Identifying & Preventing Swimmer’s Ear (Otitis Externa)

By Joseph Halphen PA-C, Lake After Hours Central

    Otitis Externa, most commonly known as swimmer’s ear, is an inflammatory process of the external ear canal. The most common cause of otitis externa is excessive moisture, which removes cerumen (ear wax) and decreases the acidity of the external ear canal, creating a growing environment for bacteria. Putting fingers, cotton swabs or other objects in your ear can cause trauma to the canal and can also lead to otitis externa.

    The two most characteristic presenting symptoms of otitis externa are ear pain (otalgia) and a discharge in or coming from the external auditory canal (otorrhea). In infants it is common for them to tug or pull on the affected ear and they are usually very irritable due to the discomfort.

The most common type of otitis externa is bacterial, although fungal overgrowth is a principal cause in approximately 10 percent of cases. Like all skin, the external ear canal has a normal bacterial flora and remains free of infection unless its defenses are disrupted. When disruption occurs, a new pathogenic flora develops that is dominated by Pseudomonas aeruginosa and Staphylococcus aureus.

    Treatment recommendations vary somewhat, but it is most commonly recommended that drops be given for three days beyond the cessation of symptoms, typically 5 to 7 days. However, in patients with a more complicated infection, 10 to 14 days of treatment may be necessary and may even require the use of an oral antibiotic (rarely). There is usually no need for reevaluation unless the infection is not resolving.

    Because of the high rate of recurrence in patients who participate in water activities on a regular base, prevention is imperative. Dry your ears thoroughly after exposure to moisture from swimming or bathing. Dry only your outer ear, wiping it slowly and gently with a soft towel or cloth. Tilt your head to the side to help water drain from your ear canal. You can dry your ears with a blow-dryer if you put it on the lowest setting and hold it at least a foot away from the ear. Avoid putting any object into the ear canal. In addition, swimmers may benefit from barrier protection. The benefit of earplugs is controversial. While properly fitted plugs will keep the canal dry, they may also cause wax (cerumen) impaction and act as a local irritant. They have even been shown to predispose people to otitis externa. A tight fitting bathing cap may offer better protection. Patients with acute swimmers ear should preferably abstain from swimming for at least 7 to 10 days.