The Medical Consumer's Advocate

Swimmer's ear (acute otitis externa)

 

Q: Are swimmer's ear and acute otitis externa the same thing? What causes this?

A: Swimmer’s ear and acute otitis externa are, indeed, the exact same thing. The common name, "swimmer’s ear," reflects the fact that WATER is the usual culprit.

Otitis externa is merely ear inflammation (otitis) involving only the ear canal or outer ear (externa.) It is most commonly due to bacteria, but may also be caused by a fungus, or sometimes a combination of the two. The pain is usually excruciating, particularly in bacterial otitis externa. The pain is made worse by pressure on the outer ear. There is usually at least some hearing loss, owing to the fact that the ear canal may be swollen shut and/or clogged with debris. Other "ear symptoms," such as tinnitus (ringing) or vertigo (a spinning dizzy sensation), occasionally accompany the pain and hearing loss.

What causes this problem? Normally, the ear canal is protected from infection by a thin coat of ear wax (and you probably thought that stuff was there just to keep the cotton swab folks in business!) Ear wax is slightly acidic, and this acidity tends to discourage growth of bacteria and fungi. Ear wax also acts as a barrier against such organisms. When people get a bit over-aggressive in cleaning out their ears, they are really not doing themselves much of a favor. By doing so, they lower their ears’ defenses against infection.

When water gets into the ear canal, it tends to change the acid/base balance in the canal, pushing it in a more basic direction. Bacteria (and/or fungi) that were kept at bay by the acidity of the canal are now free to thrive. High humidity tends promote reproduction of these organisms, too.

The treatment for otitis externa depends upon the stage of the disease. If your doctor recognizes the problem at an early phase, antibiotic ear drops may be sufficient to eradicate the disease. Typically, these ear drops contain not only an antibiotic, but also a steroid (such as hydrocortisone), which serves to reduce inflammation. Ear drops are purposefully formulated to be a bit on the acidic side, so as to restore the normal acid/base balance in the ear canal.

If hearing loss is also present, then there may be an abundance of debris in the ear canal. "Debris" usually consist of a large amount of skin that has flaked off the canal wall, along with pus, and sometimes fungal material. Ear drops may still work in such cases, but typically the course is long and drawn out. An ear, nose and throat specialist (ENT) can suction these debris from the ear canal, and the patient will get better much faster. Debris tend to block the ear drops’ entry into the canal; moreover, debris are great "food" to fuel further bacterial and/or fungal growth.

If the ENT finds that the canal is "swollen shut," he or she will usually place a small "wick" in the canal. The wick expands when ear drops are applied. This puts pressure on the ear canal skin, thus helping to reduce the swelling, but the wick also enables ear drops to travel deeper into the canal.

Oral antibiotics are sometimes necessary. In particular, if the external ear looks puffy and red, or if the lymph nodes in the neck have become enlarged and tender, then oral antibiotics are necessary.

Finally, we usually recommend that the patient observes "dry ear precautions." This means: no water of any kind in the ears– no bath water, sea water, or pool water. When the patient bathes, he/she is instructed to place a water-tight ear plug into the ear canal. My favorite ear plug is a good-sized wad of cotton, in which has been massaged some petroleum jelly (Vaseline) in order to make it water proof. This makes for an inexpensive, comfortable and effective ear plug.

The patient should observe dry ear precautions until the ear canal infection has completely resolved. In patients who keep getting swimmer’s ear (such as your husband), we usually recommend that dry ear precautions become part of the daily routine. Some folks simply can’t get water in their ears!

 

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