Summer’s going away, at least around these parts of the woods. Many of you may be going to the pool to enjoy what’s left of it. Read on to find out about otitis externa – an ear infection you can catch while swimming there.

Danger level: Medium

What is it?

Otitis externa is an inflammation of the outer part of the ear causing earache.

Who gets it?

In the US, otitis externa happens to 4 out of every 1000 people each year.

It’s most common in swimmers, divers, and others whose ears are exposed to water for a long period of time.

It can be seen in all ages, but is most common around 7-12 years.

What causes it?

Our ear has an inner and an outer part. The outer part is the one spanning from the ear you can see, inside until the eardrum. The inner part is the part which comes after the eardrum. When your outer ear gets inflamed, the condition is called otitis externa. When the inner part gets inflamed, it is called otitis media, which we will cover in a future article.

Our ear is built so that infections will not occur in it. To prevent infections from happening, it has a few things going for it:

1. Cerumen (earwax) – This is a substance which created an acid environment in our ear. This repels bacteria and prevents infection. It also repels water, and collects debris in the ear, moving it out of the ear.
2. The ear’s shape – Our ear canal has a downward direction. This helps us get rid of water accumulating in the ear.

In swimmer’s ear, bacteria overcome these defenses and cause an infection and inflammation in our ear. How can they do that?

1. Swimming a lot (or getting a lot of water in your ears for other reasons) thins out the earwax, making it less protective.
2. A breakage of the skin can happen – This can happen when using a cotton swab (Q-tip) to clean the ear. It is recommended that you don’t clean your ears using a cotton swab, as this can expose you to an infection. Believe it or not, our body gets rid of the excess earwax by itself, and you really don’t need to mess with it.

How does it feel?

Swimmer’s ear can cause pain. The pain may get worse by touching the earlobe or when chewing.

Other things which can be felt include itching, a feeling of fullness in the ear, a yellow discharge from the ear, redness in the ear canal or skin of the ear.

Otitis externa (swimmer’s ear). Photo by Dale Miller.

How is it discovered?

Usually, a physical exam in which the doctor will look at your ear canal with an otoscope to see that it’s red and swollen.

How is it treated?

Otitis externa is treated using eardrops which contain antibiotics (which fight the germs causing the infection) and sometimes also steroids (which lessen the inflammation in the ear).

What happens after treatment?

Most people improve within 48-72 hours of starting the antibiotics.

If not treated properly, two things can happen:

1. Chronic otitis externa – This is defined as an infection which lasts more than 4 weeks or happens more than 4 times a year.
2. Necrotizing otitis externa – This usually happens to diabetics and older people. In this case, the infection spreads to the bones around the ear, which can also damage nerves in the area and may lead to death.

The bottom line – How do I avoid it?

1. Keep your ears dry – Dry them after swimming or showering. You can do this by shaking your head to remove water from the ear canal, or using the corner of a towel.
2. Don’t use any foreign objects in your ear – And yes, this includes cotton swabs. Also fingernails may damage the ear canal, so don’t poke fingers inside to clean the ear.

This video, featuring Dr. John Hong of NBC, sums it all up:

What next?

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