Who does not love swimming? We all do. But with it, also comes the problem of an ear infection called swimmer’s ear or otitis externa which happens when water enters the ear and remains inside it allowing bacteria to grow and infect the skin inside the ear canal. The ear’s natural shape which slopes down to help drain out water easily and the outer canals that have natural waxes act like defences to keep the ears clean and prevent infection. Overriding or compromising these features by swimming without proper head gear and ear-plugs, swimming in a poorly maintained pool with elevated bacteria levels such as a lake, aggressive cleaning of the ear canal by using fingers, cotton swabs or other objects, use of devices like headphones or hearing aids, scratching or allergic reactions from ear accessories or hair products are risk factors that cause swimmer’s ear.
Symptoms are usually mild and can get progressively worse. Mild symptoms include itching inside the ear canal, slight redness inside the ear, mild discomfort when the outer ear is pulled or pushed on the tragus which is the little bump in front of the ear or some clear, odourless discharge. Moderate symptoms include increased itching and pain, extensive redness in the ear, excessive fluid and pus discharge, muffled or decreased hearing, ear feeling full inside besides partial blockage of the ear canal due to swelling, fluid and debris. Advanced symptoms include severe pain that radiates to the face, neck or side of the head, complete blockage of the ear canal, tender and sore outer ear, fever and swelling of the lymph nodes.
One must see a doctor immediately even if symptoms are mild The infection per se is not so serious if treated promptly. Delays would bring in complications that range from temporary hearing loss to long term infection like chronic otitis externa, deep tissue infection called cellulitis, bone and cartilage damage called necrotising otitis externa or malignant otitis externa which is not a cancer or more widespread infection.
The diagnosis is simple and usually happens quickly based on symptoms the patient reports, Q and A by the doctor, and a physical examination with an otoscope to check for a red, swollen and scaly ear canal and a visualization of the ear drum or tympanic membrane to check if it is torn or damaged. Depending on the severity and stage of the infection, the doctor may refer an ENT specialist to check the extent of damage in the eardrum and should the infection stop responding to treatment, an ear sample of the discharge and debris will be sent for lab-testing to identify the exact bacteria.
The aim of treatment is to stop infection and allow the ear canal to heal and it starts with cleaning of the outer ear canal to allow eardrops to go to the infected areas. An ear curette or suction device may be used to remove and clean all discharge, wax clumps, flaky skin and any other debris. Prompt treatment with ear drops with a combination of acidic solution to restore the normal antibacterial environment, steroids to reduce inflammation, antibiotics to fight bacteria and antifungal medication to fight infection should normally arrest the problem. If the infection is advanced and does not respond to treatment then the doctor will prescribe an oral antibiotic and pain relievers.
Avoiding any water activity like swimming or scuba diving is good till the discharge and the pain stops. It also good to use sterilised cotton balls coated with petroleum jelly on the outside to protect ears while washing hair .