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​Swimmer's Ear – the infection of a good Kiwi summer

March 12, 2018

In balmy summer weather many of us will be found in or near the water, jumping off the wharf, surfing or just splashing around in the sea. Whilst this is part of the Kiwi dream of an idyllic summer, it can lead to a painful and common ear infection, swimmer's ear or otitis externa. Interestingly on one warm public holiday this January, almost 1/3 of the patients attending Medplus had it.

Otitis externa literally means an infection of the outer ear and is quite different to otitis media (the middle ear infection common in small children) or otitis interna (an inner ear infection – which is a cause of dizziness). Otitis externa can be found in any age group.

It presents initially as a sensation of a blocked ear, with muffled sounds and some hearing loss. If it worsens, itchiness or pain can develop. This is often pain when the outer ear is touched or moved (for example putting the side of your head on the pillow) and is exacerbated by jaw movements (like chewing). Whilst otitis externa is frequently a mild infection it can sometimes become very aggressive with severe pain, significant hearing loss and fevers. Often there will be a discharge from the affected ear. Whilst otitis externa can slowly niggle away for a while before flaring, it can also come on very quickly.

It can be triggered by high humidity, and some people are particularly prone to it, possibly because of their narrow ear canals. Skin damage can also cause it, so those people who insist on scouring their ear canals with cotton buds (or worse) are particularly vulnerable, as are those with eczema or psoriasis in their ear. Chemicals, such as hair dye, shampoo or conditioner are also potential triggers for some individuals. However, the majority of our summer sufferers give a history of lots of water exposure. Bombing off the wharf seems to be more of a trigger than swimming on top of water – perhaps it is due to the pressure?

The infection is most commonly bacterial, but can be fungal or a combination of fungus and bacteria. When we look inside an infected ear canal, we can see that the canal is inflamed and narrowed by swollen skin, often the tympanic membrane can not be seen because of pus and debris blocking the canal.

Treatment is simple, usually ear drops, with or without removal of the discharge and debris in the canal, by suction, by an Ear Health Nurse. The ear drops can be acetic acid, but also, they can be an antibiotic, possibly with a steroid added in. In severe cases oral antibiotics are required. Until recovery, water sports should be avoided and the ear kept dry. Sometimes pain relief is required.

Often, those who get swimmer's ear get it recurrently. However, some simple measures can reduce the frequency of infections. Dry your ears after getting your head wet, by shaking your head and wiggling your ear lobes to help get all the water out, then patting the ear dry with a fluffy towel or using cotton wool balls. If you are careful, you can use a hairdryer on a low heat and low speed from a good distance to dry the ear. Do not blast your ears with hot air – this is more likely to cause damage. Do not use cotton buds to dry your ear canal. Some authorities recommend a few drops of mineral oil in the ear canals before a swim. Frequently, swimmers use acidic ear drops (often a combination of vinegar and rubbing alcohol) after a swim. Whilst this can help inhibit growth of bacteria and fungus it can be counterproductive, irritating and drying the ear canal skin, making it more prone to infection.

If you have ear pain, come in and see one of the Medplus doctors so that you can be given effective treatment. If you have hearing loss we do need to rule out more serious problems and advise you to come in urgently.