Swimmer’s Ear: A Special Report

Summer is here and it is time for fun in the sun and sand. When we want to cool off, most of us head for the pool or the beach. The water is warm and inviting and we love to swim the day away.

Unfortunately some swimmers can contract a condition called swimmer’s ear. In medical language it is referred to as acute external otitis. It is an infection that can start off being irritating but morph into something that can be a little more serious if not treated. But, cheer up. The treatment is easy to handle if caught early. The infection is almost always bacterial so medications do a great job clearing it up.

In this report we will discuss the ins and outs of swimmer’s ear. You will learn a little about the anatomy of the ear and how it works. Are you at risk for this condition? You will find out something about that as well.

Just like swimmer’s ear is treatable it is also preventable. Discover some simple ways that you can protect your ears so that you can continue to have fun without being bothered with a pesky infection.

The Outer Ear

The largest part of the outer ear is the “pinna.” You might call it simply, the ear. It is a soft structure that is composed of cartilage to hold its shape. That’s why your ear is bendable.

The pinna has a couple of purposes. One, it protects the eardrum (tympanic membrane) from direct contact. Second, it is shaped to conduct sound waves from the outside world to the eardrum. From there, they travel through the inner ear and on to the brain.

The distance that sound travels to the eardrum is called the ear (auditory) canal. It is lined with sweat glands that secrete earwax. The job of earwax (cerumen) is to catch and trap dust, dirt, dead skin cells and other particles that enter the ear. But, you better keep those ears clean. Wax can build up in the ear canal and become impacted, inhibiting sound transmission.

Middle Ear

Beyond the eardrum, there is an entire network of bones and other structures that conduct sound to the auditory nerve where it is transmitted to and interpreted by the brain. Let’s start with the ossicles (ear bones): the hammer (malleus), the anvil (incus) and the stirrups (stapes). They are the smallest bones in the body. These bones are vibrated by the eardrum, passing the sound waves like a conduction chain.

There is no fluid in the middle ear. It is filled with air so that sound is conducted properly. The Eustachian tubes connect to the middle ear and equalize pressure there when you swallow or chew. Normally the tube collapses on itself.

Now that you know what the ear does (besides look good and hold earrings), you can understand how important it is that bacteria stay away. Your hearing and balance can be affected when infections occur here.

Swimmer's Ear Risk Factors

How might you contract or come in contact with these bacteria? Well, the first answer is a no-brainer. The clue is in the name. Swimming is the biggest risk factor for getting it.

We don’t always swim in the best pools. Sometimes the level of bacteria is too high. This can happen in public pools during the summer when they are inundated with people on a daily basis. Don’t start shunning public pools now. You’ll just want to be a bit more careful the next time you go.

Another source of high bacteria is lakes and rivers and even the ocean. When you go to the beach or your uncle’s house by the lake, you’ll use that tire swing and cannonball all day. But, these waters are filled with all sorts of things that you can’t see that could be causing an infection in your ears.

Do you always clean out the water from your ears after you swim? If it blocks the canal and you have a hard time hearing, then you might take a towel and give it a good rub-a-dub-dub. Otherwise, water can sit in the lower part of the outer ear until it dries. People with shorter hair might have water drops falling in their ear even longer than that – until their hair dries.

Are you a competitive swimmer? You wear goggles and swim caps to keep your hair out of your face. Sometimes those caps can cover your ears as well to make you more aerodynamic in the water. Even though they are covered, water doesn’t need much space to slip between there and get trapped for long periods of time in the ear canal. In the presence of excessive earwax, even more water can get trapped there.

It is not routine for most people to cover their ears when they perform certain activities like dyeing their hair or applying hairspray or gels. The ingredients in these products can irritate the outer ear. Red or broken skin here (from scratching) can leave a window for bacteria to enter. And, if you use a cotton swab to clean it or scratch the irritation, you are just roughing up more skin and allowing more bacteria to come to the party.

All of these things will put you at risk for developing swimmer’s ear. The best thing you can do is to protect yourself while you are having fun. Besides, who wants to stop swimming?

What Casuses Swimmer's Ear?

