What is "swimmers ear"?

“Swimmer’s Ear” is a common reference to painful swelling of the outer ear canal. The medical term for “swimmer’s ear” is acute otitis externa (AOE). Chronic otitis externa (COE) is a term used for patients with persistent infection for several weeks. Acute OE is common in swimmers who sustain frequent water contamination of the ear canals. Any trauma to the skin of the canal or ear drum can lead to an infection. Some people like diabetics are prone to AOE or COE without trauma.

The causes of AOE and COE are usually bacterial, fungal, or both. Debris and wax impaction along with tissue swelling can lead to temporary hearing loss. Pain is usually significant. Other symptoms may include disequilibrium, drainage or bleeding, pressure, or ringing.

Treatment of AOE and COE is focused on three areas. First, careful non traumatic cleaning and removal of wax and debris is very important toward the resolution of infection. This should be done without scratching or irrigating the ear canal. Ear “candling” is dangerous and should be avoided. The best technique is meticulous canal suctioning or curetting under microscopic examination in the office.

The second part of treating canal infections is the use of medications. Antibiotic and antifungal ear drops are the mainstay of treatment. Several different antibiotic ear drops exist. The proper ear drop will kill the appropriate bacteria causing the infection. Fluoroquinolone drops (Ciprodex, Cipro Otic HC, Floxin Otic) are the best option for broad, aggressive, and safe treatment. Aminoglycosides (Gentamycin, Tobramycin, Tobradex, etc.) are very effective against many bacteria. They can, however, potentially cause hearing loss if they access the middle ear (through an eardrum perforation or a ventilating tube). Cortisporin and Neosporin Otic drops can be effective, but dosing is usually at least three times per day. Also, they tend not to be as effective against resistant bacteria as the other drops mentioned. A skin reaction (dermatitis) and pain are very common with the use of these particular drops. Fungal infections also need aggressive cleaning. Ear drops are limited to Lotrimin solution. Antifungal cream can be carefully applied to the outer canal. Several other ear drop choices exist. Acetic acid with a weak steroid (VoSol HC Otic) can be effective at drying the canal and killing bacteria and fungi. A simple one to one mixture of white vinegar and rubbing alcohol, 3-5 drops in the infected ear(s) will often help and can be used on a regular basis. In diabetics and very sick patients, an oral antibiotic can be added.

The third arm in the treatment of “swimmer’s ear” is avoiding trauma. Care should be used with exposure to water (bathing, swimming). If water contamination is likely, a water resistant earplug should be employed. The use of cotton swabs, fingers, keys, and other objects to clean the canal should be avoided. This “scratching the itch” can actually damage protective wax and oils made by canal skin and exacerbate the infection.

With detailed cleaning, appropriate ear drop treatment, and trauma avoidance, most patients with acute otitis externa are treatable. Hearing and pain will usually improve.