What is swimmer's ear?
Swimmer's ear (otitis externa)is an inflammation or infection of the
outer ear canal, and is distinguished both in location and cause from
the inner ear infections (otitis media) common in infants and
toddlers.
What causes it?
It is often caused by a variety of common organisms, including some types of bacteria and fungi. However, it can also have purely physical causes. When it occurs among swimmers, three elements are usually present:
- the ear canal is alkaline, rather than acid,
- the ear canal is damp or wet, &
- an infectious agent is present.
Explanations
Swimming in pools almost always provides the first two conditions, since
pools are wet (!) and usually slightly alkaline. The ear itself provides
the third condition, since many of the organisms often involved in ear
infections are already normally present in the ear canal, at least in
small quantities.
Voila': your swimmer has met all the minimum requirements for an infection
But, since some of the causative organisms (esp., some varieties of Psuedomonas)
are quite resistant to most pool sanitizers, swimmers often get an
extra helping from some pools, including some that are otherwise well
sanitized. And, of course, many natal waters, will have some of these
organisms are almost always present.
How can you avoid swimmer's ear?
While the obvious -- if unhelpful -- answer, "don't get your ears wet",
is often provided in literature from medical sources, most swimmers find
less drastic measures are sufficient.
- Dry your ears after swimming;
- Use ear drops after swimming; &
- If you are particularly susceptible, use ear drops before swimming, as well.
Children may not be able to effectively do the "head-shake" maneuver sometimes
needed to remove the water: drops are a good idea for them. And, some individuals are
MUCH more susceptible, for a variety of reasons, than others.
While ear infections often occur subsequent to swimming in well sanitized
pools, when 20% or more of a swim team gets infections simultaneously,
there is a good chance that one of the pools they have recently swum in
is badly sanitized.
And, keep in mind that if you've (or your child) has had multiple cases
of otitis externa, REGULAR preventative use of non-irritating ear
drops can work wonders, and should be a part of your swimming routine.
Drops and swimsuits should go together!
What kind of drops should you use?
Rubbing alcohol is often recommended for use as ear drops. However, rubbing
alcohol burns or stings at best, especially on young swimmer's skin, and
may hurt like the devil if the ear canal is already slightly inflamed
or irritated. (Some other, less common, types of alcohol are NOT irritating,
and are used in commercial ear drops.)
Lest drastic -- and possibly more effective -- is a mixture of 1/2 vinegar
and 1/2 hydrogen peroxide. Once the peroxide is added, the mixture is
perishable, so don't mix more than you'll use in a week or so. The peroxide
can lose its strength rather quickly once mixed. Vinegar alone is a good
preventative since it restores the ear canals acidity.
A laboratory wash bottle, filled with this mixture, and used routinely on swim
team members (line 'em up, squirt it in!) is cheap and seems to eliminate
problems almost completely. But check with parents: there are some bizarre
sensitivities out there -- and some bizarre parents!
But, please be careful. Don't jab the bottle nozzle in some wiggly kid's
ear! You may want to trim and round the nozzle so it's less 'pointy'.
And, though this mix doesn't irritate most peoples ears, it feels
pretty AWFUL in EYES! Having the kids hold a towel over their eyes,
as you squirt, is a good idea.
Even better, in my personal experience, are the commercially available
Star-otic drops. Although I'd had problems finding these in recent
years, my local Eckerds is now carrying them, and my pharmacist checked,
and said that they are a regular Eckerd's product now. So, if your Eckerd's
doesn't have them, they can probably get them easily.
The FDC has apparently messed with StarOtic on a periodic basis;
the drops we've found most effective contain "Modified Burrow's Solution",
among other ingredients. We've seen StarOtic with some other formulations,
that appear to be nothing but vinegar (acetic acid) and alcohol, which
have seemed less effective, at least to us.
The common medical advice (see articles below) is that ear drops
are preventative, not curative. However, my personal experience
suggests that this is not entirely correct. All four of us are swimmers
(as in laps back and forth). My older son and I are both somewhat prone
to swimmer's ear. We've both found that even when we've forgotten to use
the drops preventatively, that if we begin using them on the first sign
of ear discomfort, we don't have to do more. But, do NOT use the drops
on someone with an infection that has advanced to real pain, much less
pus and drainage. If you do so, you'll likely need a spatula to get
your "victim" off the ceiling: they HURT in badly infected ears!
When should I go to the doctor?
The obvious and legally acceptable answer is: ask your doctor.
However, my non-medical opinion is: if your ear really hurts a lot,
has a discharge or pus, or if you have a fever, you should go. Also,
if you have had problems in the past with serious ear infections, you
should probably hustle down to his/her office, sooner rather than
later.. A bad infection can be a real mess.
Other articles about Otitis Externa?
InteliHealth
Otitis Externa Article
National
Institutes of Health Otitis Externa Article
These articles are superior to the CDC article found
here
which focuses exclusively on psuedomonas aeruginosa as the
cause of O.E.. This is unhelpful, since it will lead to pool
operators trying to 'fix' O.E. by raising sanitizer levels.
While anyone one who knows me, knows I prefer my chlorine
levels high, such an approach is not helpful to parents of
those kids who tend to acquire O.E. simply from wet ears.
Revised 7/20/2004 - BMP
|
