Otitis Externa (Swimmer's Ear)

What is Otitis Externa?

Otitis externa, commonly referred to as swimmer’s ear, is an infection involving the skin of the external ear canal. This is different from otitis media, or middle ear infection, in which the infection is behind the eardrum. Otitis externa leads to swelling of the ear canal skin and is frequently associated with severe pain as well as ear blockage.

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How is otitis externa diagnosed?

Otitis externa typically leads to severe tenderness of the ear canal, which can be detected by pulling on the earlobe. Physical examination by the physician reveals a tender, swollen ear canal, frequently filled with infected debris. Commonly, the ear canal may be entirely swollen shut.

What causes otitis externa?

With otitis externa, bacteria, or sometimes fungus, penetrate the skin of the ear canal and cause inflammation. Pseudomonas Aeruginosa is the most common bacterial agent to cause this infection. Risks factors for the development of otitis externa include exposure to water, use of Q-tips, and pre-existing skin conditions of the ear canal. Water softens the skin barrier, allowing organisms to penetrate and cause infection. Q-tips remove the protective layer of wax in the ear canal and can create tiny abrasions that allow infections to start. Skin conditions, such as eczema, also lead to a breakdown in the skin barrier, promoting the start of infection.

How is otitis externa prevented?

The most important steps to prevent otitis externa include keeping the ears dry and avoiding the use of Q-tips. For individuals, such as swimmers, who are frequently exposed to water, evaporating moisture from the ear canal after swimming by placing alcohol drops, or using a hair dryer to dry the ear canal, can decrease the frequency of infections.

How is otitis externa treated?

The mainstay of treatment for otitis externa is topical antibiotic drops placed in the ear canal. (After an infection has started, alcohol drops are not effective, and will only cause burning and pain!) The ear doctor may need to clean infected debris from the ear canal to speed healing. Also, if the ear canal is too swollen to allow drops to be placed, your doctor may need to place a small sponge, or wick, in the ear canal to draw the drops past the obstruction. Oral antibiotics may be necessary for particularly severe infections.

By Cary Moorhead, MD

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