Swimmer's ear can be quite a headache
Sunday, August 25, 2013 10:00 PM
I've seen quite a few cases of swimmer's ear this summer. The frequency of this condition usually starts to increase when the humidity rises and people have been hitting the swimming pools.
Dr. John Roberts is a Crawfordsville physician and one of the owners of The Paper. In addition to his weekly column, he writes a daily health tip that can be found on page A1.
The medical term for swimmer's ear is otitis externa, or inflammation of the external ear. This is in contrast to the more common otitis media, or inflammation of the middle ear (the part of the ear behind the ear drum).
The number of people who suffer from swimmer's ear is about 4/1,000 per year, or about 3-5 percent of the population. It afflicts males and females in equal numbers and tends to present between 7-12 years of age.
The external ear canal is protected by a layer of wax or cerumen. There exists a delicate balance of too much or too little cerumen. If there is not enough present, the ear canal can dry out, crack and develop infection. If there is too much, the ear canal can become too moist. This leads to swelling and breakdown of the skin lining the canal.
The majority of cases of swimmer's ear are caused by too much wax. This allows water contaminated with bacteria or fungi to enter the ear canal and invade the broken down skin. Since swimmers often swim in contaminated water, they are more prone to develop this problem.
There are other conditions that predispose one to develop otitis externa. One of the more common is trauma to the ear canal. This is where grandma's advice to not put anything smaller than an elbow in your ear comes into play. Items such as Q-tips, bobby pins, paper clips and pencils do not belong in the ear canal. Repeated use of earplugs can also cause trauma and trapping of moisture.
There are other skin conditions such as dermatitis and seborrhea that can increase the risk for infection. People with small ear canals are also at increased risk.
The most common organisms to cause problems are Pseudomonas bacteria. Staphylococci and Streptococci can also cause problems. Fungi play a role in about 5 percent of cases.
Most people recover from otitis externa without minimum intervention. However, people with certain medical conditions can develop severe problems. Diabetics and those who have compromised immune systems need to be careful. Simple otitis externa can lead to a severe condition called malignant otitis externa in these people.
The malignant form can cause the infection to spread to the tissues around the ear. It should be suspected in those who have a lot of redness around the ear or swelling of the ear itself. These people need hospitalization for intravenous antibiotics. If left untreated, this condition can be fatal in half the sufferers.
The history of someone with swimmer's ear usually involves some water exposure. Itching may develop followed by worsening pain over the next couple of days. The ear may start to drain white material.
Patients may experience a pressure or fullness and can also develop hearing loss as the ear canal swells shut. A reliable physical finding is tugging gently on the ear often causes pain, whereas it typically does not in middle ear infections.
Treatment is curative over 90 percent of the time. Most people improve in 2-3 days and are back to normal in a week or so.
There are many treatments available, but prescription antibiotic drops work best. One of the oldest agents around is a milky fluid and contains two different antibiotics and a steroid. However, one of the antibiotics can sometimes cause some hearing loss and the other antibiotic may cause a local allergic reaction.
The antibiotic drops ciprofloxacin and ofloxacin are two that are usually recommended. If there is fungal involvement, doctors may prescribe simple acetic acid (vinegar) solutions or topical antifungal medication. Occasionally the pain is so intense that oral narcotics may be required.
Patients who get swimmer's ear frequently should employ preventative measures. A half-and-half mixture of white vinegar and seventy percent isopropyl alcohol works well. A couple of drops in each ear after getting the ears wet can be very effective at prevention. I also recommend directing a blow dryer on the LOW setting into the ear canal after bathing or swimming. Avoid dryers that are noisy to prevent hearing damage.