Summer is the season of vacations, vacations at sea and frequent visits to swimming pools. Swimming, apart from being a pleasant activity, can also be a predisposing factor for some infections, especially in questionable water pools from a hygienic point of view. Thus, during the summer season, cystitis, some skin infections (most often fungi), as well as inflammation of the external auditory canal, better known as swimmer’s otitis, become more frequent.
The water that remains in the ear after swimming creates a good environment (warmth and moisture) for the development of various microorganisms – most often bacteria and much less often viruses or fungi. It is important to note that it is not necessary to develop an infection after swimming, as the ear canal has a number of defense mechanisms. For example, earwax performs a barrier function (covering film) for the auditory canal. Accordingly, cleaning it too often leads to an increased susceptibility to infection.
Other risk factors are the entry of foreign bodies into the external auditory canal, injuries to the skin of the ear, reduced immune protection, various skin diseases – chronic eczema, atopic dermatitis, some metabolic diseases – for example, diabetes, and others. Children are relatively more vulnerable and more prone to developing otitis externa.
The preparations that are used to disinfect the water in the pools – most often halogen disinfectants ( chlorine ), irritate the skin of the auditory canal and, accordingly, can help the penetration of pathogenic bacteria through the epithelium.
What is the clinical picture?
The condition is acute and the first symptoms appear a few hours after visiting a pool or beach.
The ear canal is covered with foul-smelling secretions, and the cartilaginous part of the ear canal is painful when pressed. Most often, the tympanic membrane remains unaffected by the inflammatory process, but if the inflammation spreads to its structure, the symptoms increase in intensity.
Patients complain of moderate to severe itching. There is discomfort when pressing on the ear with a finger or when slightly tugging. In the presence of secretion – at first, it is most often clear, and subsequently, it can turn purulent.
A common symptom is a feeling of deafness, and hearing can be reduced to varying degrees. Accumulation of secretion, due to the presence of an inflammatory process, makes it difficult to examine the tympanic membrane. This requires the ear to be flushed first and then re-examined. Washing is contraindicated in cases in which there is a suspicion of impaired integrity of the tympanic membrane.
Regional lymphatic vessels can also react – they increase in size, and they become painful. In the case of a more deeply penetrating infection, the inflammation can affect other nearby structures – the parotid gland, the mastoid process, and others.
Treatment begins with the application of topical corticosteroid creams, which aim to reduce inflammation and, accordingly, swelling and redness. In addition, antibiotic ointments or drops are added, again topically, to eliminate the pathogenic flora. Most often, a broad-spectrum antibiotic is selected in combination with an antifungal preparation. In more severe cases, systemic antibiotic treatment is required.
In the case of local treatment, it is important to apply the drops after preliminary rejection of the possibility of impaired integrity of the tympanic membrane, because otherwise, the drops may introduce the infection into the middle ear, which will lead to otitis media.
In case of severe pain, pain-relieving drops containing lidocaine, as well as systemic administration of analgesic or non-steroidal anti-inflammatory drugs, are prescribed.
