The Doctor Is In: Swimmer’s Ear

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ST. LOUIS, MO. (KPLR) -- Summer time is time to have fun in the sun and that often means swimming.

If you've ever had swimmers ear, you know how painful it can be. Dr. Sonny, Intern, Emergency Physician and CEO of St. Louis Urgent Cares talked with Christine Buck about how to prevent swimmers ear.

You can also connect with Dr. Saggar, the Medical Director at St. Louis Urgent Cares, and ask him any questions you like.
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1. What is Swimmer's Ear?

One of the most common summer illnesses out there (and something we've been seeing a lot at St. Louis Urgent Cares over the past 2 to 3 weeks in my office) is acute otitis externa (AOE) which is also known as 'Swimmer`s Ear.'

Swimmer's ear (otitis externa) is an inflammation or infection of the ear canal (the outer ear), the passage that leads from the outer ear to the eardrum. The external, or visible, part of the ear chiefly, becomes red, swollen, itchy, and quite painful.

If you have diabetes or take medicine that suppresses your immune system, swimmer's ear can cause severe problems, which may even require hospitalization.

It`s called Swimmer's ear because it commonly occurs in people who have been swimming. But other people can get it too.

2. What are the symptoms?

Sometimes the pain becomes so intense that emergency room and urgent care clinics often capture a lot of the visits because parents aren't sure what to do. The pain is usually much more excruciating than the more common middle ear infection. 

Swimmer's ear is classically very painful. It`s typically quite tender to touch the earlobe or another part of the outer ear or when you chew. Other symptoms can include itching, a feeling of fullness in the ear, and sometimes a yellowish or brownish discharge from the ear. Your ear canal may be swollen. In severe cases, the outer ear can be red and swollen too.

If you have diabetes or take medicine that suppresses your immune system, swimmer's ear can cause severe problems, which may even require hospitalization.

3. What causes swimmer's ear?

You can get swimmer's ear when bacteria or fungus grows in your ear canal. This happens when water, sand, or other small debris irritates the delicate skin in the ear canal. The skin of the outer ear (including the ear canal) becomes macerated and traumatized from water exposure and any little trauma... scratching the ear with your finger or using a cotton-tip swab to remove the cerumen (will allow the bacteria to infect the area). This is often why many doctors and nurse practitioners will recommend against the use of Q-Tips for the removal of ear wax.

Other things that can irritate the ear canal include hearing aids, lots of ear cleaning, and eczema of the ear canal.

Swimmer's ear is more likely if you have a very narrow or hairy ear canal; live in a warm, humid climate; have little or no earwax; have lots of ear infections; or have eczema or dry skin. If you have had swimmer's ear in the past, you are more likely to get it again.

Bacteria are the typical culprits but factors that predispose a child or adult to swimmer`s ear includes swimming (or any prolonged water exposure for that matter) as well as heat and humidity.

4. How is swimmer's ear diagnosed?

A doctor or nurse practitioner can usually tell whether you have swimmer's ear by looking into your ear and asking questions about your symptoms. This is quite a common urgent care case, because it`s quick, a classic 'walk in symptom' which allows for rapid assessment and treatment, without having to make an appointment and then sitting in a waiting room for long.

5. How is it treated?

Follow these tips when treating swimmer's ear:

  • If your doctor prescribed ear drops, use them as directed.
  • Talk with your doctor before putting anything in your ear.
  • Avoid getting water in the ear until after the problem clears up.
  • Use a hair dryer to carefully dry the ear after you shower.
  • Take an over-the-counter pain medicine like Tylenol or Ibuprofen.
  • In severe cases, the ear canal should be carefully cleaned out by an ear specialist. Occasionally, if the ear canal is very swollen, we will place a wick with antibiotic drops will be placed in the ear canal.

Treatment measures are rather straight-forward as typically antibiotic ear drops (often including a corticosteroid) for at least about a week`s time are all that is needed.

The general rule of thumb is the drops should be continued for a few days after the symptoms resolve.

The catch during the treatment period is the child or adult needs to avoid submerging their head in water during the treatment period which is obviously not an easy sell when your 6-year-old fish of a child wants to be in the pool all day long.

I have noticed that it appears to be more distressing for a child to say they can`t go underwater swimming for the next week when compared to the actual pain from the infection!

6. How can you prevent swimmer's ear?

As far as preventing swimmer's ear, it's pretty straight forward. Keep the outer ear (again, including the ear canal) as dry as possible and try not to traumatize the ear (even a simple scratch from a fingernail).

And for more specific tips, per the Centers for Disease Control and Prevention (CDC):

  • After swimming or bathing (particularly with children with long hair covering their ears), it is important to dry the ears thoroughly with a towel.
  •  Tilt your head and hold ear facing down to allow water to run out of the ear canal.
  •  Pull your earlobe in different directions while ear is face-down to help water drain out.
  • OK to use a hairdryer on the lowest heat and lowest speed to move the air within the canal. But so important to keep the hairdryer a few inches from the ear when doing this.
  • Never put objects in the ears... including cotton-tip swabs, pencils, fingers, etc. Avoid prolonged use of earplugs and in-ear headphones. Like cotton swabs, these can cause irritation and itching and can plug the ear with wax.
  • Keep soap, bubble bath, and shampoo out of the ear canal. These products can cause itching and irritation.
  • Do not swim in dirty or polluted water.
  •  Leave the ear wax alone, it helps to protect the canal from infection,, but obviously if there's so much that you can`t hear anything - that`s when we can irrigate the canal. Such irrigation can occasionally cause a swimmer`s ear too!

Connect with Dr. Saggar, the Medical Director at St. Louis Urgent Cares at:
• Twitter: @DoctorIsInSTL
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