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Pain After Pool-Time?

Swimmer’s Ear Update

Summer is here, so ’tis the season for sun, swimming, and unfortunately, swimmer’s ear. Otitis externa, more commonly referred to as swimmer’s ear, is an infection of the outer ear canal. This condition is more common with water exposure to the ear, and can develop in all age groups. Common symptoms include pain, mild to severe hearing loss, ear fullness, ear discharge, and tinnitus (noise or ringing in the ears). Symptoms typically occur in only one ear. Preceding events include activities in water such as swimming, surfing, kayaking, or trauma to the canal including overzealous ear cleaning or cotton swab usage.

Most commonly, swimmer’s ear is caused by bacteria. However, fungal organisms can cause an ear canal infection as well, with symptoms often becoming more itchy than painful. These infections thrive in the warm, moist environment of the ear canal, so keeping water out of  the ear is essential for resolution.

Drops for swimmer’s ear are over-the-counter and essentially made of alcohol that help in drying the ear only. A good home remedy is a one-to-one mixture of white vinegar and rubbing alcohol. The vinegar will help make the ear canal environment more acidic and make it more difficult for bacteria and fungi to survive, while the alcohol will dry the ear. It is important to be sure there is no hole in the eardrum with alcohol-containing drops, or significant pain will occur as these drops pass through the drum.

With the typical swimmer’s ear infection, antibiotic ear drops are the mainstay of treatment. The concentration of antibiotic in a drop is thousands of times higher than that in an oral antibiotic. Oral antibiotics are primarily reserved for extension of infection into surrounding tissues or failure of drops, and should be combined with drop therapy. It is also important to be aware if a hole is present in the eardrum, as some drops can be damaging to the inner ear. At times, the ear canal can be so swollen that drops cannot pass down it to effectively treat the canal. A physician may place an ear wick, which will temporarily help stent the canal so the drops can completely treat the affected ear.

At times, the pain of otitis externa can be severe and even require prescription pain medications. However, over the counter anti-inflammatory medications or Tylenol can typically treat the pain appropriately until antibiotic therapy can begin to take effect. Some ear-drop preparations contain steroids which will help resolve swelling and resulting pain more quickly.

Certain anatomic factors may promote the development of otitis externa. Ears with lots of cerumen (or wax) in them may aid in the trapping of water in the canal. Narrow ear canals may help trap water inside them as well. Some people have a condition of the ear canal that produces flaky skin, which also may accumulate and trap water in the canal. This condition may cause itchiness, prompting the usage of cotton swabs which further predisposes a person to develop swimmer’s ear.

There are preventative steps to take to help avoid the painful outer ear infection. Most ear, nose, and throat physicians recommend avoiding cotton swabs in the ear canals in all instances. Using ear plugs in the water may also be a good idea if kids are more prone to develop these types of infections. Many of these can be found at your local pharmacy and are moldable to fill the outermost canal. Others may be sold in certain sizes. If swimmer’s ear is recurring, custom ear plugs can be fit specifically for the ear canals.

Daniel Van Himbergen, MD, is an otolaryngologist at Virginia Ear, Nose and Throat and sees patients at the West End and Hanover locations. He lives in the West End with his wife and three children.
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