Swimmers Ear- Causes, Symptoms, Prevention and Management

Introduction:

Swimming, sea diving, and various aqua-marine activities are liked by many people, mostly in the summer seasons. People participating actively in these water activities sometimes tend to spend longer time underwater, which is why water enters the outer ear canal, further passing to the eardrum. This long-standing water in the outer ear canal creates a moist habitat for the bacteria to grow, resulting in acute diffuse otitis externa or swimmer’s ear.

The swimmer’s ear is seen in both adults and children. It is frequently seen in people indulging in aqua activities for a longer duration. Swimmer’s Ear is non-contagious. Therefore, it does not spread from one person to another.

What Type of Infection Is Swimmer’s Ear?

Swimmer’s ear is a common bacterial infection caused by Pseudomonas aeruginosa due to long-term exposure to water. Pseudomonas aeruginosa is the most common pathogen responsible for water-borne infections. Streptococcus aureus microbes are also sometimes responsible for ear infections.

What Causes Swimmer’s Ear?

Causes of swimmer’s ear include:

• A warm and moist environment.

• Use of cotton-tipped applicator, cotton swabs, or other external objects to clean the ear.

• Ear canal injury.

• Swimming in contaminated water.

• Swimming in water with a high pH (potential of hydrogen) value.

• Having skin diseases like dermatitis (skin inflammation) or eczema (itchy, dry, and bumpy skin).

• Excessive use of earphones and hearing aids.

What Are the Risk Factors of Swimmer’s Ear?

• Contaminated water can increase the risk of exposure to high bacteria levels.

• Tiny breaks in the skin can also occur due to ear devices, such as hearing aids or earbuds.

• Due to prolonged humid weather, heavy perspiration and water remaining in the person’s ear can lead to excess moisture in the ear canals.

• Abrasion or scratches can also occur due to the use of cotton swabs, fingernails, or hairpins used for cleaning.

What Are the Symptoms of a Swimmer’s Ear?

• Ear pain aggravates on pressing the tragus.

• Perforation of the eardrum.

• Watery or blood-stained discharge from the ear.

• Ear swelling.

• Itching inside the ear.

• Conductive hearing loss in severe cases.

• Redness.

• A feeling of Pressure imbalance in the ear.

• Fever.

• Head heaviness.

• Ear blockage.

Can Swimmer’s Ear Be Prevented?

Swimmer’s ears can be prevented by taking precautionary measures like :

• Try to keep the ear canal clean and dry.

• Avoid continuous usage of earphones or ear aids as heat generated from these devices makes the canal warm and damages the cerumen (protective ear wax layer).

• Avoid scratching and cleaning of ears with external objects like cotton-tipped applicators, pencils, and paper clips, as they are not sterile and tend to cause damage and infection to the eardrums.

• Get the swimming pool water pH levels checked, and clean the pools regularly.

• Avoid staying in water with the head immersed for a longer duration.

• Try removing excess water accumulated in the ears after swimming or bathing by tilting the head alternately on each side.

• Consult the doctor if one is experiencing earache and discharge continuously for more than six days.

How Can Swimmer’s Ear Be Diagnosed?

• A proper history and clinical examination by the otolaryngologist help in the diagnosis of otitis externa.

• Oto-microscopic examination of the ear canal, eardrum, and tympanic membrane is done by the doctor to check the extent of infection.

• A hearing examination is done if the tympanic membrane is not visible to check whether the infection has involved the inner ear canal or not. In cases of swollen ear canals, a tuning fork test and audiogram can be performed to rule out conductive hearing loss.

What Are the Investigations Done for Swimmer’s Ear?

Swimmer’s ear infection with continuous fluid drainage from the ears needs immediate investigation. A sample of the discharge coming out from the ear is taken using a swab or cotton-tipped applicator and is sent to the laboratory for further investigations to know the type of ear infection.

What Are the Types of Otitis Externa?

Otitis externa are of two types:

• Acute Otitis Externa- Also called a swimmer's ear. A mild ear infection is treated within three to four days by symptomatic treatment. Repetitive acute otitis externa episodes may turn into a chronic form, so regular follow-up with a doctor is needed in such cases.

• Chronic Otitis Externa - Otitis externa occurring three to four times a year and lasting for more than three months is a chronic form of otitis externa. It can turn into malignant otitis externa, which is a destructive form of otitis externa that mainly affects people who are systemically compromised, causing involvement of the bone of the skull base if left untreated.

When Should a Person Consult a Doctor?

The doctor should be consulted:

• If one has severe pain in the ear.

• If one experiences a rash on the scalp or near the ear.

What Is the Management and Treatment of Swimmer’s Ear?

1. Management of Swimmer's Ear

• Atraumatic Cleaning of Ear Canals: Atraumatic cleaning of external ear canals is done with the help of sterile gauze in cases of mild swimmer’s ear infection. If the condition does not get clinically resolved in 72 hours and a noticeable yellowish-green discharge is seen dripping from the ears, then consult the doctor.

2. Treatment of Swimmer’s Ear

• Systemic Antibiotics Therapy: Systemic antibiotics against the causative microbe (Pseudomonas aeruginosa) are used for the management of otitis externa after an antibiotic culture sensitivity test.

• Topical Antibiotic Therapy- Topical antiseptics (ear drops) and antimicrobials are the first line of treatment in cases of acute otitis externa. In cases where the eardrum is found perforated when examined under an otoscope, topical antiseptics that are not toxic to ears are only prescribed.

• Analgesics: Over-the-counter pain medications like non-steroidal anti-inflammatory drugs (NSAIDs) can be taken to get relief from ear pain. If the pain does not subside, avoid frequent self-medication and make an appointment with the doctor.

• Oral Antibiotics: For people with compromised immune systems and uncontrolled blood sugar levels, or if the infection has spread from the external ear canal to the eardrums reaching the internal ears, oral antibiotics are the drug of choice for otitis externa. Antibiotics in such cases should be prescribed after an antibiotic culture sensitivity test.

• Reduce Frequent Swimming: If repetitive earaches and discharge are seen after swimming or other water activities, try to avoid frequent swimming. Switch to floating above water swimming pattern rather than underwater swimming.

What Are the Complications Associated With Swimmer’s Ear?

• Chronic Otitis Externa: It is the long-term swimmer's ear that occurs if the condition does not go away within three months. This mainly arises due to some complex and difficult-to-treat fungi, bacteria, or other skin conditions, such as eczema or psoriasis (scaly, itch, and dry skin patches).

• Infections: This usually occurs when bacteria spread to other body parts, such as malignant otitis media, a condition affecting cartilage and bones in the head. Malignant otitis media is a medical complication and mainly affects people suffering from HIV (human immunodeficiency virus), diabetes (high blood sugar levels), or other problems related to the immune system.

Conclusion:

Swimmer’s ear is an annoying and painful external ear infection that disturbs daily activities. In cases of mild swimmer’s ear infection, symptomatic treatment is enough to get rid of the problem within a few days. Ear infections can be severe if left undiagnosed and untreated. So, any abnormal changes felt in the ear, like earache, ear blockage, abnormal ear pressure, and continuous pus drainage from the ears for many days, repetitive ear infection should be noticed, and an early appointment with an otolaryngologist is preferred for immediate management.