Swimmer's ear

• Alternative Names

  Ear infection - outer ear - acute; Otitis externa - acute

• Causes, incidence, and risk factors

  Swimmer's ear is fairly common, especially among teenagers and young adults.

  Causes of swimmer's ear include:

  • Swimming in polluted water
  • Scratching the ear or inside the ear
  • Object stuck in the ear

  Trying to clean wax from the ear canal, especially with cotton swabs or small objects, can irritate or damage the skin.

  Swimmer's ear is occasionally associated with middle ear infection (otitis media) or upper respiratory infections such as colds. Moisture in the ear makes the ear more prone to infection from water-loving bacteria such as pseudomonas. Other bacteria, and rarely, fungi, can also cause infection.

• Symptoms
  • Drainage from the ear -- yellow, yellow-green, pus-like, or foul smelling
  • Ear pain -- may worsen when pulling the outer ear
  • Itching of the ear or ear canal
• Signs and tests

  The doctor will perform a physical exam, which includes looking inside the ears. The ear, including the ear canal, appears red and swollen. The skin inside the ear canal may be scaly or shedding.

  Touching or moving the outer ear increases the pain. The eardrum may be difficult for the doctor to see because of a swelling in the outer ear.

  The doctor may take a sample of fluid from the ear and send it to a lab so any bacteria or fungus can be identified.

• Treatment

  The goal of treatment is to cure the infection. Medicines may include:

  • Ear drops containing antibiotics
  • Corticosteroids to reduce itching and inflammation

  The ear canal should be cleaned of drainage. This allows the medicines to work better.

  Four or five ear drops should be used at a time, so that the medicine can get into the end of the ear canal. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal.

  Analgesics may be used if the pain is severe. Placing something warm against the ears may reduce pain.

• Expectations (prognosis)

  Swimmer's ear responds well to treatment, but complications may occur if it is not treated. Some individuals with underlying medical problems, such as diabetes, may be more likely to get complications such as malignant otitis externa.

• Complications
  • Chronic otitis externa
  • Malignant otitis externa
  • Spread of infection to other areas of the body
• Calling your health care provider

  Call for an appointment with your health care provider if:

  • You develop any symptoms of swimmer's ear
  • The symptoms worsen or continue, even with treatment
  • New symptoms appear, including pain and redness of the skull behind the ear or persistent fever
• Prevention

  Protect ears from further damage.

  • Do not scratch the ears or insert cotton swabs or other objects in the ears.
  • Keep ears clean and dry, and do not let water enter the ears when showering, shampooing, or bathing.
  • Dry the ear thoroughly after exposure to moisture.
  • Avoid swimming in polluted water.
  • Use earplugs when swimming.
  • Consider mixing 1 drop of alcohol with 1 drop of white vinegar and placing the mixture into the ears after they get wet. The alcohol and acid in the vinegar help prevent bacterial growth.
• References

  Pier GB. Pseudomonas and related gram-negative bacillary infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 328.

  Haddad J. External otitis (otitis externa). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 638.

Review Date: 11/10/2008

Reviewed By: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.