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.

See also: Swimmer's ear - acute

Alternative Names

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

Causes, incidence, and risk factors

Swimmer's ear (otitis externa) is fairly common.

Swimming in polluted water is one way to get swimmer's ear. Moisture makes the ear more prone to infection from water-loving bacteria such as Pseudomonas. Other bacteria, or fungi (in rare cases) can also cause infection.

Other causes include:

• Disease of the bone (malignant otitis externa)
• Having an object stuck in the ear
• Inadequate treatment
• Scratching the ear

Symptoms

• Ear pain -- may get worse if you pull on the outside of the ear
• Hearing loss
• Itching of the ear or ear canal
• Persistent drainage from the ear -- yellow, yellow-green, pus, or foul smelling

Signs and tests

During the examination, the health care provider may find:

• The ear and ear canal look red and swollen
• The ear canal may have scaly shedding of skin
• Touching or moving the outer ear increases the pain
• It may be difficult for the health care provider to see the eardrum with an instrument called an otoscope
• The eardrum may look red
• The outermost part of the ear (the tragus) may be infected, and look red and swollen

Treatment

The goal is to cure the infection, usually with ear drops containing antibiotics.

Other treatments include:

• Corticosteroids to reduce itching and inflammation
• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to help relieve pain
• Vinegar (acetic acid) drops

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.

In elderly people or those who have diabetes and persistent ear pain or drainage, malignant otitis externa is a possibility. Malignant otitis externa is treated with high-dose antibiotics given through a vein (intravenous).

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