Otitis Externa - "Swimmer's Ear"

WARNING: If you already have an ear infection, or if you have ever had a perforated or otherwise injured eardrum, or ear surgery, you should consult an ear, nose and throat specialist before you go swimming and before you use any type of ear drops. If you do not know if you have or ever had a perforated, punctured, ruptured or otherwise injured eardrum, ask your ear doctor.

Causes of Swimmer’s Ear

When water gets into the ear, it may bring in bacterial or fungal particles. Usually the water runs back out; the ear dries out; and the bacteria and fungi do not cause any problems. But sometimes water remains trapped in the ear canal and the skin gets soggy. Then bacteria and fungi grow, flourish and can infect the outer ear.

Symptoms of Swimmer’s Ear

The ear feels blocked and may itch. The ear canal becomes swollen, sometimes swelling shut. The ear starts draining a runny milky liquid. The ear becomes very painful and very tender to touch, especially on the cartilage in front of the ear canal.

If you experience these symptoms or if glands in the neck become swollen, see your doctor.

Prevention of Swimmer’s Ear

If your ear feels moist or blocked after swimming, hair washing, or showering, tilt your head sideways and with that ear up pull the ear upwards and backward to put in eardrops to dry out the ear. Wiggle your ear to get the drops to go all the way down in the ear canal, and then turn your head to let them drain out. These eardrops are sold without prescription; check with your pharmacist.

If your doctor says it is safe, make up your own ear drops to use after swimming. Many doctors recommend rubbing alcohol as part of the mixture. As the alcohol evaporates, it absorbs the water, helps dry out the ear, and may even kill the bacteria and fungi that cause swimmer’s ear. Another effective ingredient is boric acid powder (2 tsp/pint)l or white vinegar (mixed 50/50 with alcohol). A weak acid environment discourages the growth of bacteria and fungi.

A dry ear is least likely to get infected. Efforts to remove water from your ear should be limited to the drying effects of alcohol or, if you have a perforated eardrum, a hair dryer. You should not use cotton swabs (Q-tips) because they pack material deeper in the narrow ear canal, irritate the thin skin of the ear canal, and make it "weep" or bleed.

If yours is a frequently recurring problem, your otolaryngologist (ear, nose and throat doctor) may recommend placing oily (or lanolin) ear drops in your ears before swimming to protect them from the effects of the water.

People with itchy, flaky ears or ears that have wax build up are very likely to develop swimmer’s ear. They should be especially conscientious about using the alcohol ear drops as described whenever water gets trapped in the ears. It may also help to have ears cleaned out each year before the swimming season starts.

Why Do Ears Itch with Swimmer’s Ear?

An itchy ear is a maddening symptom. Sometimes it is caused by a fungus or allergy, but more often it is a chronic dermatitis (skin inflammation) of the ear canal. One type is seborrhea dermatitis, a condition similar to dandruff of the scalp; the wax is dry, flaky, and abundant. Some patients with this problem will do well to decrease their intake of foods that aggravate it, such as greasy foods, carbohydrates (sugar and starches), and chocolate. Doctors often prescribe a cortisone eardrop at bedtime when the ears itch. There is no long-term cure, but it can be kept controlled. Frequently patients continue to scratch the ear canals with q tips, bobbi pins, or fingernails, all of which cause more or recurrent itchiness. Topical steroid medication drops can be helpful for treatment of neurodermatitis.

What About Gnats or Other Insects?

Many types of insects get into the ears. Gnats get tangled in the wax and cannot fly out. Bigger insects cannot turn around; neither can they crawl back out. They keep struggling though, and their motion can be painful and frightening.

Wash out gnats with warm water from a rubber bulb syringe. (Remember to dry the ear out afterwards with alcohol drops.) For a bigger insect, the first step is to fill the ear with mineral oil, which plugs off the breathing pores of the insect and kills it. It takes 5 to 10 minutes or so. Then see the doctor to have the insect removed; don’t try to do it yourself.

What About Foreign Objects?

Beads, pencil lead, erasers, bits of plastic toys and dried beans are common objects that children put into their ear. Removal is a delicate task that must be performed by a doctor.