Swimmer's Ear

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What is it? Swimmers ear is an infection and swelling of the ear canal.

What the difference between a swimmers ear and a regular ear infection? Swimmers ear differs from a regular middle ear infection in that a middle ear infection is an infection of the space behind the eardrum. A middle ear infection has a fever, cold symptoms and does not hurt when you pull on it, where a swimmers ear hurts when you pull on it and generally does not have cold symptoms or fever.

 

Swimmers ear

Middle Ear Infection

Hurts to pull on ear

Yes

No

Fever

No

Yes

Cold Symptoms

No

Yes

Starts with water in ear

Yes

No

Ear canal narrowed or red

Yes

No

  How do you get it and prevent it? Swimmers ear starts by leaving water in the ear too long, not just getting water in the ear. When the water causes the ear canal skin to get “water logged” it cracks and allows bacteria or fungus, that’s normally in the ear, to invade the skin and cause an infection. The infection invades the surrounding tissue and causes swelling and pain. Prevention involves getting the water out before it causes the skin to get “water logged”. You can prevent water getting in the ear with ear plugs (wax or plastic, bought at any drug or grocery store) or by wearing a head band (large rubber band type device that covers the ears). Ear plugs occasionally leak, fall out, get lost, and some children don’t like them. Ear plugs will also hurt a lot when used in a ear already infected with swimmers ear. You can also use swimmers ear drops to get the water out. Swimmers ear drops can be made by mixing rubbing alcohol and white vinegar half and half. Squirt this mixture in the ear after swimming to get the water out. The vinegar kills yeast and fungus. The alcohol kills bacteria and gets the water out (lowers the surface tension to get it out and what’s left evaporates). You can place this mixture in a plastic squirt bottle for use around the pool. The store bought version of these drops are mainly rubbing alcohol and are not as effective as home made.

  How do you treat it? About half of doctors use the above-mentioned alcohol / vinegar mixture to treat swimmers ear. It will work on mild cases, but since the ear canal is infected and raw, the alcohol will hurt. Most doctors use a prescription mixture of Neosporin, Polymixin B and Hydrocortisone (Cortisporin brand). The Neomycin is an antibiotic, the Polymixin B is an antifungal and the Hydrocortisone is a steroid to reduce swelling. For both of these mixtures, place 3 to 4 drops in the affected ear 4 times a day until the infections resolves. Generally it takes 5 days for a cure depending on how severe the infection was. Most doctors want to see the ear in 5 to 7 days to make sure the infection has resolved. If the infection was mild to begin with, the doctor may tell you to do the following: after the 3rd to 4th day, start placing the alcohol / vinegar mixture in the ear daily, if the mixture hurts, then the infection has not resolved, keep treating it, if you get to 7 to 8 days without resolution or have worsened at any time, then call the doctor. Swimming and getting water in the ear before the swimmers ear has completely resolved will dramatically delay the healing process, but can be done. If your are going to swim, simply use the alcohol / vinegar mixture after swimming, let dry a few minutes then put the Cortisporin in. In 1998/9 a few newer medicines came out for swimmers ear. Floxin and Cipro Otic are much more expensive, but can be used if there is a ruptured ear drum, where the previous mixtures cannot. If these drugs are used, then detailed instructions for use will be given. IMPORTANT NOTE: When you place the drops in the ear, if the ear canal is blocked with wax or debris, then the drops won’t penetrate it and won’t work. Look in the ear with a flash light before each treatment. If you see a white plug or can’t see a dark hole, then you should see the doctor to flush out that plug. If we see the plug here in the office, we will flush it out and may instruct you to return in 1 to 2 days to make sure it hasn’t re-accumulated.

  What are the complications to watch for? Swimmers ear can invade the deeper tissue around the ear or even the bone behind the ear. A serious complication to watch for is called Mastoiditis. The mastoid bone is the bone immediately behind the ear. If you feel about 1/3rd of the way up the ear and immediately behind the ear, you will feel a protrusion or knot, this is the mastoid process. If this gets infected, the bone will be very tender and the ear may prop forward due to swelling. IF you see either of these, the condition worsens or a fever shows up, then call the doctor immediately.

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