Health Encyclopedia

Swimmer's ear - chronic

Definition

Swimmer's ear is inflammation, irritation, or infection of the outer ear and ear canal. Chronic swimmer's ear occurs when the condition does not go away or comes back multiple times.

Alternative Names

Ear infection - outer ear - chronic; Otitis externa - chronic

Causes, incidence, and risk factors

Swimmer's ear (otitis externa) is fairly common. It consists of inflammation, irritation, or infection of the outer ear and ear canal. Swimming in polluted water is one way to contract swimmer's ear. Moisture predisposes the ear to infection from water-loving bacteria such as Pseudomonas. Other bacteria, or rarely, fungus, can also cause infection. Swimming is not the only cause, however -- the condition can be caused by scratching the ear or an object stuck in it.

Chronic swimmer's ear may result from inadequate treatment, or may suggest the presence of a disease in underlying bone, a complication called malignant otitis externa.

Symptoms

Ear pain -- may worsen with pulling on the external ear
Itching of the ear or ear canal
Persistent drainage from the ear -- yellow, yellow-green, pus, or foul smelling
Hearing loss

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, or the eardrum may appear red.

The outermost part of the ear, the tragus, may ultimately become infected, and appear red and swollen.

Treatment

The goal is to cure the infection, usually with ear drops containing antibiotics. Corticosteroids can reduce itching and inflammation. Sometimes other remedies such as acetic acid (vinegar) drops may be used.

If the ear canal is very swollen, a wick may be placed in the ear to allow the drops to travel to the end of the canal. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may help relieve pain.

In elderly individuals or diabetics with persistent ear pain or drainage, malignant otitis externa is a possibility. The ears should be evaluated with CT scanning to look for bone erosion. Malignant otitis externa is treated with high-dose intravenous antibiotics effective against Pseudomonas aeruginosa.

Expectations (prognosis)

Chronic swimmer's ear usually responds to treatment. Treatment may be prolonged or repeated. If untreated, complications may develop.

Complications

Infection of the surrounding skin
Malignant otitis externa, which can cause bone infection, hoarseness, and difficulty swallowing

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of chronic swimmer's ear, or if acute swimmer's ear does not respond to treatment.

Prevention

Dry the ear thoroughly after swimming. Individuals who swim frequently should consider earplugs. Swimmer's ear from any cause should be treated completely, and treatment should not be stopped sooner than recommended by the doctor.

Review Date:6/22/2007
Reviewed By:Cyrus Badshah, M.D., Ph.D., Assistant Professor of Clinical Medicine, College of Physicians and Surgeons, Columbia University; Assistant Attending Physician, Department of Medicine, Division of Infectious Diseases & Medical Director, Chest (TB)Clinic and Directly Observed Therapy Program, Harlem Hospital Center. Review provided by VeriMed Healthcare Network.

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