Statistics

Otitis externa affects one in 200 Americans every year and is present in chronic form in 3-5 percent of the population. Swimmers, surfers and other individuals who are exposed to wet and warm conditions are at an increased risk.

Mechanism

The external auditory canal is the tubular opening between the outside environment and the eardrum (tympanic membrane). It is covered by skin and secretes earwax (cerumen), which helps protect against infection.

Otitis externa, commonly referred to as swimmer’s ear, is the acute inflammation or infection of the external auditory canal, resulting in ear pain and pus discharge.

Breakdown of the external ear canal’s protective barrier leads to infection. Excessive moisture, mechanical trauma or underlying skin conditions are contributing factors. The bacteria normally found in the external ear canal often trigger the infection. With frequent immersion, water swells the cells lining the ear canal. Eventually, these cells separate far enough for the bacteria that are normally found on the surface of the ear canal to penetrate the skin, where they find a warm environment and start to multiply. Otitis externa is more likely to develop if the skin in the ear canal is already chafed and cracked by excessive moisture from showering or scratching. Bacteria or fungus from the water can easily invade damaged skin.

Seborrheic dermatitis, psoriasis and excessive cleaning of wax from the ears that injures the skin lining the external ear canal may increase susceptibility of the ear canal to infection. Excessive debris or cerumen may trap water in the canal.

Manifestation

The chief complaint is generally itching often accompanied by pain, tenderness and swelling of the ear canal. If left untreated, the swelling can increase to include nearby lymph nodes and produce enough pain that moving the jaw becomes uncomfortable.

Management

First Aid

• Avoid getting in the water until after the problem clears up.

• Use a hair dryer to carefully dry the ear after you shower (take care to ensure the air is not too hot).

• In case of pain, over-the-counter pain medications can be effective. Examples of such medications include acetaminophen (Tylenol), ibuprofen (Advil or Motrin) or naproxen (Aleve). Read and follow all instructions on the label.

Treatment
Stop swimming and diving; schedule an appointment with your physician. Do not put anything in your ear unless instructed to do so. If you have diabetes or take medicine that suppresses your immune system, swimmer’s ear can cause severe problems that require immediate medical attention.

It is important for your physician to rule out external ear squeeze, otitis media and mastoiditis (infection of the bone just behind the ear).

Fitness to Dive

Return to diving is possible once your physician determines that the infection
has resolved.

Prevention

Keep your ears clean and dry.

• Dry ears with a towel after swimming or showering by tilting your head and pulling your earlobe in different directions while your ear is facing down.

• Refrain from putting objects — such as cotton swabs or your finger — in the ear canal or removing ear wax yourself; both actions can damage the skin, potentially increasing the risk of infection.

• You can dry your ears with a blow dryer if you put it on the lowest setting and hold it at least a foot (about 0.3 meters) away from the ear.

• Talk to your doctor about whether you should use alcohol-based eardrops after swimming.

If you know you don’t have a punctured eardrum, you can use over-the-counter eardrops or homemade preventive eardrops before and after swimming. This mixture of one part white vinegar to one part rubbing alcohol may help promote drying and prevent the growth of bacteria and fungi that can cause swimmer’s ear. At the end of each day of diving, put five drops of the solution into each ear. Let it stay for five minutes before draining back out.