Otitis externa is fairly common, especially among teenagers and young adults. Swimming in polluted water is one way to contract swimmer's ear, but it is also possible to contract swimmer's ear by swimming in a pool that is well maintained or even from water trapped in the ear canal after a shower, especially in a humid climate. Water trapped in the ear canal is not the only cause, however -- the condition can be caused by scratching the ear or an object stuck in it. Trying to clean wax from the ear canal, especially with cotton swabs or small objects, can irritate or damage the skin. It is occasionally associated with middle ear infection (otitis media) or upper respiratory infections such as colds. Middle ear infections can occur after the ear drum is perforated by a fungal growth from the outer ear. Moisture in the ear predisposes the ear to infection from fungus or water-loving bacteria such as Pseudomonas.

Symptoms

Ear pain -- may worsen when pulling the outer ear
Itching of the ear or ear canal
Drainage from the ear -- yellow, yellow-green, pus-like, or foul smelling
Decreased hearing or hearing loss

Signs and tests

When the physician looks in the ear, it appears red and swollen, including the ear canal. The ear canal may appear eczema-like, with scaly shedding of skin. Touching or moving the outer ear increases the pain. It may be difficult for the physician to see the eardrum with an otoscope. Taking some of the ear's drainage and doing a culture on it may identify bacteria or fungus.

Treatment

The goal of treatment is to cure the infection. The ear canal should be cleaned of drainage to allow topical medications to work effectively. Depending on how severe the infection is, it may be necessary for a doctor to aspirate the ear as many times as twice a week for the first two or three weeks of treatment.

Effective medications include eardrops containing antibiotics to fight infection, and corticosteroids to reduce itching and inflammation. Use of antibiotics to treat ear infections may result in treatment of the wrong cause of the infection because not all ear infections are bacterial; some are fungal, and it is possible to have both a bacterial and fungal ear infection.

Ear drops should be used abundantly (four or five drops at a time) in order to penetrate the end of the ear canal. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. Occasionally, pills may be used in addition to the topical medications. Analgesics may be used if pain is severe. Putting something warm against the ears may reduce pain.

Read more at Wikipedia.org

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Treating Swimmer's Ear
From Pediatrics for Parents, 1/1/99 by Harry Pellman

Otitis externa, commonly called "swimmer's ear," is an infection of the ear canal. It's not related to the more common otitis media (usually referred to as an "ear infection"). The causes of otitis externa, along with the treatment, are very different.

To become infected, the ear canal must have a scratch or other defect in the skin, and be exposed to bacteria that can cause otitis externa. When a child has swimmer's ear he has pain in the ear, decreased hearing, ear itching, foul smelling ear discharge, and swelling of the ear canal. Sometimes the swelling is so severe that the canal is totally closed.

The treatment is steroid drops to lessen the swelling and appropriate antibiotic drops. Rarely are oral antibiotics required. There are combination antibiotic-steroid drops available to treat this problem. Now there's a new combination product available to treat otitis externa.

Ciprofloxacin is an antibiotic used to treat many infections. It's been combined with the steroid hydrocortisone, resulting in a safe and highly effective drop used to treat otitis externa. This new combination (sold as Cipro HC Otic) was compared to the standard treatment, polymyxin B-neomycin-hydrocortisone drops. There were 1,286 patients in the study; half treated with Cipro, the other half with polymyxin.

The ciprofloxacin combination was much more effective in eradicating the bacteria than the polymyxin product. If not treated properly, otitis externa may, in rare circumstances, develop into chronic inflammation or infection of other parts of the body.

The Medical Herald, 8/98, p. 28.

Harry Pellman, M.D.

Dr. Pellman's column appears monthly in Pediatrics for Parents. He's a Board Certified Pediatrician practicing in Huntington Beach, California, a Clinical Professor of Pediatrics at the University of California, and a Medical Associate of the La Leche League International. He welcomes your comments.

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