Otitis Externa (Swimmer’s Ear)

What is otitis externa?

Otitis externa, commonly known as swimmer’s ear, is an infection involving the skin of the external ear canal. This is different from otitis media (middle ear infection) where 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.

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 Dr. Lieberman reveals a tender, swollen ear canal, frequently filled with infected debris. Frequently the ear canal may be entirely swollen shut.


What causes otitis externa?

With otitis externa, bacteria or sometimes fungus penetrates the skin of the ear canal causing 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 (e.g. swimmers) who are in the water frequently,, the number of infections can be decreased by using drops of a ½ alcohol and ½ white vinegar solution in the ear canal. These drops will help to evaporate the moisture.


How is otitis externa treated?

The primary treatment for otitis externa is topical antibiotic drops placed in the ear canal. (After an infection has started, the alcohol and vinegar 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.

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