The Medical Consumer's Advocate

Swimmer's ear revisited

Q: Last winter my 15-year-old daughter came down with an ear infection that the doctor said was caused by swimmer's ear. At that time she was in severe pain. She was given antibiotic ear drops and we took her to an ear specialist to have her ear vacuumed out. She was fine until this summer when she went swimming. Her ear has been plugged since. I have been putting drops of hydrogen peroxide in the ear. Although it has not turned into a painful infection, her ear is uncomfortable. Do you think that this will be a ongoing problem? What do you recommend to help unplug the ear? She does use ear plugs in the shower, but they are not totally effective at keeping all the water out. Is there any treatment that can cure or prevent this?

A: Swimmer’s ear is also known as acute otitis externa. "Acute" refers to its rapid onset; "otitis" is a generic term for ear inflammation; "externa" indicates that it is an infection of the outer part of the ear– the auditory canal, to be exact. The common name, "swimmer’s ear," refers to the fact that otitis externa often occurs after water gets into the ear canal. Otitis externa may occur without water exposure, however. Otitis externa is almost always due to a bacterial infection of the canal skin. As a result of this infection, the outer layers of skin slough (flake off.) This skin debris, pus (dead white blood cells and bacteria, living and dead) and ear wax form a gloppy mess that typically plugs the canal, causing a temporary hearing loss. Swelling of the canal skin contributes to this hearing loss.

Otitis externa is almost always caused by overgrowth of a bacterium called Pseudomonas. Pseudomonas is a water-loving bacteria, hence the association with swimming. At present, the only treatment you are providing your daughter is hydrogen peroxide, which you can think of as "water with an attitude." Hydrogen peroxide liberates oxygen (that’s the fizz), and consequently has a mild antibacterial effect. After it has finished fizzing, all that’s left behind is water– just what Pseudomonas loves!

The best treatment for otitis externa involves removal of the skin debris, pus and wax from the canal (that was why your daughter’s ENT suctioned her ear) and treatment with an appropriate topical antibiotic (ear drops). Until the infection resolves, it is a good idea to keep water out of the infected ear canal. A cheap, comfortable and effective ear plug can be made by massaging petroleum jelly (Vaseline) into a cotton ball. She should use such an ear plug whenever she bathes. For the time being, swimming is out of the question. Needless to say, you should stop putting hydrogen peroxide in her ear.

If your daughter’s ear is uncomfortable, then you really ought to take her to her ENT. Suctioning of the ear canal will often result in immediate relief of the pain and hearing loss associated with otitis externa. For the reasons given above, you cannot unplug her ear yourself; over the counter ear wax irrigation kits all involve flushing the canal with a water-based liquid (often a peroxide), and this may make matters worse, not better.

Will this be an ongoing problem? Maybe. Some people simply cannot get water in their ears, because they get an otitis externa whenever their canals get wet. This can be tough on kids, who may regard "dry ear precautions" as punishment. Nevertheless, with appropriate ear protection, most aquatic activities are permissible for patients who need to observe strict "dry ear precautions." Your daughter’s ENT can help you find an appropriate combination of protective devices (ear bands and plugs) that will enable your daughter to "stay in the water."

Strict observation of "dry ear precautions" is the key to successful prevention of otitis externa. Once otitis externa develops, antibiotic ear drops can cure the infection if it is mild. With more severe infections, debridement (cleaning of the ear canal with suction) is essential. There is no permanent cure for recurrent otitis externa.

Back to The Question and Answer Page

	More information available on other diseases of the ears, nose and throat!
	Click here if you have questions, comments or criticisms for Dr. Hoffman.

Copyright (c) 1998 -2001, Douglas Hoffman, all rights reserved. Reproduction in whole or part without permission is prohibited.