An infection of the outer ear canal caused by water entering the ear canal is called Swimmer’s ear. Even though it’s called a swimmer’s ear, it can affect anybody. Medically known as otitis externa in this infection, when the moisture or water enters the ear canal, it might get trapped there– this could potentially become a breeding ground for bacteria, which in turn causes the infection.
Note: The ear canal or the outer ear is the area that leads up to the eardrum, after which the middle ear starts. Typically the ear canal inherently has a few types of bacteria; however, they are different from the bacteria that cause the Swimmer’s ear infection.
Some of the most common ways in which the water can enter your ear include:
• Taking a bath
• As a consequence of some other disease
• Ear cleansing – after the cleansing some water may get left behind
Typically the water should drain out by itself; however, if it doesn’t, and you notice some uncomfortable symptoms, you should consult your doctor.
Since it is elementary for water to seep into the ear canal, Swimmer’s ear infection, or the effects of water in the ear canal affects 10% of the people at some point in their lives.
Alert: 90% of the cases of Otitis externa is caused by the bacteria “Pseudomonas aeruginosa.” If you notice the symptoms associated with this infection, you should not overlook it and consult your doctor for the diagnosis of a possible infection
There are 4 forms of Swimmer’s ear infection or Otitis Externa, namely:
• Malignant or Necrotizing
Each of these stages differs in the associated symptoms. Therefore knowing these symptoms may help you or your doctor in diagnosing the form of your infection.
|Acute diffuse otitis externa||Inflammation throughout the external ear canal||Ear drainage, Itching, and pain|
|Circumscribed Otitis Externa||Infection of the hair follicle in the ear canal leading to swelling and pus formation in the tissue of the ear canal||Inflammation and pus formation in the tissue or the cartilage of the ear canal|
|Chronic Otitis Externa||Inflammation of the skin lining of the ear canal and is a spontaneous cause of dermatitis of the ear canal.||Itching, redness, clear ear discharge, peeling, darkening, and painful cracking of the skin.|
|Malignant or Necrotizing Otitis Externa||It is an invasive bacterial infection that affects the outer ear canal and the skull base||• Ear pain that generally increases at night|
• Ear discharge
Note: In an invasive infection, the germs invade the body parts that are typically free from germs.
Following are some of the symptoms that should prompt you to see a doctor consult about a swimmer’s ear infection from water in the ear canal:
• Otalgia- Severe pain in the ear
• Otorrhea– Ear discharge
• Itching or the tendency to itch all the time
• Erythema– Redness of the skin
• Swelling of the ear canal
Alert: As the infection progresses to the advanced stages, water in the ear and the associated symptoms may lead to conductive hearing loss – sound doesn’t go through the outer and middle ear. Hence it would be best if you did not overlook these symptoms.
Several factors can cause bacterial infection; however, some of the most common causes include:
• Bacterial infection– Typically, Swimmer’s ear is caused by the bacteria “Pseudomonas aeruginosa” or “Staphylococcus aureus.”
• Middle ear infection– This can lead to ear discharge from the middle ear, which in turn infects the outer ear. It is also known as Otitis media.
• Allergy– could be caused by a reaction to things that come in contact with your ear like shampoo or prolonged use of earplugs or as a side effect of a medication you are taking.
• Seborrhoeic dermatitis– common skin disorder in which scales from inside the ear. It leads to the reddening of the skin and pain.
• Fungal infection– Fungi is a rare cause of acute otitis externa but can cause chronic otitis externa.
Note: If you are taking an ear medication, always consult with your doctor about the possible side effects and whether it can lead to a possible allergy and an infection of the ears. This is because there has always been a strong relation between allergies and infections.
Alert: If the full course of medication is not completed, then otitis externa can return in the future despite the previous treatment.
Some of the trigger factors that increase the risk of a swimmer’s ear infection include:
|Increased moisture in the ear canal||Water entering your ear while swimming or while taking a bath or if you live in humid conditions|
|Skin diseases||Eczema, Acne, Psoriasis, Seborrhea, Neurodermatitis, Inflammatory diseases of the skin|
|Environmental factors||High humidity, High temperature|
|Trauma or ear damage||Hearing aids, earplugs, foreign bodies, Earwax removal, ear adjustment|
|Diseases||Diabetes, Metabolic diseases, Immunosuppression|
|Internal/Endogenous issues||Excessive sweating, underproduction or overproduction of ear wax|
|Anatomical factors||An excessive amount of hair in the external auditory canal, bone growths in the external auditory canal, Narrowing of the external auditory canal|
|Other factors||Use of potential irritants like soap and shampoo, Radiation, Chemotherapy, past surgery of the external ear canal|
If you fall in any of the above categories, the chances of you developing a Swimmer’s ear are incredibly high.
In case you are noticing the symptoms of Otitis Externa, you would need to see one of the following doctors depending on your symptoms and underlying cause:
Depending on the symptoms you are facing, and the stage otitis externa is in, your doctor may perform different tests:
• History and physical examination using an otoscope:
– An otoscope is a medical device to look into the ears.
