by Rob Lamberts, MD
Today’s article is brought to you by sound waves. Without their continuing presence, this podcast would not exist at all, and you would not be enchanted and delighted with the dulcet tones of my voice. All of this, of course, would not be possible without the generous support of the organs of hearing: the ears. Thank you for your support. As a doctor, I would like to thank the ears for a huge portion of my business over the past 15 years.
[Swallows]. Sorry…that subject just makes me emotional.
Ear problems are a common reason for people to go to the doctor -- especially young children. I personally remember as a kid, sitting at the top of the steps crying because my ear hurt so badly, and two of my children had bad enough ear problems to get tubes through their eardrums. Ears cause a lot of trouble, so I’ll need several podcasts to cover them. I'll tackle ear infections in episode 14, but today’s podcast will focus on the summertime nemesis: swimmer’s ear.
Before getting on with it, however, let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
What Causes Swimmer’s Ear?
There are two common types of ear infections: middle ear infections, or otitis media, and external ear infections, or otitis externa. Since most people would feel hoity-toity saying otitis externa, this infection is commonly called swimmer’s ear. Of the two kinds of ear infections, swimmer’s ear is probably the more painful. In that painful memory of my childhood, it was swimmer’s ear that kept me (and my parents) miserable that night.
So how does a person get swimmer’s ear? Obviously, swimming can play a part in the process -- and we really do see 95% of our cases of this in the summer months. But you can get swimmer’s ear in the shower, bathtub, or from playing in your neighbor’s sprinklers at night when they aren’t watching. The key is that water gets into the ear canal.
You may recall in the antibiotic podcast that I talked about how things like to grow in warm, wet places where the water is stagnant. The ear canal meets these criteria wonderfully. Water that’s in your ear after swimming can become a breeding ground for infection-causing bacteria. Sometimes the shape of the ear canal plays into this, and other times wax makes it so water can get in but not back out. Whatever the case, water staying in the ear canal long enough will be at risk of infection.
Why Does Swimmer’s Ear Hurt?
The main way to tell you have swimmer’s ear is if it really hurts when your outer ear is wiggled. So if your honey goes to nibble on your ear and you scream in pain and head-butt him, you probably have swimmer’s ear. It’s really painful. Swimmer’s ear hurts so bad because your ears--like your eyes--are full of pain receptors. When something threatens to hurt the eardrum or eyeball, the pain causes you to pull away. It’s really remarkable what your body does to protect itself.
How to Treat Swimmer’s Ear
Swimmer’s ear is treated with antibiotic eardrops, some of which also have an anti-inflammatory mixed in to reduce the pain. Occasionally the ear canals become so inflamed and swollen from the infection that they close up, making it nearly impossible to instill drops. In this situation, the doctor inserts a paper wick into the swollen ear canal and covers the wick with antibiotic drops. The drops are sucked into the wick, which holds the antibiotic right against the inflamed walls of the canal.
That may sound painful, but people usually love the feeling of the cool antibiotic on the painful canal. The wick is kept wet until the inflammation is gone and the wick falls out.
Generally, swimmer’s ear is painful, but not deadly. But there is one way in which external ear infections can be dangerous. People with diabetes can develop something called malignant otitis externa, in which the infection extends to the bone and soft tissue around the ear. This requires hospitalization and possibly surgery; so if you are a diabetic, go to your doctor right away if you get an earache.
How to Prevent Swimmer’s Ear
People who are prone to swimmer’s ear can prevent it by making sure all the water gets out after swimming. Hopping idiotically with the head down is one way to do this. Another way is to put drying drops into the ears right after swimming. These drops usually contain alcohol and vinegar. The alcohol makes the water evaporate and the acidic vinegar discourages any bacteria that are having evil thoughts of ear domination.
But don’t use a cotton swab in the ear to dry it out. That can harm the external canal, rupture the eardrum, or just push wax further in.
So here are my quick and dirty tips about dealing with swimmer’s ear:
Tip 1: Get the Water Out of Your Ears
If it takes a funny dance to dry out your ears, do the dance. Maybe you will make it rain. We need rain. Otherwise get some drops to dry out the ear canal. If you are the do-it-yourself sort, you can actually make these drops by mixing a 1:1 ratio of rubbing alcohol and vinegar. I don’t really think it matters, but most things I read said to use white vinegar. Apple cider vinegar may make your ears smell good, though.
Tip 2: Don’t Use Drying Drops if You Already Have Swimmer’s Ear
Drying drops are meant to prevent swimmer’s ear, not treat it. The vinegar is an acid, and acids usually hurt a lot when poured into wounds. Trust me on this one.
Tip 3: If Your Ear Hurts When You Wiggle it, It’s Probably Swimmer’s Ear
Call or visit your doctor if this is the case. Most of the time I still make people come in to make sure it’s not a middle ear infection. The visit is usually very fast and easy, though.
Tip 4: Diabetics Should be Extra Careful
Malignant otitis externa is nothing to mess with, so get seen right away if you are a diabetic with ear pain.
That’s it for today’s podcast. I hope this information keeps you from having this very painful problem. I’ll cover other ear problems, including middle ear infections, in future podcasts. If you have topics you want me to cover, send them to firstname.lastname@example.org. Please put the problem you want covered in the subject line.
Catch you next time! Stay Healthy!