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Swimmer’s Ear — Not Just for Swimmers

By Rod Moser, PA, PhDApril 02, 2006
From the WebMD Archives

When the ear becomes painful, most people assume it is a middle ear infection, but many times, the problem is in the ear CANAL. The ear canal is lined with skin that is rich in sensory nerves, so an infection in this area can be quite humbling, sometimes even more painful than a middle ear infection.

Swimmer’s ear, also called otitis externa, can be caused by frequent water exposure, hence the relationship to swimming. But, exposure to bath or shower water is equally as problematic if the right conditions are present.

The delicate lining of the ear canal is protected by ear wax. When water gets on the wax-coated ear canal surface, it will bead up and fall out when you shake your head, just like water droplets on waxed furniture or your car. However, if you are one of those people who go through a box of Q-tips every month, or routinely swab out their ears after every shower, you are stripping off the protective wax surface and creating the right conditions for an infection.

Swimmer’s ear is perhaps the only ear condition that you may be able to accurately diagnose yourself; however, it is still advisable for you to see your medical provider. Obviously, you can’t look inside your own ear, but there is a characteristic clinical sign that you can do. Just in front of your ear canal opening is a little area called the TRAGUS. If you have PAIN when firmly push on the tragus like button, or tug on your ears, there is a very good chance you have a condition in your ear canal, such as otitis externa.

In most cases, the standard treatment for otitis externa is a prescription ear solution (ear drops), NOT an oral antibiotic. However, sometimes the ear canal is so swollen, that your medical provider is not able to even touch your ear, let alone carefully inspect it and your eardrum. In this case, your medical provider may elect to do BOTH, although recent studies indicate that this may not be always necessary.

The use (or overuse) of oral antibiotics should be avoided if possible. Severely swollen ear canals may require the insertion of a wick to allow the penetration of the eardrops. This wick is often made with tightly compacted seaweed that gently expands with moisture. As the wick expands, it allows for the eardrops to reach the source of infection or inflammation. Many prescription ear drops also contain a mild anti-inflammatory steroid to help with this swelling. Keep in mind that not all cases of otitis externa is bacterial; yeast and fungal infections of the ear canal are also quite common. These would be treated differently, with an antifungal preparation.

If you have PETs (Pressure Equalization Tubes) in your ears, then you are limited with the type of eardrops you can use. The same goes if your eardrum is ruptured or may be ruptured. Many of the prescription eardrops not approved if your eardrum is open. Some of the newer class of medications, such as Floxin or Cipro HC can be used in this case. Unfortunately, they are more expensive and not currently available generically.

As the warmer, swimming months are approaching, what can you do to prevent swimmer’s ear?

  1. If you are one of those militant (or secretive) Q-tip users. Stop it! Allow for the protective wax coating to re-establish. Of course, feel free to remove any excess earwax that drains to the outside of your ear. Beneficial or not, this is still unappealing. Needless to say, don’t dig around in your ear canal with other found objects.
  2. Bacteria (and even yeast) will not grow well in an acidic environment. Incidentally, natural earwax is very acidic. You can make up a homemade acetic acid solution by using half white vinegar and half tap water. Put a few body-temperature* drops of this solution in your ear after a showering or swimming and you will likely prevent most cases of otitis externa. (* All eardrops should be instilled at body temperature. Hold them in your hand for a while to warm them up a bit. Cold drops in the ear can cause dizziness.) You should not use acetic acid drops in your ear if you have tubes or a known eardrum rupture, unless specifically prescribed by your medical provider.)
  3. Protective earplugs when swimming or showers can be helpful if you are particularly prone to recurrent otitis externa. There are many types available at your local pharmacy. Cheap, disposable ones are best for children (who lose them). Also, children with earplugs have decreased hearing, so it will be more difficult to yell at them when they are in the pool. Don’t put the cat in the pool! No standing on the sliding board! No peeing!
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