Ask the Pharmacist

Q) I was at the beach on the weekend and now my left ear hurts like the dickens and my sense of hearing seems muffled. What’s going on?

A) As Canadians adjust to a summer best spent on this side of the border and away from the confined quarters of the local mall, our numerous and beautiful beaches are becoming prime destinations for an escape from the drudgery of our homes. One of the unfortunate realities of swimming at these beaches is that sometimes the amount of bacteria in the water can be quite high making some swimmers susceptible to an ear infection known as acute diffuse external otitis, or, as its better known by, swimmer’s ear.

Interestingly enough, according to a study conducted by the University of Iowa, swimmer’s ear is actually more commonly found in people who are, in fact, not swimmers. According to their data, most cases are found in people who spend plenty of time outdoors such as farmers who are exposed to wind and rain for long periods of time.

This seems odd but it makes sense when you consider the genesis of swimmer’s ear, which in 98% of cases in North American can be attributed to bacteria. Yes bacteria can be found in lake water, but there plenty of other sources of it as well. These include sand, grit or other small debris and water from other sources such as excessive sweat or humidity. When moisture from any source gets in the ear, it can remove some of your ear wax thereby softening the skin and making it easier for bacteria to get in.

Let’s tangent away for a second to talk about our poorly misunderstood friend ear wax, or cerumen as it’s known in the medical community. It is amazing to me that such an innocuous and helpful substance as this has spurred the growth of a billion dollar industry designed to remove it, even if it means damaging our ear drum in doing so (yes, I am looking at you Mr. Q-tip).

Ear wax is produced by glands in our ear canal and carries out several vital functions. One is it provides a thin waterproof film that forms on the skin of our ear that helps prevent water from damaging that skin. It also collects potentially harmful debris such as dead skin and dirt and transports them out of the ear where they form a waxy clump at the opening of the ear canal. Lastly, it contains chemical properties which give it antibacterial activity, a very handy quality when we recall the source of most ear infections.

Now, let’s return to our discussion of otitis externa. Water, from any source poses multiple threats to our ear health.  As noted, it can bring bacteria with it and remove our protective ear wax. Water also serves as a great breeding ground for any bacteria that has already been introduced into the ear allowing it to reproduce rapidly. Bacteria love a warm and moist environment so a wet inner ear is a near perfect location for it to thrive.

Other causes of swimmer’s ear include trauma to the skin of the ear canal usually in the form of a scratch or a scrape from the insertion of a cotton swab or the use of inner ear products such as ear buds or a hearing aid.

Skin disorders such as eczema, acne or psoriasis can also damage the skin allowing bacteria to enter. A tiny scratch is all that is needed for bacteria to penetrate the skin and start the inflammatory process that results in the classic symptoms of swimmer’s ear. These include pain, of course, as well as the possibility of redness and swelling both in the outer ear and within the ear canal, a watery or pus-like discharge which may give off a foul odour (but does not necessarily mean you have perforated your ear drum), sore and perhaps swollen lymph nodes (glands) in the throat, some degree of hearing loss (usually described as muffled), a sensation of tenderness when you move the ear or jaw, scaly skin in and around the ear canal which my eventually start to peel off and itchiness in and around the ear canal.

Diagnosis can easily be made by a doctor by looking into your ear using an instrument known as an otoscope. However, in this day and age of COVID where seeing your doctor is neither as easy nor as safe as it usually is, one can usually compare your symptoms to the above list and perform the following test to get at least a pretty good idea if this is indeed the issue with your ear. The test involves pulling on your outer ear or pushing on the little “bump” in front of your ear (known as the tragus) and seeing if you notice at least a mild discomfort.

The reason being able to self-diagnose this just a little is so nice because this is the rare infection you can usually successfully treat without seeing a doctor. For those with an intact ear drum, an over the counter antibiotic ear drop such as Optimyxin or Polysporin instilled in the ear at 3 to 4 times a day for 7 to 10 days should treat the majority of the cases.

I actually prefer to use the eye version of the Polysporin brand in the ear as opposed to the ear version (they both use the same antibiotics at the same strength) as the ear version has an anaesthetic which can numb the pain but comes with two downsides to it. First, it is not uncommon to be allergic to the anaesthetic used. Secondly, the severity of your pain is the best guide you can use to determine just how well the drops are working.

There is a chance you can mask a worsening ear infection by artificially numbing the ear drum leaving you at risk for rare but serious complications such as an abscess (a pus filled growth), cellulitis (a bacterial infection of the deeper layers of the skin), otomycosis (a fungal infection of the ear), stenosis (when the now chronic infection leads to thick dry skin accumulating in the ear canal thereby narrowing it and possibly leading to hearing loss) or, in a worse case situation, malignant otitis externa which happens when the infection moves into the bone and cartilage of your head. All of these complications require more aggressive type treatments from your doctor so it is best, as it is with just about any medical concern, to get on top of treating swimmer’s ear promptly.

Sometimes it is not appropriate to self-treat a suspected case of swimmer’s ear. If the discharge from your ear is white, yellow or bloody or if you have had discharge for more than 5 days you should absolutely consult your doctor. Other signs or reasons that indicate you should see your doctor is if the pain is severe, if you are having other “systemic” symptoms such as a fever or a feeling of “unwellness” or if the antibiotic drops you have chosen have not made a positive impact after 72 hours of use.  Your doctor has a bevy of treatment options available including other, possibly stronger antibiotic drops, adding a cortisone drop to the treatment to reduce the pain and swelling within the ear or possibly adding an oral antibiotic on occasion.

For those who seem to get these nuisance infections frequently, there are a number of steps you can take to help prevent them in the future. Before swimming, check out the local public health website for a recommendation as to whether water bacterial counts are too high at your intended beach. Use ear plugs with or without an ear band (a neoprene band that wraps around the head and kelps keep out water while keeping the ear plugs in). Dry your ears after swimming and showering.

There are various over the counter drops that can acidify the ear making it less hospitable for bacteria to grow in. These can be used both before and after water exposure and include such products as Auro-Dry and Swim-Ear. Or you can make your own version by combining 1 part white vinegar with one part water or isopropyl alcohol and adding 5ml to each ear and then allowing them to drain out (note these should not be used in people with tubes in their ears or a history of damaged or ruptured ear drums).

Lastly, for heaven’s sake keep cotton tipped swabs and your finger out of your inner ears where they can damage the skin. For more information about this or any other health related questions, contact your pharmacist.