Ear canal infection (otitis externa) is an inflammation or infection of the outer ear canal - the passage leading from the external ear to the eardrum.

In Australia, and the rest of the world, it is a fairly common condition. And since it’s often associated with excess water in the ear canal, and frequently occurs in children and young adults who swim a great deal, the pet name for this inflammation is "swimmer's ear".

Causes


It is mostly caused by excessive exposure to water from swimming or even routine showering, and some cases indicate that the skin of the outer ear may have been predisposed to infection by various chemicals such as shampoos, hair sprays and hair dyes.

When water pools in the ear canal and gets trapped by wax, the skin becomes soggy and creates a suitable condition for bacteria to develop. The moisture can cause the skin inside the ear canal to flake and a break in the skin, which may result from scratching the persistent itch of the flaking skin, can allow bacteria or, more rarely, fungi to invade the tissue of the ear canal and cause an infection. Common causes may include:

    • Chronic skin conditions

    • Swimming in polluted water

    • Hot and humid weather

    • Excessive and harsh cleaning of ears

    • Placing foreign objects in the ear

    • Irritation from hearing aids and ear buds

    • Insects trapped in the ear



What are the symptoms?


Swimmer's ear symptoms have been reported to be mild at first, but they usually become worse if your infection isn't treated. It is classified by doctors according to mild, moderate and advanced stages of progression.

Mild symptoms include:

    • Itching and slight discomfort

    • Slight redness inside the ear

    • Swelling of the ear canal

    • A discharge of clear, odorless fluid



Moderate symptoms include:

    • Feeling of fullness inside the ear

    • Increased pain pulling the lobe or pressing down on the little bump on the ear

    • A foul-smelling, yellowish discharge

    • Temporarily muffled hearing



Advanced symptoms include:

    • Swelling of the side of the face

    • Enlarged neck glands

    • Fever



When to see a doctor


Consult your doctor if:

    • The pain worsens or does not improve within 24 hours. In rare cases, the infection can spread and damage underlying bones and cartilage.

    • You are experiencing dizziness or ringing in the ears. Such symptoms may indicate a more serious problem.

    • You also notice a rash on your scalp or near your ear.



Treatment


Your doctor will probably clean your ear with a cotton-tipped probe or suction device to relieve irritation and pain. The most common treatment consists of antibiotic eardrops with or without an oral antibiotic.

You may be given prescription eardrops to relieve the itching, and an antibiotic to fight the infection. In some situations, a "wick" will need to be placed in the ear canal. This is impregnated with a cream or ointment containing cortisone and an antibiotic and is left in place for 48 hours.

Periodic suctioning of the ear canal helps to keep it open, remove debris, and decrease bacterial counts.

If the pain is severe, your doctor may suggest aspirin, paracetamol or some other over-the-counter pain medication. If the infection does not improve within three or four days, your doctor may prescribe an oral antibiotic.

Prevention


Swimmer’s ear is usually preventable with the following measures:

    • Keep your ears dry. If you are prone to infections, use earplugs or a bathing cap when showering or swimming. Afterwards, tilt and shake your head to drain water from your ears. Gently dry your ears with the corner of a tissue or towel.

    • Put a few drops of rubbing alcohol or alcohol mixed with an equal amount of white vinegar into the ear after swimming or showering. This solution will increase the rate of evaporation of water in the ear canal and has antibacterial properties.

    • To create a protective coating for your ear canal before you go swimming, squirt a drop of mineral oil, baby oil or lanolin into your ear. This is a good method when a dry, crusty skin condition exists.

    • Avoid swimming in dirty water.

    • If you wear a hearing aid, take it out as often as possible to give your ear a chance to dry out.

    • Do not dig into the ear canal with a pointed object. Do not scratch in your ears, or insert foreign objects, even ear buds.

    • Keep soap and shampoo out of the ear canal, as these products can cause irritation and itching.

    • Try to keep the ear free of excess wax. This may require maintenance visits to a doctor to have your ears cleaned, or, if your ear will tolerate it, the use of an over-the-counter wax remover.

    • If you already have an ear infection, if you have a hole in your eardrum, or if you have ever had ear surgery or ear tubes inserted, first consult your doctor before swimming or using any type of eardrops.



Although swimmer’s sometimes clears up on its own, it is advisable to always call your doctor if you experience even mild symptoms. And you should definitely see your doctor or visit an emergency room if you experience fever or pain.