Acute Otitis Externa

          With summer in full swing and people cooling off in swimming pools everywhere, this is a good time to review a common, though usually mild condition known as acute otitis externa or AOE.  If you parse out the words, what may seem like a complicated medical condition simply means acute inflammation (itis) of the external (externa) ear (ot is the Greek root word for ear).  But the more common term, swimmer’s ear, actually describes this condition just as well.

          It is estimated that each year swimmer’s ear (AOE) accounts for 2.4 million visits to a health care provider in the United States.  Children between the ages of 5 and 9 years have the highest incidence.  AOE is actually an inflammation of the outer ear canal manifested by redness, swelling, and itching and it is sometimes even accompanied by a discharge of pus.  One of the more prominent symptoms is pain, particularly with movement of the ear.

Bacteria Are the Culprits

          Two bacteria, Pseudomonas and Staphylococcus, are the most common causes of AOE.  Because high temperature and humidity are predisposing factors for this condition, the incidence is highest during the summer months and in areas of high humidity such as the Southeastern United States.

          Exposure of the external ear canal to water, particularly while swimming, causes the skin to become more vulnerable to trauma from such things as fingers or swabs.  The injured lining of the ear canal then gives bacteria an opening in which to begin an infection.  Swimmers who spend prolonged periods of time in the water and submerge their heads more frequently are at increased risk of AOE.  It is believed that prolonged contact with water can wash away the cerumen (ear wax) that provides a protective, water-repellent barrier.

Treatment

          Treatment consists of placing drops containing antimicrobials with or without corticosteroids in the ear canal for at least a week.  Treatment should continue for several days after symptoms resolve, which is usually by six days after treatment is begun.  Patients should not submerge their head in water for seven to ten days.

Prevention 

          The main strategies for preventing swimmer’s ear involve keeping water out of the ears as much as possible and maintaining a healthy barrier of skin lining the ear canal.  The Centers for Disease Control and Prevention (CDC) recommends the following steps to prevent and control swimmer’s ear:

-keep your ears as dry as possible

-dry ears thoroughly after swimming or showering, by using a towel and tilting the head to each side to allow water to drain

-avoid putting objects in the ear canal, like fingers and swabs, which can injure the ear canal

-don’t try to remove ear wax, which helps protect your ear from infection

-discuss with your personal physician whether you might benefit from use of ear plugs or preventive ear drops

-consult your physician if your ears are itchy, flaky, swollen or painful, or if you have drainage from your ears.

          Swimming is a great way to stay physically active and can provide hours of fun during the summer months and year round for many.  Just being aware of the causes of swimmer’s ear and taking a few precautions to prevent this painful infection can keep you from being sidelined while everyone else is having fun!