and hydrocortisone. In people who are allergic to neomycin, the use of these drops may cause the ear canal to become red and swell. The reaction may extend to the outer ear and surrounding skin and may be accompanied by blisters. If you get a reaction like this, stop using the eardrops and contact your doctor immediately.  

In some cases of swimmer's ear, swelling may make it difficult for the medicated drops to get down into the ear canal. In these cases, your doctor may place a wick in the ear canal to help the eardrops get deeper into the canal. For very severe cases, your doctor may prescribe an oral or intravenous antibiotic.

When To Call a Professional

The treatment of swimmer's ear usually requires prescription medication. Call your doctor if you or your child has symptoms of this condition. 

With treatment, symptoms usually improve within 24 hours and go away in two or three days. If you currently are being treated for swimmer's ear, call your doctor for follow-up if: 

• The symptoms worsen  
• Fever develops  
• New symptoms develop  
• The symptoms are not beginning to go away in two to three days 

Some people, particularly those who have diabetes or other immune system problems, can develop a severe form of this condition known as malignant otitis externa that requires immediate hospitalization for treatment with intravenous antibiotics. If you have diabetes or another condition that makes you more susceptible to infections, contact your doctor immediately if you develop symptoms of swimmer's ear. 

Prognosis

Uncomplicated cases of swimmer's ear should go away within five days with appropriate treatment. Muffled hearing should return to normal as the swelling subsides.

Additional Info

American Academy of Otolaryngology - Head and Neck Surgery
https://www.entnet.org/