Outer Ear Infections (Swimmer’s Ear): Symptoms, Causes, Risks, Complications, Diagnosis and Treatment and Prevention

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A illustration of Outer Ear Infections (Swimmer's Ear)

1Overview

When people swim or take a bath, there are times that water comes inside the ears.
When the water does not come out, it might lead to an infection called outer ear infection or swimmer’s ear.

A swimmer’s ear is an infection of the outer ear canal which is usually caused by water trapped inside the ear after swimming, making the environment in the ears ideal for bacterial proliferation.

Also called otitis externa, a swimmer’s ear is commonly caused by the bacteria invading the skin in the ear canal. Immediate treatment can help prevent serious complications.

The condition is common in children and teenagers, but adults, too, who spend a lot of time swimming. In fact, in the United States, swimmer’s ear accounts for 2.4 million health care visits each year.

2Symptoms

The most common symptom of swimmer’s ear is a pain when the outer part of the ear is pulled or pressed on. It may also be painful to chew on food and initially, the patient may feel ear canal itching before the pain begins.

The condition may appear mild but can get worse if the infection is not treated appropriately. The signs and symptoms of outer ear infection include:

Mild signs and symptoms

  • Redness in the ear
  • Mild pain when the outer ear is pulled
  • Clear and odorless secretion
  • Itching in the ear canal

Moderate signs and symptoms

  • More severe itching
  • Redness in the ears
  • Worsening pain
  • Pus discharge
  • Increased fluid drainage
  • The ears feel full
  • Altered or decreased hearing

Severe ear infection

  • Severe pain that can affect other parts of the face, the neck, and side of the head
  • Swelling and redness of outer ear
  • Blockage of ear canal
  • Inflammation of lymph nodes
  • Fever

3Causes

One of the most common sources of infection in the ears is too much moisture in the ear canal. This moisture usually results from having showers and going swimming. When water or moisture is stuck in the ear canal, the normal flora or good bacteria in the skin in this area will begin to grow and proliferate, leading to an infection of the ear canal.

Aside from swimming or frequent showers, there are other causes of outer ear infection:

  • Contact with bacteria and other pathogens that are in hot tubs and polluted water
  • Certain chemicals like hair dye or other hair products
  • Too much cleaning of the ear
  • Scratches or wounds in the canal of the ear.
  • Damage to the ear canal skin after ear wax water irrigation
  • Certain skin conditions such as seborrhea or eczema

4Risk Factors

Some factors may increase the risk of developing outer ear infection such as:

  • Having narrow ear canal
  • Hair ear canal
  • Living in a tropical or warm and humid climate
  • Have no earwax, or little earwax
  • Swimming in water with increased bacteria levels like in a lake
  • Frequent swimming
  • Aggressive cleaning if the ear canal
  • Using hearing aid or headphones
  • Skin hypersensitivity to hair dyes, spray or jewelry
  • Dry skin (eczema)
  • Frequent ear infections

5Complications

If outer ear infection or swimmer’s ear is not treated immediately, this may lead to serious complications including:

Hearing loss People with an ear infection or swimmer’s ear may experience temporary hearing loss. This is characterized by muffled hearing that gets better when the infection clears up.

Frequent ear infections – If swimmer’s ear is not treated promptly, it may lead to recurrent ear infections or chronic otitis externa. A swimmer’s ear is considered chronic if the signs and symptoms persist for more than three months.

Cellulitis or deep tissue infection – When the infection is not treated or managed,
it may spread to the surrounding tissues of the skin. When the bacteria invade the deep layers and the connective tissues, it’s termed as cellulitis.

Bone and cartilage damage – An outer ear infection may spread and cause inflammation to the skin. The infection may also affect the cartilage and the bones, leading to damage of these tissues. Some people are at a higher risk of having this complication such as older adults, children, infants, and those with weakened immune systems.

Systemic infection – When the infection becomes severe, it may travel to other parts of the body like the brain and cranial nerves. This is uncommon but can be potentially fatal.