– This is done to examine the ear canal and the eardrum.
– Additionally, the outer ear (pinna), the surrounding lymph nodes, and the skin is also evaluated.
• Audiological examination:
– Done primarily when the eardrum is not visible
– The objective is to find if the inner ear is involved.
• Tuning fork examination:
– Done when there is a swelling in the ear canal and
– When the audiological examination reveals a conductive loss of hearing.
• Ear secretion is swabbed for culture and pathogen resistance testing.
• Body temperature is also checked. If you have a fever upto 102.2°F, it might indicate that the infection has spread beyond the ear canal.
There are many possible treatments for the cure and management of complications associated with water in the ear or swimmer’s ear. The treatment that your doctor will recommend if you suffer from Swimmer’s ear will depend on the results of the diagnostic tests and history examination.
1. Systemic antibiotics: Recommended when:
a. The patient’s age is more than 2 years and/or
b. Suffers from diabetes or has low immunity and
c. The infection has spread beyond the external auditory canal
2. Cleaning of the external auditory canal: Recommended when:
a. The infection is only in the external auditory canal and
b. The external auditory canal is blocked
3. Topical antiseptic/antimicrobial treatment and analgesia: Recommended when:
a. External auditory canal is clear and
b. The eardrum is intact
4. Topical non-ototoxic antiseptic/antimicrobial treatment and analgesia: Recommended when:
a. External auditory canal is clear but
b. The eardrum is perforated or
c. A surgical incision is made in the eardrum to decrease the pressure or to drain the fluid
After treatment, generally, you should see improvements within 48-72 hours. If there is no improvement within 48-72 hours, then your doctor may recommend a re-examination.
• If in the re-examination otitis externa is diagnosed again, your healthcare provider will either:
– Continue with the same treatment plan
– Change certain aspects of the treatment plan
• If in the re-examination, other underlying diseases are diagnosed as the possible cause for the symptoms, then those diseases are treated.
Specific home remedies can alleviate the symptoms and avoid potential complications from Swimmer’s ear.
Here are 5 home remedies and over-the-counter treatments for Swimmer’s ear or otitis externa:
1. Avoid the usage of things that may cause an allergy: These could include anything from hearing aids, earplugs to even earrings.
2. Use painkillers: Painkillers like paracetamol and ibuprofen can help in controlling and decreasing the pain caused by Swimmer’s ear
Note: Before taking any painkiller to be sure to consult with your doctor about it since not all painkillers are suitable for everyone
3. Avoid water near the ear that is affected: You can prevent the affected ear from getting wet by using things like a shower cap while bathing. Additionally,it would help if you altogether avoided certain non-essential activities like swimming, wherein there is a definite high chance of water entering your ear canal.
4. Use cotton wool for removing the discharge or debris in your ear: Avoid putting the cotton wool or cotton bud inside the ear
5. In case of a boil in the ear: Placing a warm cotton cloth over the affected ear can speed up recovery
There are many effective treatments for Otitis Externa. However, if left untreated, otitis externa can lead to certain complications like:
• Abscesses: Pus filled swelling can be formed around the affected ear
• Narrowing of the ear canal: If chronic otitis externa is left untreated for a long time, then it could lead to the formation of thick and dry skin around the ear canal.
• Perforation of the eardrum: Infection can spread to the eardrum, followed by the formation of pus inside the eardrum. The pus formation can eventually rupture your eardrum. The symptoms of a perforated eardrum include:
– Loss of hearing
– Tinnitus – persistent ringing sound in the ear
– Ear discharge
• Cellulitis: Otitis externa can damage the skin. Through the damaged section of the skin, bacteria that usually live on the skin surface can enter the deeper layers of the skin. The chances of Cellulitis following an untreated case of Otitis externa are incredibly high
If you are suffering from Cellulitis, the symptoms may include:
– Reddening of the skin
– Tender skin
– Shivering sensation and chills
• Malignant otitis externa: In this, the infection caused by otitis externa spreads to the bones of the ear canal. This is a severe complication even though its rare. Its symptoms include:
– Intense ear pain
– Severe headaches
– Facial nerve palsy: on the side of the affected ear, the functionality of the face is partially or entirely lost. Due to this the face drops
– The bone becomes exposed and visible in the ear canal
Since 10% of the people suffer from Swimmer’s ear at some point in their lives, you should learn and follow some of the following preventive measures:
• Protect your ears from trauma or accidents
• Treat and avoid any skin conditions and infections
• Most importantly, keep your ears dry and clean, especially after a shower or swimming.
Yes, Swimmer’s ear can be treated and cured permanently when diagnosed, and the right treatment plan is recommended and followed.
MBBS (ENT- Honours) (KGMC-Lucknow),
M.S. (KGMC- Lucknow), FAOI (AIIMS), FAOI (U.K.)
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