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 due to which 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.

What Is the Prevalence of Swimmer's Ear?

The swimmer’s ear is seen in both adults as well as children. It is frequently seen in people indulging in aqua activities for a longer duration.

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.

Can Swimmer’s Ear Spread?

Swimmer’s Ear is non-contagious.Therefore, it does not spread from one person to another.

What Causes Swimmer’s Ear?

• 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 value.

• Having skin diseases like dermatitis or eczema.

• Excessive use of earphones and hearing aids.

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 We Prevent Swimmer’s Ear?

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 make 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 do the cleaning of the pools regularly.

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

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

• Consult your doctor if you are experiencing earache and discharge continuously for more than six days.

How Can We Diagnose Otitis Externa?

• A proper history and clinical examination by the otolaryngologist helps 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 Otitis Externa?

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 lab for further investigations to know the type of ear infection.

What Are Types of Otitis Externa?

Otitis externa are of two types:

1. Acute Otitis Externa- Also called a swimmer's ear. It is a mild ear infection that gets treated within 3 to 4 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.

2. 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 affecting mostly people who are systemically compromised, causing involvement of the bone of the skull base if left untreated.

How Can We Manage Otitis Externa?

Flowchart Presenting 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.

What Are the Drugs Used in Treatment of Otitis Externa?

• Systemic Antibiotics Therapy: Systemic antibiotics against the causative microbe (Pseudomonas aeruginosa) is 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 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 the ear pain. If the pain does not subside, avoid frequent self-medication and make an appointment with your doctor.

• Oral Antibiotics: For people who have compromised immune systems and are having 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.

Conclusion:

Swimmer’s ear is an annoying and painful external ear infection disturbing 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.