Swimmer’s Ear or Middle Ear Infection?

For many of us, a dip in the pool or a trip to the beach is the perfect medicine for a hot summer day. Unfortunately for some, it can also spell trouble for your ears. Swimmer’s ear (also referred to as Otitis Externa) is a condition, often occurring in children, caused by water remaining in the ear after swimming. Swimmer’s ear can be confused with a middle ear infection (also known as Otitis Media) if you don’t know what to look for. While both infections affect the ear, the treatment for these conditions is different, which makes identification of the type of ear infection important.

What is swimmer’s ear?

Swimmer’s ear is an infection of the external ear canal and, in some cases, the external ear. This condition is colloquially known as “swimmer’s ear” because it is frequently seen during the warmer months of the year and often after water exposure or aggressive Q-tip use. Most people don’t encounter issues with swimmer’s ear after water exposure unless they’ve also done something to upset the ear canal (using Q-tips, aggressive ear cleaning, etc.). The ear naturally produces an acidic wax that keeps bacteria and other organisms in the ear canal from overgrowing.

Over time, repeated exposure to water can cause the pH of your ears to become less and less acidic, allowing organisms and bacteria to grow. The first symptoms of swimmer’s ear involve feeling like the ear is full or itching. Once people start to feel that initial irritation, they might try to resolve the feeling through cleaning implements While it may seem intuitive to try and clean out your ears using Q-tips or other tools when they feel full or itch, this can actually do more harm than good.

Because the skin of the ear canal is very thin, it doesn’t take much trauma to abrade the skin and create a cut. Once organisms or bacteria enter the skin, the cartilage of the external ear canal could become inflamed, leading to infection. Those with an external ear infection may experience swelling, difficulty hearing due to ear canal obstruction, and pain.

Swimmer’s ear is commonly seen in diabetics because they produce less ear wax and the wax they do produce is less acidic. Some diabetics experience a condition called malignant otitis externa, a very severe infection of the ear canal and cartilage.

What is a middle ear infection?

Alternatively, a middle ear infection is any infection that occurs behind the eardrum, causing a buildup of fluid. Each of your ears has an eustachian tube running from the middle of the ear to the back of the throat. These tubes can become swollen and/or blocked (either by allergies, illness, excess mucus or saliva, tobacco smoke, infected or overgrown lymph tissue, etc.), causing fluid to build up and infection to occur. While anyone can get a middle ear infection, they are most commonly seen in infants between the ages of six months and two years of age because their eustachian tubes are shorter, narrower, and more horizontal. Children who attend daycare or are exposed to secondhand smoke are at a higher risk of middle ear infections.

Why are these conditions confused?

Both swimmer’s ear and middle ear infections are associated with symptoms of pain, which can make it difficult to distinguish between the two. However, a simple exam will be able to tell you what type of infection you’re dealing with. These infections are found in completely different sections of the ear. If you suspect you might have an ear infection, consult a physician regarding your symptoms for more information and treatment options.

What is the treatment for these conditions?

“Diagnosis is critical,” said Otolaryngologist, Eric J. Simko, MD, FACS, FAAOA of TPMG Otolaryngology | Head & Neck Surgery | Allergy in Newport News. The treatment of your ear infection will depend on what type of infection you have. Otitis externa (swimmer’s ear) is typically treated using an ototopical ear drop while otitis media (middle ear infection) is typically treated using an oral antibiotic. Generally, these conditions do not occur at the same time.

How can I prevent swimmer’s ear from happening in the future?

If you’re seeing a repeated recurrence of external ear infections, there are a couple of things you can do to prevent future occurrences. First, those who spend a lot of time swimming or exposed to water should consider custom-made ear molds. These molds have a small hole to facilitate hearing while in the water but won’t allow much water into the ear itself.

Additionally, don’t try to clean your ears unless instructed by a doctor to do so. The ear naturally cleans itself through a process called epithelial migration. Using cleaning implements like Q-tips in your ears can lead to further infection.

When should I see a doctor?

Ear infections rarely resolve themselves on their own and can lead to complications, if left untreated. If you or a loved one experience an earache or sense of fullness in the ear—especially combined with a fever–that isn’t resolved in a couple of days, consider making an appointment with an ENT specialist.

Eric J. Simko, MD, FACS, FAAOA

About Dr. Eric J. Simko, MD, FACS, FAAOA

Eric J. Simko, MD, FACS, FAAOA is a board certified otolaryngologist (ENT) practicing Head and Neck Surgery, ENT, and Allergy in Newport News, VA. His areas of special interest include pediatric ear, nose, and throat disorders such as recurrent ear infections , sleep-disordered breathing, thyroid/parathyroid surgery, nasal and sinus problems to include allergy and the treatment of hearing loss.

For more information or to make an appointment with Dr. Simko at TPMG Otolaryngology in Newport News, call (757) 534-7975.

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