Joseph R. Anticaglia MD
Medical Advisory Board
Acute External Otitis (AEO), known as Swimmer’s Ear, is a diffuse infection of the ear canal usually due to bacteria, which at times causes horrific pain. It can spread beyond the ear to the jaw and neck glands making it difficult and painful to open your mouth, chew and swallow.
It can have a rapid onset, generally within 48 hours, with the external ear canal swollen, the ear canal completely closed and both extremely tender to touch. Also the ear might drain pus-like fluid and be accompanied by hearing loss.
It’s often seen in children and teenagers who swim but you don’t have to go swimming to get AEO. If water gets trapped in the ear, fungal and bacterial organisms, which are normally found in the ear canal, multiply to cause the infection.
Clinicians have classified AEO into various categories. External Otitis can be acute or chronic, localized or diffused. This article emphasizes Swimmer’s Ear. (1)
INFLAMMATORY EXTERNAL OTITIS
- Acute Localized External Otitis
- Acute Diffused External Otitis (Swimmer’s Ear)
- Chronic Diffuse External Otitis
- Malignant External Otitis
WHAT CAUSES SWIMMER’S EAR?
People with excessive ear wax, chronic skin conditions such as Eczema (dry, itchy, flaky skin) or Seborrheic Dermatitis, (dandruff) are more likely to get AEO.
When water- moisture accumulates in the ear canal, the soggy ear canal serves as a petri dish for the growth of bacteria and fungus. Exposure to water sports, showering or the accumulation of sweat in the ear canal on those hot, hazy, humid summer days, makes one susceptible to AEO.
Chemicals from hairsprays can trigger an inflammation of the ear canal. Hearing aid molds, stress, allergies have been linked to AEO. Any abrasion or cut in the ear canal can lead to AEO. Scratching the ear with a bobby pin’, or excessive use of cotton swabs prime the ear for infection of the ear canal.
WHAT ARE THE SYMPTOMS?
- Itchy ear canal
- Sensation of fullness in the ear
- Drainage from the ear
- Ear pain
- Extreme tenderness to touch
- Loss of hearing
- Infection spread beyond the ear to the jaw and neck glands
- Fever
The symptoms may be mild, severe or chronic. Initially the ear may feel full or itchy and there is a tendency to use a cotton swab to relieve the itchiness. A watery discharge may follow and rather rapidly the symptoms become painful when the ear canal swells and the infection spreads beyond the ear.
The chronic form is associated with recurrent inflammation of the skin of the ear canal. The symptoms are milder in this type but those with a suppressed immune system or in elderly, dehydrated diabetic patients AEO can become a serious problem.
In elderly diabetics, the otitis is misnamed Malignant External Otitis. This is an aggressive form of the infection with serious, potential complications. It is not cancerous.
WHAT YOU CAN DO
- Keep the ear dry
- Be nice. Don’t irritate the ear canal. Avoid scratching the ear canal and avoid inappropriate use of cotton swabs. Don’t use cotton swabs to remove ear wax.
- Keep the hearing aids out of the ear canal as much as possible especially during summer months.
- Protect the ear from certain chemicals (hair sprays, hair dyes). Use cotton balls in the ear canal or use an ear shield.
- Use ear plugs when swimming and try covering it with a bathing cap to prevent them from slipping out.
- After showering or swimming use a hair dryer to dry the ears.
- For chronic external otitis or ear wax visit your doctor periodically.
WHAT DOCTORS CAN DO
- Evaluate and relieve AEO patients of their pain. Prescribe pain medication.
- Clean the ear canal of debris.
- Prescribe ear crops for initial treatment.
- When needed, place a “wick” into the ear canal to facilitate the introduction of medicine.
- Prescribe oral antibiotics for infections that extend outside the ear canal.
- Obtain a culture and sensitivity from the draining ear when necessary.
- Follow up evaluation
SUMMARY
Patients can do a lot to minimize AEO. There are many causes of ear infections, ear pain and ear drainage. The clinician should differentiate them from Swimmer’s Ear. In the mild form of AEO, ear drops are usually sufficient. In the severe form pain medication, oral antibiotics and ear drops are needed to manage the problem.
(1) David Austin, MD, Diseases of the Ear
Frank E. Lucente, Diffuse External Otitis, W.B. Saunders
Richard M. Rosenfeld, MD, OTO-HNS, Sage journals, Nov.26, 2013