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Summer’s Ouch!

The Best Defense for Swimmer’s Ear

Adults and kids know the pain of a summer earache can keep you awake all night.

While middle ear infections (otitis media) are most common in the cold and fl u season, outer ear infections, or otitis externa, or swimmer’s ear, peak in the warm, humid months. Lazy days by the lake or pool, a dip in the river, or perspiration can fill the ear canal with moisture and promote bacterial or fungal growth. A small itch becomes a little scratch, and the infection invades the damp skin.In patients with diabetes or weak immune systems, this infection can even invade the cartilage and bone of the ear.

The best protection against swimmer’s ear is a clean ear. In fact, it is usually not the water alone that causes the infection.Typically, the ear canal fills first with wax, a normal secretion called cerumen, that keeps the ear canal lubricated and protected. When water enters the ear, the wax expands and fills the canal, blocking hearing or causing a plugged feeling. If the moist wax sits around long enough, the ear starts to itch. Eventually, you start digging or picking at it, creating little cracks in the water-logged skin, inviting infection.

So how do you safely keep your ears clean? Do not use cotton swabs, bobby pins, or paperclips. These are among the most common causes of holes in the eardrum.Ironically, the safest way to prevent swimmer’s ear is to flush the ears with water.You can use a small rubber bulb syringe, or simply aim the shower directly into the ear canal. The stream of water will flush out the wax. You may use a hair dryer or a few drops of rubbing alcohol to dry out the water afterwards, if necessary. Do this no more than once a week, as a little bit of wax is useful to protect the ear. If this does not work, it is best to see your physician and have your ears examined and safely cleaned Under magnified vision.

There are strategies for preventing swimmer’s ear. If you swim regularly, you may retain water in the ear canal for prolonged periods. Commercial drying drops are available over the counter. Common brands include Aqua Ear, Swim-Ear, and Auro-Dri.Most of these are 95 percent isopropyl Alcohol, often with a little bit of acidity added to balance the normal pH of the skin.Alcohol displaces the water, kills most fungi and bacteria, and then evaporates quickly at body temperature. You can make your own ear drops by combining equal amounts of isopropyl alcohol (rubbing alcohol) with white vinegar. Place four to six drops in each ear after swimming or bathing, massage the ear canal to mix the alcohol with the water, and then dump it out. Important note: Do not use alcohol or any over-the-counter ear drops if you have pain, if you have an active infection, or if you may have a perforated ear drum.

If treatment of swimmer’s ear is necessary, your physician may prescribe antibiotic ear drops for a painful infection. However, ear drops are useful only for outer ear infections.They do not cure middle ear infections, unless there is a tube or perforation through the eardrum. Alcohol, neomycin, polymixin B, and other commonly used swimmer’s ear Drops can damage hearing if placed through a perforated eardrum. Finally, the drops will not be effective unless the ear canal is clean. The first step is for the physician to completely clean the ear canal and examine the eardrum. If the ear canal is so swollen that the physician cannot see the drum, a small foam rubber wick can be placed to draw the medication into the canal. For these reasons, if there is pain present in the ear, you should always be examined by your doctor before starting treatment.

Of course, pain is the most important symptom for most patients. While many small children may be oblivious to middle ear fluid and even to bacterial middle ear infections, bacterial otitis externa just plain hurts.Usually the canal is so tender that just tugging on the lobe results in pain. Most prescription ear drops contain a steroid to reduce the inflammation and pain. Numbing drops intended for pain relief may not treat the infection. Tylenol or Advil is appropriate for most children and adults, although prescription pain relievers are sometimes needed.

Symptoms of swimmer’s ear include fullness, pain, swelling, drainage, tenderness, redness, and hearing loss. If you suspect swimmer’s ear, the best place to start is with your primary physician. Recurrent or severe infections may warrant referral to an ear, nose, and throat specialist, also known as an otolaryngologist/head and neck surgeon.

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