6Diagnosis

A doctor can tell whether a person has a swimmer’s ear by looking into the ears and asking about the symptoms.

The initial test includes measures to evaluate if the person has an external ear infection. The doctor may need to examine the ear canal with an otoscope, a lighted instrument.
The ear canal may look red, scaly and inflamed.

After examining the ear canal, the doctor will assess the eardrum or tympanic membrane to ensure that it’s intact and the eardrum isn’t torn.

7Treatment

Outer ear infections may heal on their own without treatment. However, if the infection becomes severe, the doctor may prescribe antibacterial agents. Only doctors are allowed to prescribe medicines. Do not self-medicate because you might end up causing more harm to yourself.

The goal of treatment is to stop the spread of the infection and let the ear canal heal.

Cleaning – The doctor may recommend eardrops to clean the outer ear canal. Then the doctor will use suction or curette to clean away debris and discharge.

Medications – The doctor will prescribe some medications to curb the infection. Antibiotics are commonly prescribed, which will be taken for seven days. This will fight off the ongoing infection. Other medicines prescribed are an acidic solution to restore the ear’s normal antibacterial environment, antifungal medication if the pathogen is a fungus, and steroids to reduce the inflammation. Medications for pain may also be prescribed to reduce the discomfort. Ear drops may also be prescribed.

How to use eardrops?

Ear drops are easier to administer if another person does it. The patient should lie down with the affected ear facing upwards. The ear drops should be administered until the ear canal is full. The patient should remain to lie down until the drops are absorbed. This will take about a few minutes.

For people who have a perforated eardrum, using eardrops is contraindicated. To make sure, you need to consult with an otolaryngologist.

8Prevention

Prevention is the key to keep ear infections away. Keeping the ear dry as much as possible also reduces the risk of infection. To prevent having a swimmer’s ear, it is important to keep all these measures in mind.

Take caution in swimming or taking a bath – Use a cotton ball or earplugs to prevent water from entering the ear while swimming or taking a bath. Moreover, use a swim cap.

Be careful when cleaning your earDo not remove ear wax on your own. Avoid scratching the inner ear with cotton swabs.

Keep your ears dryWhen the ears have been exposed to moisture from bathing, showering or swimming, dry your ears thoroughly by wiping it with a towel or a piece of cloth. You can tip your head to the side to drain water from the canal.

Home remedy or preventive treatment – For those who have an intact eardrum, you can do this procedure before and after bathing or swimming. Mix a part of white vinegar and one part rubbing alcohol. Pout 5 milliliters of the solution to each ear and let it drain. This will prevent the growth of bacteria and promote faster drying.

Protect the ears – You can protect the ears with cotton balls or ear plugs when you’re swimming or applying certain hair products that can irritate the ear canal. When water has entered your ears, make sure you drain it out and dry the ears after. Water promotes moisture, making the ear canal an ideal ground for bacterial growth and proliferation.

Do not put foreign objects inside the ear – Do not insert objects such as cotton swabs, hairpins and other objects in an attempt to get the earwax. This could damage and irritate the skin in the ear canal.

Here are other preventive measures to reduce the risk of swimmer’s ear:

  • Always maintain proper earwax hygiene. Too little or too much earwax may lead to an infection.
  • Take good care of your skin. Hydrate with water to prevent skin dryness.
  • If you have a swimmer’s ear, complete the treatment to prevent recurrence.
  • Do not scratch inside the ears using small and long objects.
  • Do not use earphones or hearing aids when there is an acute infection or swelling.
  • Decrease exposure to water when you’re prone to having outer ear infections.
  • Don’t swim in ponds, lakes or rivers with lots of bacteria and other disease-causing microorganisms.
  • Make sure the pools or spas you’ll be swimming in are clean and well-maintained.
  • Drain or shake water from your ears after bathing or swimming.
  • Use preventive eardrops to promote faster drying or mineral oil drops to keep the skin moisturized.
  • Avoid rigorous cleaning inside the ear to remove ear wax. Ear wax is dispelled on its own and you don’t need to use cotton swabs or other foreign instruments to dig them out.