Therapy areas

Swimmer's Ear - Inflammation of the ear canal, External otitis

Inflammation within the ear canal, often referred to as external otitis or swimmer's ear, is a widespread and global condition, affecting approximately 10% of the population. This issue is more prevalent in warm tropical regions and during the bathing season in colder climates. The condition is frequently triggered after bathing and inadvertently manipulating the ear.

Causes of Swimmer's Ear

Inflammation in the external auditory canal of the ear typically arises from an attack by skin bacteria and/or fungus. While the ear canal is naturally safeguarded by normal wax, its thin skin and narrow structure make it susceptible to damage, leading to inflammation.

A key factor is the increased production of wax due to frequent ear poking, which can also push the wax further into the ear, creating a wax plug. This wax serves as a protective and lubricating layer over the skin within the ear canal, fostering an acidic environment that combats bacterial growth. However, repeated bathing in saltwater or pool water, prolonged sauna exposure, and the use of various wax removers or flushing agents can disrupt this environment, leading to skin irritation.

Additionally, wearing earplugs inside the ear canal, using hearing protection, or wearing hearing aids heightens the risk of inflammation. In cases of acute otitis media (inflammation in the middle ear), the eardrum may rupture, leading to inflammation in the ear's skin.

Conditions such as eczema, contact allergies, psoriasis, and diseases that compromise the immune system, like diabetes, also elevate the likelihood of ear canal inflammation.

Symptoms & Diagnosis

Early symptoms often involve localized itching and irritation within the ear, followed by pain and a sensation of swelling.

In more severe cases, intense pain may radiate throughout the ear, resulting in discomfort during chewing, potential discharge, and even hearing loss. In advanced instances, the entire outer ear may become swollen and red.

To diagnose troublesome ear canal inflammation, it's advisable to consult healthcare professionals, especially for individuals with diabetes, weakened immune systems, or chronic skin conditions like psoriasis or eczema. Diagnosis typically involves visual examination of the ear canal using instruments such as an ear microscope or otoscope.

For mild cases, self-care may involve solutions like Aluminum acetotartrate (Alsol) or Burow's solution, along with olive oil as a lubricant.

Treatment of Swimmer's Ear

Treatment typically entails prescription ear drops containing cortisone, sometimes combined with antibacterial and antifungal agents. In cases of recurrent swelling, local treatment with a cotton tamponade soaked in alcohol may be required for a few days. However, this treatment significantly impairs hearing by obstructing the ear canal. Sometimes, a doctor may need to clean the ear canal to facilitate local treatment, which is done using methods like micro suction or ear suction. In rare instances, inflammation may lead to an abscess within the sebaceous glands of the skin, necessitating drainage with a needle or scalpel. In other exceptional cases, prolonged, chronic, or outer ear-affected inflammation may require antibiotics or antifungal tablets.

Preserving Ear Health

It's crucial to emphasize that the packaging of cotton swabs should always include a warning against using them inside the ear canal. Self-cleaning instruments for the ear are equally risky, as they can inadvertently damage the eardrum or other internal structures, potentially resulting in hearing loss.

Prognosis & Preventive Measures

Treatment is generally effective and leads to a complete cure, although relapses are not uncommon. Individuals with sensitive ear canals or underlying conditions like eczema may be more prone to recurrence. Preventive strategies include refraining from poking, scratching, or rubbing the ear canal and protecting it from water exposure using cotton wool or external silicone plugs. If occasional itchiness or dryness occurs, a few drops of olive oil can provide relief. After bathing, rinsing the ears with sterile, body-warm water can be beneficial. Over-the-counter solutions like Alsol or Burow's solution can be employed, with subsequent application of olive oil due to the drying effect of these solutions. Pre-filled dropper bottles or ear sprays with lubricating oil, available without a prescription, can also be helpful. Proper hygiene of earplugs, hearing protectors, or hearing aids is essential to prevent complications.

Keywords

Ear itching, ear pain, wax, cotton swabs, ear drops, swimmer's ear

Compiled by

Dr. Peter Åhnblad, Medical Doctor, Senior Physician and Specialist in Ear, Nose and Throat Diseases, Head-Neck Surgery, Danvik ÖNH (ENT), Nacka, Stockholm, Sweden

Version

2023-08-09

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