We touched a bit on what the role of the outer ear is in hearing and also protection for the structures that are more delicate in the middle and inner ear. Your ears are shaped a certain way to help invading substances to roll right back out where they came from. The ear canal angles downward towards your pinna. That’s so that water that gets into your ear when you swim can gently roll back out. You don’t even have to lean to the side or bang your head to get the water to move.

Another deterrent to bacterial growth is presence of cerumen (earwax). We just think that it is a gross brown substance that we have to clean out of our ears, but it is a friend. It forms a thin layer over the ear canal that is acidic in nature. There are also proteins present that stop bacteria from growing. This is what happens in the normal ear.

That earwax layer of protection can be washed away by lots of water in the ear. That comes from – you guessed it – lots of swimming. Water dilutes the acidic nature of the wax until it becomes a more palatable environment for bacteria. In trapped places, your temperature is higher which is what they like.

What Are the Symptoms of Swimmer's Ear?

Mild to Advanced

Now that you know how you get it and where, we’ll explore what it looks and feels like to the sufferer. Like we said, it is mild at first but can get worse over time.

Infections cause serious irritation in the tissues. In the water you might not notice it but once you get out and go home, you may feel that your ears are itchy. That could be due to dust or hair or something simple. When the itching continues to occur day after day and often in the ear canal just beyond your reach, you may be dealing with bacteria.

Anyone who looks at your ears will notice redness often associated with irritation of some sort. You may not see it but there could be serous fluid that forms as the body tries to muster its defenses to fight the infection. It won’t smell like pus, but will be clear. None of these symptoms will confine you to your bed, but they will get aggravating.

If not treated, the existing symptoms will become a little more persistent. The redness may become more pronounced. Your itching will get on your nerves. Resist the urge to use a cotton swab or worse, a bobby pin or other penetrating object to scratch it.

The fluid that you see will no longer be clear but yellowish. It is now a pus-like discharge. Pus is the fluid created as the body tries to squeeze out the infection. It is infection as a matter of fact.

Because there is fluid where there is normally none, you may get the feeling that something is in your ear. Fluid just like too much earwax makes it hard to hear sounds clearly. And, your ear will become more sensitive, even hurting to the touch.

Maybe you have a high tolerance for pain if you are still not seeking some sort of attention for your ear problem. As more and more bacteria grow, the pain will increase. As the infection spreads, the lymph nodes in the area will become involved. When they fill with infection they enlarge. You’ll be able to palpate them in your neck and behind your ears.

Your reddish area will spread to the entire outer ear area. It may even swell from the inflammation. Seek medical attention right away at this point.

Complications

When left untreated, the infection may travel beyond the primary point or deeper into the body tissues. This requires more extensive treatment options.

One complication is hearing loss. It is only temporary but can be distressing. The accumulation of fluid in the ear hinders the sound waves as long as the infection persists.

Cellulitis is an infection of the deeper layers of the skin. It can occur anywhere in the body when an infection is out of control and starts to find its ways other places. Cellulitis can be serious if not handled immediately.

Infections can wear away at bones over time. The bones of the ear can be at risk here. One sign of this is increased pain. After the bones in the skull, the skin and cartilage of the ear can also break down.

Rarely will the infection spread so far as to infect the tissues of the brain but it can happen. Your middle and inner ear are very close to the layers of tissue that protect the brain inside the skull. After the bone has eroded away, the infection will proceed to the nerves and other areas.

What Are the Treatment Options?

Doctor's Intervention:

When you come in at the later stages of the infection, there is probably no doubt that you have contracted swimmer’s ear. All the same, the doctor will want to properly examine your ears and perform diagnostic tests for confirmation.

First he will ask you to describe what you are feeling and the timeline for your experiences. To make sure that you don’t forget anything, write it all down ahead of time. Here are a few questions to help you record the right information:
* When did these symptoms start?
* Do you spend a lot of time in the water?
* Have you recently used any type of hair dye, gel or any other substance near your ears?
* How have you been treating your symptoms? What medications are you taking, if any?

Also mention any allergies you might have to medications. If one is needed, your doctor will want to ensure that there are no drug interactions.

