McCullough: Be aware of swimmer's ear this summer

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McCullough: Be aware of swimmer's ear this summer

but a simple solution of 1:1 white vinegar and rubbing alcohol will

both dry and acidify the canal.

By J. McCullough, M.D./ HEALTH TIPS

Thursday, July 27, 2006

http://www2.townonline.com/georgetown/opinion/view.bg?

articleid=545588

Swimmer's ear or Otitis Externa is one of the most common infections

in Essex County this time of year. Our beautiful natural landscape

of beaches, ocean, rivers and ponds (not to mention backyard

swimming pools) combined with warm summer weather predisposes us all

to this type of infection. In short, if you swim, shower or

otherwise get wet than you, too, can get swimmer's ear.

Let's start with the basics: swimmer's ear is different from

other types of ear infections. Typically when we say ear infection,

especially in children, we mean otitis media or a middle ear

infection. This is the type of bacterial infection happens after a

cold virus or a change in altitude blocks the eustacian tube and the

bacteria take over. Swimmer's ear happens when fungus or bacteria

grow in the outer ear or the ear canal. The fungi that cause this

type of infection are aspergillus or candida and the dermatophytes,

the same fungi that cause athlete's foot or jock itch. Bacterial

swimmer's ear tends to be more severe with a fever, swollen glands

and is caused by staphylococcus or pseudomonas species.

From an anatomical perspective, the ear canal is the only skin-

lined cul-de-sac in the human body. Since fungus and bacteria both

love warm, moist and dark places, this external canal is the perfect

place for their growth. The skin here is very thin and easily

traumatized by fingernails or Q-tips. Some people are born with a

curve at the junction of the cartilage and bone, which further traps

water in the canal. Surfers or people with chronic swimmer's ear can

also change the shape of the canal over time making them even more

likely to get swimmer's ear. In all ear canals you will find that

the delicate skin is protected by a thin layer of acidic yellow or

red wax. This wax both repels water and is too acidic for bacterial

growth. Additionally, the canal is defended by a unique and delicate

epithelial migration down the cul-de-sac, which carries dead skin

and old wax with it. If this wax is disturbed by trauma or washed

away by water, the pH rises and then the fungus or bacteria can grow

and the ear canal gets painful and swollen. Unfortunately too much

wax can also trap water behind it and allow the infection in. There

are many causes for an outer ear infection but the most common are:

moisture from swimming, bathing or perspiration; insertion of

foreign objects into the ear such as Q-tips, fingernails, hearing

aids or even ear plugs; or chronic skin conditions such as eczema,

psoriasis, seborrhea, acne or even diabetes.

The main symptoms of swimmer's ear are pain and discharge. Some

people notice that it is harder to hear or that their ear is full or

swollen. Some self-care steps can help relieve the symptoms and

prevent the infection but a severe case of swimmer's ear will

require a trip to your family doctor. You should make an appointment

if you have a fever, ear pain and drainage. Your family doctor can

look inside your ear with an otoscope to determine if it is an

internal or external infection and whether it needs a wick to drain

the pus away. Some severe infections may even need to be referred to

an ear, nose and throat specialist or otolaryngologist. The

treatment may include cleaning of the ear with an irrigation or

suction device, topical prescription antibiotics or corticosteroids,

and oral medications such as non-steroidal anti-inflammatory drugs

such as ibuprofen or even oral antibiotics if the inner ear or

surrounding skin is involved. The treatment is usually for three

days after all symptoms resolve or five to seven days in total.

Certain activities such as swimming, flying and scuba diving can

make the infection a lot worse. Getting water in your ear during

bathing may also make it worse. Your doctor may instruct you to

avoid the water while being treated for swimmer's ear.

An ounce of prevention is truly worth a pound of cure and there are

many things you can do to avoid swimmers ear: Dry your ears

completely after swimming or bathing. Dry your outer ear gently with

a towel or cloth, never with a Q-tip. Use earplugs, which are

specifically designed to keep water out of your ears while swimming.

A tight fitting bathing cap may serve this purpose even better. Some

swimmers who do not tolerate earplugs or caps will find that putting

oil or lanolin drops in their ears before swimming can repel the

water. Put drying or acidifying drops in your ears after swimming.

There are many over the counter products but a simple solution of

1:1 white vinegar and rubbing alcohol will both dry and acidify the

canal. Some swimmers who do not tolerate earplugs will find that

putting oil or lanolin drops in their ears before swimming can repel

the water.

Never dig out earwax yourself. This usually packs the wax father

back in the canal and irritates the delicate skin layer. Your mother

was right: never stick anything smaller than your elbow in your ear.

Avoid getting irritating substances into your ear canals. Cotton

balls can prevent these substances when applying hair dyes or hair

spray. This may seem like a lot to think about but if you think you

might have gotten swimmer's ear this summer, visit your family

doctor for a consultation.

J. McCullough, M.D., M.Phil, Cummings Center Medical

Associates, Beverly is on the medical staff at Beverly Hospital