Does your ear hurt all the time? Let's learn about Swimmer's Ear (Otitis Externa)!

Have you ever felt a strange, heavy, or itchy sensation in your ear after a bath, especially after a swim in a swimming pool or the sea? Maybe your little one is always crying and clutching at his ear? Then this is something that may be very important to you. Today we will talk about a condition called 'Swimmer's Ear' or, as doctors call it, 'Otitis Externa'.

What is Swimmer's Ear?

Simply put, Swimmer's Ear is an infection of the tube-like part of our ear that starts from the outside of our ear and ends at the eardrum, that is, the external auditory canal. Think of it like when we have a wound somewhere on our skin, it gets infected. What happens here is that germs get into the delicate skin inside the ear canal and cause an infection. This can be a bacterial infection or a fungal infection.

This is called 'swimmer's ear' because it is more common in people who spend a lot of time in the water, especially swimmers. However, it can happen to anyone, not just swimmers. This risk is especially high during hot weather, when we often bathe and play in the water.

The most important thing is that if this is not treated properly, sometimes hearing loss can occur, even temporary loss of hearing. But don't worry, most of the time this condition can be completely cured with proper treatment. Usually, doctors prescribe ear drops for this.

How common is this condition?

Swimmer's ear is actually quite common. Surveys suggest that about 10% of people in the United States alone have had it at some point in their lives. Although it can develop at any age, it is most common in children between the ages of 7 and 14 .

What are the symptoms of Swimmer's Ear (Otitis Externa)?

The symptoms of swimmer's ear can affect some people to varying degrees. Some people may experience severe symptoms. See if these symptoms sound familiar to you:

• A feeling of fullness and heaviness inside the ear.
• Ear pain, especially if the pain increases when the earlobe is pulled back, is a key symptom.
• Some people may get a fever .
• Fluid or pus-like discharge from the ear.
• Severe itching inside the ear.
• Hearing is slightly reduced, and it feels like you are hearing slowly (muffled hearing).
• Redness and swelling of the skin around the ear.
• Swollen lymph nodes around the ear or on the top of the neck.

If you have one or more of these symptoms, it's very likely that you have swimmer's ear.

Why do we get swimmer's ear?

There can be a number of reasons for this. But the main reason is that water is trapped inside the ear canal. Think about it, pathogens like bacteria and fungi like to grow in a warm, moist environment. So when water is trapped inside the ear, it becomes a perfect haven for these germs. They settle there, multiply quickly, and cause an infection.

This is usually caused by a bacterial infection, rather than a fungal infection. In rare cases, a combination of several types of bacteria can cause this infection. The main types of bacteria that can cause swimmer's ear are `Pseudomonas aeruginosa` and `Staphylococcus aureus`. The fungi `Candida` and `Aspergillus` can also cause it.

Who is more likely to develop this? (Risk factors)

Some people are more likely to develop swimmer's ear. See if these facts apply to you:

• For those with skin conditions: If you have a skin condition such as eczema or psoriasis around the ear canal, you are at higher risk of developing swimmer's ear.
• For those who injure their ears: When we try to remove earwax with things like cotton swabs, pen tips, bobby pins, and paper clips , the delicate skin inside the ear can be injured. These injuries are more likely to allow germs to enter and cause infections. So remember, do not insert sharp objects into the ear to clean the ear.
• For those living in areas with hot, humid climates: The risk is higher because germs grow more easily in such environments.
• For those with low earwax: Earwax is a natural protective substance that protects our ears from bacteria and fungi. If we get water in our ears frequently, or if we remove too much earwax when cleaning our ears, this protection can be lost and infections can develop.
• For those who swim in unclean water: Although it is possible to get infected from a swimming pool, the risk is higher when swimming in natural bodies of water like lakes, ponds, rivers, streams, and the ocean . This is because the water in these places can contain more germs than a clean swimming pool.
• For those who frequently use earbuds or hearing aids: If these are not cleaned properly, dirt and germs can build up and cause ear infections.

What complications can occur if left untreated?

Most of the time, swimmer's ear is a treatable condition if treated quickly. However, sometimes, especially if left untreated or delayed, complications can occur. These are very rare, but it's important to be aware of them.

