Dear reader,

Summer is in full swing, and many of you may be beset by external ear infections (otitis externa [OE]), also known as ‘swimmer’s ear.’ This condition is a skin infection limited to the external ear canal, and can be caused by swimming or other ear water exposure, scratching the ear with a cotton-tipped applicator or other device (such as a hair pin), or something foreign entering the ear canal – dirt, sand, even small bugs. It manifests with pain, ear drainage, and sometimes hearing loss.

Treatment is straightforward, but if not treated early or correctly, things can of course get complicated. The vast, vast, vast majority of patients with OE do not need oral antibiotics at all.

OE is correctly treated by cleaning the ear under otoscopic or microscopic guidance, i.e., by a physician, and then having the patient apply ear drops once or twice daily for several days.

During and immediately after treatment, the patient should prevent any water (shower, lake, pool, ocean) from entering the ear by using commercially available ‘water protection’ ear plugs or by using cotton balls in the ear coated with petrolatum jelly to make them waterproof. Dry cotton in the ears will very effectively wick the water into the ear canals, accomplishing exactly the opposite of the goal.

If the ear is infected for too long or the patient has an underlying serious medical problem that interferes with wound healing (such as bad diabetes), the surrounding tissues can get infected, and then the treatment would include oral antibiotics.

Sometimes, the initial bacterial infection in the ear canal is overrun by a fungus. Fungal OE itches like crazy. Regular antibiotic ear drops are not the correct treatment for fungal OE. Your doctor should clean the ear very carefully and thoroughly in these cases, and then particular medications that are effective for fungal organisms are applied to the ear, either by the doctor and/or by the patient at home. Water protection is very important in these cases, as fungi love a moist, dark, warm environment!

If you or your child do not have OE but are predisposed to it, you should wear ear plugs and perhaps even a bathing cap or neoprene ear band (these are all available commercially) to protect your ears when you swim or bathe. You should also ‘shake’ any water that has entered the ear canal out, and can use either a hair dryer – on low, cool (don’t burn yourself!) – or you can buy a commercially available ‘ear dryer’ to gently dry up any droplets. Additionally, if your ear drum is fine – no perforation or hole or tube – you can put a drop or two of rubbing alcohol in your ear to eliminate any remaining water droplets. If your ear hurts or burns when you put in the alcohol, STOP! and go see an ENT specialist right away.

Have a great rest of the summer!

Dr. Chandrasekhar