Ear infection - outer ear - acute

Alternative names
Swimmer’s ear; Otitis externa - acute

Definition
Swimmer’s ear is an inflammation, irritation, or infection of the outer ear and ear canal.

Causes, incidence, and risk factors

Swimmer’s ear (otitis externa) is fairly common, especially among teenagers and young adults. Swimming in polluted water is one way to contract swimmer’s ear. Swimming is not the only cause, however - the condition can be caused by scratching the ear or an object stuck in it. 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 predisposes the ear to infection from fungus or water-loving bacteria such as Pseudomonas.

Symptoms

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

Signs and tests
When the physician looks in the ear, it appears red and swollen, including the ear canal. The ear canal may appear eczema-like, with scaly shedding of skin. Touching or moving the outer ear increases the pain. It may be difficult for the physician to see the eardrum with an otoscope. Taking some of the ear’s drainage and doing a culture on it may identify bacteria or fungus.

Treatment

The goal of treatment is to cure the infection. The ear canal should be cleaned of drainage to allow topical medications to work effectively.

Effective medications include ear drops containing antibiotics to fight infection, and corticosteroids to reduce itching and inflammation. Ear drops should be used abundantly (four or five drops at a time) in order to penetrate 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.

Occasionally, pills may be used in addition to the topical medications. Analgesics may be used if pain is severe. Putting something warm against the ears may reduce pain.

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.

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 doctor if you develop any symptoms of swimmer’s ear. Call your doctor if the symptoms worsen or persist despite treatment, or if new symptoms appear, including pain and redness of the skull behind the ear or persistent fever.

Prevention

     
  • Dry the ear thoroughly after exposure to moisture.  
  • Avoid swimming in polluted water.  
  • Use earplugs when swimming.  
  • Consider putting a few drops of a 1:1 mixture of alcohol and white vinegar in the ears after they get wet. The alcohol and acetic acid prevent bacterial growth.

 

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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