• Chronic ear infections:If swimmer's ear persists for more than three months, it is considered a chronic infection. If both bacteria and fungi combine to form an infection, this can happen to people with skin conditions or those who have an allergic reaction to ear medications.
• Cellulitis (infection of the deeper tissues of the skin): Very rarely, this ear infection can spread to the deeper tissues beneath the skin.
• Bone or cartilage damage (early osteomyelitis): This is also a very rare complication. The ear infection can become severe and spread to the nearby cartilage and bone. People with weakened immune systems are at higher risk.
• Advanced skull base osteomyelitis: If the ear infection spreads further and reaches the bones at the base of the skull, it can affect nearby nerves, the brain, and other parts of the body. Swimmer's ear is rare, but if it does, it can be life-threatening.

Don't worry! These serious complications are very rare, especially if you seek medical attention as soon as you start experiencing symptoms. That's why it's important to see a doctor without delay, even if it's just a little thing.

How does a doctor recognize this?

When you go to see a doctor, they will first examine your ear carefully. They will look for redness, swelling, or other signs of damage. If there is any discharge from your ear, they may take a sample of it and send it to a lab to find out exactly what is causing the infection. This is because the medicine you use for a fungal infection is not the same as the medicine you use for a bacterial infection. Therefore, it is important to know the exact cause for treatment.

Don't confuse Swimmer's Ear with Middle Ear Infection!

Sometimes, swimmer's ear can be confused with another common ear condition in young children, a middle ear infection (Middle Ear Infection or Otitis Media) . A child with a middle ear infection will usually have ear pain that gets worse when they lie down. They may also experience symptoms such as vomiting, diarrhea, and loss of appetite.

Both conditions are treated differently. The same medication for swimmer's ear will not work for a middle ear infection, and vice versa. That's why it's important to see a doctor for an accurate diagnosis.

What are the treatments for Swimmer's Ear?

Most often, doctors prescribe ear drops to clear up this infection. Depending on your condition, they may recommend the following medications:

• Ear drops containing antibiotics: Kill bacteria.
• Antifungal ear drops: Fight fungus.
• Steroid-containing ear medications:Reduce swelling and pain.

It is very important to use this ear medication exactly as your doctor tells you, for the full duration of time. Do not stop halfway through.

Also, to reduce pain, you can take painkillers such as acetaminophen (e.g. Tylenol®) or ibuprofen (e.g. Advil®) as prescribed by your doctor.

What will happen after treatment?

Swimmer's ear is usually a self-limiting condition that resolves with treatment. In most cases, the infection will clear up completely within a week. However, if left untreated, complications such as the infection spreading can occur, as mentioned earlier. In that case, you may need to use stronger antibiotics or antifungals.

Will this get better automatically?

No, it doesn't. Swimmer's ear is an infection of the ear canal. If left untreated, it will not heal on its own. If left untreated, the infection can spread to the base of the skull, the brain, or the cranial nerves.

Since the infection can spread beyond the ear canal, it's best to see a doctor as soon as you notice symptoms and begin treatment. The sooner you get treatment, the faster you'll recover.

How to prevent swimmer's ear?

Yes, there are things we can do to prevent this. The main thing is to keep our ears as dry as possible.

Follow these tips to further reduce your risk:

• Minimize bathing and swimming in dirty water as much as possible.
• Do not insert anything, including cotton swabs, into the ear canal. The skin inside the ear is very delicate. If it gets injured, it can easily become infected.
• If water gets into your ear while bathing or swimming, turn your head to the side and gently pull the earlobe from side to side to let the water drain out.
• Dry your ears thoroughly after bathing, swimming, or being in water. You can do this with a clean towel or by gently drying them with a hairdryer on a low setting.
• When showering, you can place cotton balls in your ears to reduce the risk of water getting into your ears.
• Use earplugs when swimming or in water.

When should I see a doctor?

If you develop any of the previously mentioned symptoms of swimmer's ear (such as ear pain, ear discharge, itching, or hearing loss), see a doctor immediately.

If you have already been prescribed ear drops by a doctor for swimmer's ear, and your symptoms do not improve after about 10 days, see your doctor again. You may need to be given a stronger medication.

Finally, a few things to remember

Before you go to a swimming pool, lake, or sea, take a little extra care of your ears. If you feel pain or itching in your ears after getting out of the water, don't dismiss it as normal, but tell a doctor. He or she can prescribe you an ear medication that will help. Your symptoms should go away in about a week. Remember, swimmer's ear is not a serious condition if it is recognized and treated early. So don't panic, seek medical advice quickly. I wish you a speedy recovery!

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