Swimmer Ear:

Swimmer's Ear Treatment

By Dr. Ben Kim

Swimmer's ear, also known as otitis externa, is an infection of the outer ear canal. It's a condition that parents of children and teenagers need to understand because it is often confused with a middle ear infection, also known as otitis media.

The outer ear canal and the middle ear canal are divided by the ear drum, a thin but strong membrane that functions to transmit sounds from the air to tiny bones that exist in the middle ear that vibrate in a way that allows a person to differentiate the countless sounds of life.

How can you tell if your child has swimmer's ear or a middle ear infection? Here are some essential guidelines to help you differentiate these two conditions:

  1. Swimmer's ear tends to have an obvious cause, the most common of which are:

    • Swimming in a lake, ocean, or pool
    • Getting large amounts of water in the ears during a bath
    • Irritating the outer ear canal with scrapers, cotton swabs, and fingers

  2. With swimmer's ear, there are usually no accompanying symptoms like a fever, runny nose, or congested sinuses, some or all of which tend to accompany a middle ear infection.

  3. Pus or other colored fluids seeping out of the ear in the absence of cold-like symptoms are often a strong indication of swimmer's ear.

  4. Pain when pressure is applied anywhere along the outer ear is usually indicative of swimmer's ear. The classic tests are to put pressure on the small flap of cartilage that sits right in front of the ear canal and to pull back on the upper portion of the ear. If either of these tests produce pain and any of the criteria listed above hold true, swimmer's ear is likely.

  5. Itchiness in the ear that is distinctly in the outer ear canal is usually associated with swimmer's ear.

Swimmer's ear tends to occur after the ears have been exposed to large amounts of water, because when water is allowed to sit in the external ear canal it can irritate the skin that lines this canal. Once this irritated skin is invaded by bacteria or fungi, an infectious process begins its course.

If you know that your child has swimmer's ear, here are some steps that you can take to treat his or her infection:

  1. By far, the most important step is to keep your child's ear dry. Allowing water to fill the outer ear canal while it is infected can cause further irritation and prolong healing. Your child will be just fine without washing his or her hair for a few days while healing takes place. If water enters the ear canal by accident, do your best to drain the ear by holding a tissue up against the outer ear canal with your child's head tilted towards it to encourage maximum drainage and drying.

  2. If your child is very uncomfortable and/or you want to speed up the healing process, place a few drops of prescription antibiotic ear drops in the infected ear canal two to three times per day. Depending on the severity of the infection, you may need to use these drops only for a day or two. Most cases of swimmer's ear require no more than about a week of antibiotic ear drops. Do your best to have your child remain in a position that allows the drops to remain in the ear canal for 5 to 10 minutes. The drops can then be drained with a tissue as described in the previous step.

  3. An over-the-counter pain killer is not necessary in most cases because antibiotic ear drops will provide a mild anti-inflammatory effect in addition to their anti-microbial effect. If you decide that your child needs extra pain relief and you can afford to do so, consider using a homeopathic pain reliever like Hyland's teething tablets for babies.

  4. Encourage your child to get as much physical rest as possible. Being physically active can use up internal resources that could otherwise be used to facilitate healing of the infected ear.

  5. Encourage your child to eat plenty of fresh vegetables and some fruits. Foods that are naturally rich in vitamin C should be emphasized for their tissue healing-properties.

Some practitioners and pharmacists recommend over-the-counter ear drops for swimmer's ear. Most of these products contain some alcohol, which can help dry out an infected ear. While alcohol drops may be effective at drying out the external ear canal, I am wary of recommending the use of rubbing alcohol in and around any pores in children and adults, but particularly in children, because a relatively small amount of rubbing alcohol absorbed into one's blood stream can result in alcohol poisoning. The risk is very small, but it exists nonetheless.

If you choose to use alcohol drops as a treatment or preventive measure, I strongly encourage you to refrain from using it during an active infection, as it can be quite painful upon contact.

For adults and children who experience swimmer's ear on an intermittent basis, I recommend the following preventive measures:

  1. Every time the ears are exposed to water, care should be taken to tilt the head to each side for at least a few seconds while applying a gentle, backward force on the back of the ear to help drain the external ear canal of any water that may have entered it.

  2. After following the first step, a towel or paper towel should be pressed gently but firmly against the outer ear canal while tilting the head towards it to further dry out the area.

  3. After swimming in a lake, ocean, or pool, consider placing a few drops of white vinegar into each ear, one ear at a time. Vinegar has anti-microbial properties that can help to suppress bacterial growth and potential infectious processes.

Please note: if a case of swimmer's ear does not show improvement within 48 hours while following the steps outlined above, it is prudent to see one's primary care provider for a thorough evaluation.

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