You don't have to swim to get `swimmer's ear'

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Posted on Sun, Aug. 14, 2005

HEALTH COLUMN | DR. DARRELL KLOTZ

http://www.charlotte.com/mld/charlotte/12379989.htm

You don't have to swim to get `swimmer's ear'

Painful inflammation of ear canal can be bacterial or fungal

Otitis externa, an infection of the very thin skin lining of the ear

canal, is

more commonly known as " swimmer's ear. "

However, this condition of ear pain, itching, foul discharge and

decreased

hearing can develop in anyone -- swimmers and nonswimmers alike.

This

infection is unlike the common ear infection of childhood, which

involves

an infection of the middle ear space (behind the eardrum), and its

treatment

requires a different approach.

Bacteria or fungus causes swimmer's ear. Excessive moisture,

humidity

and heat in the ear canal or trauma to the skin lining, or both, may

begin the

process of an infection. Cerumen, or ear wax, is acidic and provides

an

oily coating to the ear canal, preventing bacterial or fungal

growth. Those

at highest risk for swimmer's ear are people overzealous in cleaning

the

cerumen or in scratching their ears with Q-Tips or other objects

(e.g. paper

clips, pens, etc.), or who block off circulation of air into the ear

by

wearing things like hearing aids, helmets, headphones or earplugs.

Some

people are at risk simply because they were born with narrow ear

canals.

For swimmers, the dirty water found in lakes, ponds and rivers is

notoriously worse than swimming pool water for causing an infection.

This

infection is more common in temperate climates and during the summer

months.

Fortunately, treatment of this type of ear infection is fairly

simple. Frequent

cleansing of the ear canal with a few drops of a diluted white

vinegar

solution will often treat mild infections without needing

antibiotics. The

vinegar solution changes the acidity of the ear canal, deterring

growth of

the infection. However, in most cases, topical ear drops (antibiotic

or

antifungal) are required in addition to vinegar irrigation. Often

the

appearance of the infection can give clues as to whether the

infection is

fungal or bacterial, guiding your doctor in selecting the correct

topical ear

drop without performing a culture. Taking a culture is a simple,

painless

procedure that allows your doctor to learn more about the type of

bacteria

present in the ear and may be recommended if your swimmer's ear

becomes a chronic problem.

Oral antibiotics or antifungals are seldom used in treating routine,

uncomplicated cases of swimmer's ear. They are generally used only

in

situations of severe infection where the outside portion of the ear

or the

lymph nodes around the ear become involved, or in cases of chronic

infection that do not seem to respond to ear drops and irrigations.

Sometimes the ear can contain so much swelling and inflammation that

the

ear canal closes and a small sponge or " wick " needs to be inserted

to keep

the canal open while administering the ear drops.

Often your doctor will suction the debris from the canal initially

and on

later visits, to enhance the effectiveness of the ear drops that you

are

applying at home. While treatment is in progress, it is recommended

to

keep any further water from entering the canal during showering,

swimming, etc.

As with many things in medicine, prevention can go a long way. Good

ear

hygiene is important to prevent infections of the ear canal.

Cleansing your

ear with a few drops of mild-vinegar solution after swimming or

scuba

diving is a good idea, particularly if you are someone who has

repeated

difficulty with swimmer's ear. Q-Tips should never be used to remove

residual water or wax from the inner portion of the ear (provides a

small

break in the skin of the ear canal, allowing easy introduction of

the

infection). Remember the old adage, " You shouldn't be putting

anything

smaller than your elbow in your ear. "

At least that's what my grandmother used to say.

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Dr. Darrell Klotz is an otolaryngologist on staff at Gaston Memorial

Hospital.