Medical Moment: Ear Infection or Swimmer’s Ear?

02 May Medical Moment: Ear Infection or Swimmer’s Ear?

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Dr. Diana Koelliker, Medical Director of Emergency Services & Telluride EMS Director

Dr. Diana Koelliker answers this week’s question: Is it an ear infection or swimmer’s ear?

Ear pain is a common presenting complaint in the Emergency and Primary Care Departments. Oftentimes, children present with ear pain after an upper respiratory infection, which may have resulted in a collection of infected fluid behind the eardrum called otitis media. This can be caused by a viral or a bacterial infection and is frequently treated with a course of oral antibiotics if we determine the cause is bacterial. Otitis media is diagnosed by looking at the eardrum with an otoscope and sometimes testing its mobility with a pneumatic device.

Otitis media can cause pain and fever and we usually recommend treatment with pain relievers like acetaminophen or ibuprofen.

Recurrent otitis media sometimes requires a simple surgical procedure to put “tubes” in the ears to assist with drainage. We see this type of ear infection year round and it is very common in children less than age 7, but it can occur at any age.

Swimmer’s ear, or otitis externa, is an infection of the outer ear canal. It is typically the result of excessive moisture or trauma, both of which impairs the ear canal’s natural defenses, and allows the onset of a bacterial (occasionally fungal) infection outside the ear drum. It is very common in the spring and summer months when we spend more time in the water and can be precipitated by trauma to the ear canal, like with a scratch from a fingernail or a cotton swab.

Swimmer’s ear is seen most commonly in older children and young adults. It presents as a painful, red and swollen ear that may have drainage coming out of the canal. Your healthcare provider can diagnose otitis externa with a physical exam.

We treat the infection by removing the debris from the canal and instilling antibiotic and sometimes steroid drops into the ear canal. Pain medications, like acetaminophen and ibuprofen, can help with discomfort as can a warm compress on the external ear.

Prevention is the key to avoiding future infections. Do not scratch the inner surface of the ear with cotton swabs or other objects. Avoid swimming in polluted water (like lakes or ponds), and dry the ear thoroughly after swimming. You may consider mixing 1 drop of rubbing alcohol with 1 drop of white vinegar and placing the mixture into the ears after they get wet (there are also over the counter preparations available). The alcohol and acid in the vinegar help prevent bacterial growth.

Persons with diabetes or other conditions that result in an impaired immune system (cancer patients, persons on chronic steroids, etc.) can develop a very severe form of otitis externa. These persons should seek medical attention immediately if they develop any of the symptoms as outlined here. If you have any questions, ask your healthcare provider.

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