After the preliminaries he will examine your ear with a device called an otoscope. It is used to see down through the ear canal. He will see if there is redness or flakiness of the skin going on down there and how far it extends. This is an indication that the protective cerumen barrier is gone since it would normally trap dead skin.

Any time that an infection extends to the eardrum, it can be serious for your hearing. Since the middle ear is filled with air, an active infection could damage the eardrum and introduce fluid into that space. Your doctor will check for that as well.

He may have to remove any remaining earwax from deep in the ear canal to visualize the membrane. This requires the use of a curette. You may feel the scraping but try not to move. Once the ear canal is clean then the pathway is clear for any medication the doctor may prescribe for you.

Medications for Swimmer’s Ear

The most common medicine prescribed is ear drops. There are different ingredients within the drops to take care of all or most of the symptoms that you are experiencing. To treat the lack of acidity, the drops will restore the acidic environment to retard the bacterial growth. For inflammation in the ear canal and the outer ear, steroids are needed. An antibiotic needs to be present to kill off the bacteria.

The doctor will probably take a sample of the fluid in your ear for testing. Sometimes, the infection might be fungal in nature. In that case, an antifungal drop will be needed to clear the infection up completely. Having seen the condition before, the doctor will offer the best ear drop. You may need to return if your symptoms don’t resolve.

For maximum effect, the ear drops need to stay in your ear. Remember how the ear is shaped. Simply trying to shoot them in your ear won’t do it. To properly instill ear drops:
* Lean your head sideways so that the drops roll back into the canal.
* Roll the bottle of drops between your hands to warm them before using.
* To keep the drops from rolling out again, use a cotton ball in your ear.

An antibiotic may be given orally if your symptoms are more advanced. The infection will be fought on two fronts to clear it up sufficiently. If you are already taking ibuprofen or acetaminophen for pain, you will probably be allowed to continue taking it. Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug) so it reduces inflammation.

While being treated for this bacterial infection, any water in the ear will be forbidden. That means no swimming for a while. You may also be asked to avoid flying as changes in pressure can cause more pain in your ear. For people who wear hearing aids or other devices, you will have to keep them out until there is no sign of discharge or infection. That cotton ball will come in handy again when you take a bath so you don’t introduce water into the canal.

Prevention of Swimmer's Ear

Just because you have had swimmer’s ear once doesn’t mean that you will have it again. You can protect yourself from this painful infection with a few tips like the ones listed below.

Use earplugs – These can keep water out of the ear canal while swimming. With hair dyes or perms, use cotton balls to remove any liquid from the ears.

Dry your ears – After emerging from the pool, washing your hair or swimming in the lake, use a towel to dry the ear canal and the outer ear. Completely dry your hair too so water won’t fill the outer ear again. At the gym, you can use a blow dryer to get the job done faster.

Avoid using cotton swabs or other implements in the ear canal – They look harmless but you can damage the skin with them. Anything sharp is also a recipe for disaster. You may not have bacteria in the ear now, but open, irritated skin will welcome them in if you encounter some.

Swim in well-treated water – Avoid swimming in bodies of water that contain lots of bacteria or other pollutants, as much as possible. It isn’t good for your ears or the rest of your body for that matter.

Clean your ears regularly – No, you aren’t supposed to use cotton swabs but you can use a simple homemade solution to keep bacteria away. Mixing together equal parts of vinegar and rubbing alcohol into an ear drop solution stops bacteria in its tracks. Rinse the ear with it before and after you go swimming.

Follow doctor’s orders – Even if your ear begins to feel better after treatment for swimmer’s ear, don’t stop taking your medication until directed. The infection is not necessarily all gone just because you are experiencing fewer symptoms. Also, ask the doctor before resuming your swim routine. Encountering water too soon could lead you right back to square one.

Spending time in the water when the weather is warm is great. It’s a traditional summer pastime. You can continue to enjoy it as long as you take the necessary precautions to keep your ears safe from bacterial infections. So, do yourself a favor: Keep your ears high and dry.

If you think you may have swimmer’s ear already (based on symptoms listed here), seek medical treatment from a doctor right away. Remember, in the early stages, the symptoms are mild and respond well to medication. As the condition worsens, you are looking at longer treatment time and more pain.