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Otitis externa (swimmer's ear)

Understanding otitis externa (swimmer's ear)

Discover comprehensive insights into otitis externa, also known as swimmer's ear, a prevalent ear canal infection caused by water exposure. This guide explores the nuances of swimmer's ear, covering its causes, symptoms, prevention strategies, and effective treatment options. 

What is otitis externa or swimmer's ear?

Otitis externa, commonly referred to as swimmer's ear, is an inflammatory condition that specifically affects the outer ear canal. This condition often occurs due to exposure to water, which can lead to irritation and infection of the ear canal lining. Swimmer's ear typically develops when water becomes trapped in the ear after swimming or bathing, creating an environment where bacteria or fungi can thrive. 

Why water exposure triggers swimmer's ear

Water exposure is a common trigger for swimmer's ear due to the unique environment it creates within the ear canal. When water enters the ear during swimming or bathing, it can get trapped in the ear canal, leading to prolonged moisture. This moisture softens the protective layer of earwax and the skin lining the ear canal, making it more susceptible to irritation and infection by bacteria or fungi present in the water. Additionally, water can wash away the natural oils that normally protect the ear canal, disrupting its natural defense mechanisms against pathogens. The warm and moist environment created by water exposure provides an ideal breeding ground for microbial growth, increasing the risk of developing swimmer's ear. Understanding the role of water exposure in triggering swimmer's ear highlights the importance of drying the ears thoroughly after water activities and taking preventive measures to minimise the risk of infection.

Other causes of otitis externa

While water exposure is a common trigger for otitis externa, several other factors can contribute to the development of this outer ear canal infection:

  • Excessive moisture: apart from swimming or bathing, prolonged exposure to humid environments or excessive sweating can create a moist setting within the ear canal, which promotes bacterial or fungal growth.
  • Skin irritation: scratching the ear canal with fingernails or using cotton swabs can irritate the delicate skin lining, compromising its protective barrier and increasing the risk of infection.
  • Allergies: allergic reactions to hair products, earrings, or other substances that come in contact with the ear can cause inflammation and irritation, making the ear canal more susceptible to infection.
  • Injuries or trauma: minor injuries from using earbuds, inserting foreign objects into the ear, or even aggressive cleaning can damage the ear canal lining, creating openings for bacteria or fungi to invade.
  • Skin conditions: pre-existing skin conditions like eczema, psoriasis, or dermatitis affecting the ear canal can weaken the skin's defenses and contribute to the development of otitis externa.
  • Foreign objects: objects lodged in the ear canal, such as earplugs or debris, can cause irritation, blockage, and trap moisture, creating an ideal environment for infection to occur.
  • Anatomical factors: some individuals have naturally narrow or constricted ear canals, which may lead to poor ventilation and difficulty in clearing moisture, increasing the likelihood of otitis externa.

Recognising the symptoms of otitis externa

Some common symptoms of otitis externa, also known as swimmer's ear, include:

  • Ear pain: ear pain is a prominent symptom of swimmer's ear and can range from mild discomfort to severe, sharp pain. The intensity of the pain often correlates with the severity of the infection and may worsen when touching or pulling on the ear.
  • Itchy feeling in the ear canal: persistent itching inside the ear canal is a common early symptom of otitis externa. The urge to scratch the ear may worsen as the infection progresses.
  • Temporary hearing loss: otitis externa can lead to temporary hearing loss or a sensation of muffled hearing. This occurs due to inflammation and fluid accumulation in the ear canal, which affects sound conduction.
  • Ear discharge: an infected ear may produce abnormal discharge, which can be clear, white, or yellow in color. The discharge is often accompanied by a foul smell and indicates an active infection.
  • Redness and swelling: the skin of the outer ear and ear canal may appear red, swollen, or inflamed. This inflammation is a response to the infection and may cause discomfort and tenderness.
  • Tenderness when moving the ear or jaw: touching or manipulating the affected ear can be painful and tender. There may also be pain or discomfort when moving the jaw, especially in severe cases.
  • Swollen and/or sore throat gands: in some cases, swollen lymph nodes (glands) in the neck or around the ear may accompany otitis externa, indicating a localised immune response to the infection.

Otitis externa treatments

Otitis externa can usually be remedied with a simple course of ear drops, as prescribed by your local GP. If your symptoms linger or your case has been particularly severe, you may be referred to a specialist who may undertake micro-suction or dry swabs to remove ear wax and other debris to make your drops more effective. Severe cases may require an earwig, a plug made from soft cotton gauze that helps insert medication into your ear.

While you take your medication, it is important to take certain steps at home to help aid your recovery. Avoid getting your ear wet by wearing a shower cap when you bathe and gently remove any discharge by gently swabbing around your ear rather than in it. Removing any hearing aids, ear plugs and earrings will also help prevent the spread of bacteria.

If you are experiencing symptoms of otitis externa, it is important to make an appointment with your local doctor.

Otitis externa versus middle ear infections

Otitis externa (swimmer's ear) and otitis media (middle ear infection) are two distinct ear conditions with different causes and locations.

Otitis externa (swimmer's ear) primarily affects the outer ear canal and is often triggered by water exposure, leading to symptoms like ear pain, itching, redness, discharge, and temporary hearing loss. Treatment involves ear drops to clear the infection. 

In contrast, otitis media is an infection of the middle ear located behind the eardrum, typically caused by respiratory infections. Symptoms of otitis media include ear pain, fever, fluid drainage from the ear, hearing loss, and a feeling of fullness in the ear. Treatment for otitis media may include antibiotics and pain relievers. Recognising these differences based on location, cause, and symptoms is important for accurate diagnosis and appropriate treatment.

Preventing recurrent swimmer's ear

To prevent recurrent swimmer's ear, it's important to keep the ears dry after swimming or bathing by gently drying them with a towel or using a hairdryer on a low setting. Consider wearing swimmer's earplugs or a swim cap during water activities to prevent water from entering the ear canal. Avoid inserting objects into the ears and minimize exposure to chemical irritants. After showering, gently dry the ear canal with a soft towel or tissue. If recurrent swimmer's ear persists, consult an ear specialist for personalised preventive advice. Taking these preventive steps can help reduce the risk of recurring infections and promote ear health.

Potential complications of swimmer's ear

Swimmer's ear (otitis externa) can lead to potential complications if not properly treated. These include the spread of infection to nearby tissues such as the skull bones (mastoiditis) or facial soft tissues (cellulitis), which can pose serious health risks. Chronic swimmer's ear may result in recurrent infections and discomfort. Severe cases can cause temporary or permanent hearing loss due to inflammation and fluid buildup in the ear canal. In rare instances, cartilage damage (auricular chondritis) or nerve damage affecting facial muscles or balance can occur. To prevent complications, it's crucial to recognise symptoms early and seek prompt medical care for appropriate treatment with ear drops and other interventions. 

When to seek medical attention

Knowing when to seek medical attention for swimmer's ear is important:

  • Persistent symptoms: if ear pain, itching, or discharge continues despite home care.
  • Severe symptoms: seek immediate help for severe pain, fever, or worsening condition.
  • Difficulty hearing: sudden or significant hearing loss should be evaluated promptly.
  • Recurrent infections: frequent or non-resolving cases require medical assessment.
  • Underlying health conditions: individuals with diabetes or weakened immune systems should see a doctor promptly.
  • Ear canal bockage: avoid attempting to remove blockages yourself; seek medical assistance.
  • Unresponsive to treatment: if symptoms don't improve with treatment or worsen, consult a healthcare provider promptly.

Seeking timely medical attention ensures proper diagnosis and treatment for swimmer's ear, preventing complications and promoting recovery.

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