Swimmer's ear

Swimmer's ear, also called otitis externa, is an inflammation or infection of the ear canal.


Causes/associated factors
Normally, water drains out of the ear canal. However, if the water becomes trapped, it can make the skin that lines the canal swollen and prone to infection. The pH balance (the degree of alkalinity or acidity) in the lining of the ear canal may also change, making it easier for fungus or bacteria (such as staphylococcus or Pseudomonas) to infect the ear.
You may be more prone to swimmer's ear if you swim often, especially in swimming pools. The chlorine can kill the normal bacteria in the ear, making it especially easy for harmful bacteria to take over. Other factors that may lead to swimmer's ear include:

showering often
wearing a hearing aid or poorly fitting ear plugs
injuring the ear by cleaning it with cotton-tipped swabs
chronic inflammation or infection related to hair spray or dye
dermatitis (inflammation of the upper layers of skin) of the inner ear canal or other skin conditions, such as eczema or seborrhea
being in hot, humid weather
swimming in polluted water

Signs/symptoms
Inflammation may cause the outer ear canal to itch. As the itching intensifies, your ear may feel plugged and swollen. It may also hurt, especially when you move your jaw or tug the lobe of the affected ear. The tragus (the triangular piece of cartilage in the front of the ear) may be tender. You may also notice watery drainage from the ear. The discharge may become thick, yellow or yellow-green, and foul smelling. If the ear canal is completely blocked, you may have some degree of hearing loss.

Diagnosis
The doctor will ask questions about your medical history and current symptoms and do a thorough ear exam. In some cases, a lab culture of the drainage from the ear canal may be helpful.

Treatment
The ear canal is often cleaned with a suction device or cotton-tipped probe. If the eardrum isn't damaged, the doctor may flush out the ear canal with warm, half-strength white vinegar or another solution. Once the ear canal is open, the doctor may prescribe a combination of antibiotic and corticosteroid ear drops. You may need an oral antibiotic if you have a bacterial infection or an antifungal medication if you have a fungal infection.
With proper treatment, symptoms often improve within one to three days. You may need a follow-up exam after seven to 10 days. Your doctor may recommend waiting to swim until the symptoms have completely disappeared.


Complications
If left untreated, external ear infections may become severe. They may also become severe if you have a weak immune system or diabetes. Structures adjacent to the ear canal -- such as the outer ear itself, cartilage, bones or even the central nervous system -- can also become infected.

Pregnancy-specific information
Pregnancy does not increase the risk for developing swimmer's ear.

Senior-specific information
Initially, otherwise healthy older adults have no increased risk of developing this ear condition. Older adults may develop more severe forms of swimmer's ear if a debilitating disease is also present, however.

Prevention
Here are some steps to help you prevent swimmer's ear.
Avoid earplugs unless they're recommended by your doctor. They may push water back into the ear canal and trap moisture.

Don't clean your ears with cotton-tipped applicators. They can push water or wax back into the ear canal and may injure the eardrum.

Avoid swimming in polluted water.

Drain water from your ears after swimming or bathing. Turn your head to the side and gently pull the lower earlobe in different directions to help the water run out. Repeat on the other side. Then, carefully dry your ears.

If your ears are prone to excessive wax buildup, have your doctor clean them once a year and just before the swimming season, if necessary.
If you're especially prone to swimmer's ear, ask your doctor if it would be appropriate to routinely flush your ear canal at home. The doctor may recommend using two to three drops of a homemade solution made of white vinegar and rubbing alcohol. This solution can help restore the normal pH balance in the ear canal and keep it dry. You can store the solution in a dropper bottle from any pharmacy. This procedure should only be done when the eardrum is intact, however. Never flush your ear canal if you have an infection or the eardrum is injured. Remember, the mixture is meant to prevent an infection -- not treat one.