Ear Canal Problems


 

Swimmer’s ear

Swimmer's Ear is an inflammation
or infection of the outer ear canal.

Symptoms

  • Ear pain- The ear may become very painful and tender to touch (especially on the cartilage in front of the ear canal)
  • Jaw pain, particularly when chewing
  • Ear itchiness
  • Swelling of the skin within the ear canal
  • Hearing loss. A feeling that the ear is blocked
  • Ringing or other noises within the ear
  • Watery or creamy discharge
Causes
  • Importance of ear wax: moisture, local trauma, and allergic or skin disease lead to a loss of the protective wax layer that normally protects the ear canal. Without the wax, the skin can become swollen and the bacteria or yeast that usually lives on the surface of our skin in small numbers, can grow unchecked.
  • For swimmers, the problem is that the water washes away the ear wax and also leaves behind moist, swollen ear canal skin. Those conditions makes it much easier for bacteria to grow. Otitis externa is five times more common in regular swimmers compared to non-swimmers.
  • For those with a mild skin disorder, such as eczema or psoriasis, the ear canal skin does not produce the normal protective ear wax and sometimes accumulates excessive amounts of sloughing dead skin.   In addition, this condition causes the skin to be very itchy. Out of desperation, people cannot resist scratching the ear canal with something, such as a Q-tip or bobby-pin. The ear canal can become abraded and more vulnerable to infection.
  • Hot, humid, and 'sweaty' weather can initiate otitis externa. It is more common in hot countries.
  • Commonly occurs for no apparent reason. Perhaps simply getting water, shampoo, soap, hair spray in the ear canal or cleaning the ear with candling, a syringe or other wax softener or Q-tip caused enough irritation to the canal skin to start the infection.
Treatment
  • A doctor or nurse practitioner will usually clean the ear canal. Gentle suction may be used. Avoid any syringing.
  • Often a special tiny sponge is inserted into the ear canal when it is swollen. This is very valuable because it can deliver the antibiotic medicine deeper within the canal and will hold it where it can work for longer.  You should discuss with your doctor how the ear wick (otowick) will be removed. 
  • A doctor may also use a swab of the ear canal to find out which germ is causing the infection. This helps to guide the choice of antibiotic ear drops to use.
  • Ear drops
    Prescription ear drops usually contain an antibiotic to clear any infection and a steroid to reduce the inflammation and itch. The drops must be applied properly to be effective and are usually applied twice a day. It may take a week or two of treatment for symptoms to go completely.

    Use of ear drops for weeks will often lead to the overgrowth of yeast, a new problem.

    Some ear drops can cause an allergic reaction. If the outer ear is getting more red and itchy, stop the ear drops and call your doctor. Also some ear drops can be expensive if not covered well by your insurance. If this is the case, also call the office.
When you use ear drops:
  • Lie with the affected ear upwards.
  • Put several drops in the ear, and lie in this position for 5-10 minutes.
  • Press the cartilage at the front of the ear canal a few times to push the drops deep inside the ear canal.
  • The ear drops are only working when they are in contact with the ear canal and they will drain out when you turn over or sit up. It will be less messy if you put some cotton in the outer ear before getting up. After a few minutes with your head upright, you can discard the cotton.
Antibiotics by mouth
  • These are sometimes needed if the infection is severe.
General measures
  • Keep water away from the infected ear.
  • As a rule, do not leave balls of cotton wool in the ear canal. However, if the discharge is heavy, you may need to place some cotton wool lightly in the outer part of the canal to absorb the discharge. Clean just the outside of the ear with a cloth when any discharge appears.
Painkillers
  • Tylenol or, even better, ibuprofen (Motrin) will usually ease any pain.
Prevention
  • Try not to let soap or shampoo get into your ear canal. You can do this when you have a shower by placing a piece of cotton ball coated with Vaseline into the outer ear or purchase ear plugs. Customized plugs are available in our office.
  • Let the ear dry naturally. Or dry the ear canal with a hairdryer, held at least 6 inches from the ear or a specialized commercial ear dryer (DryEar).
  • When you swim try to keep your ears dry. You can do this by wearing a tightly fitting cap that covers the ears. Some swimmers use silicone rubber earplugs or customize-fitting ear plugs.
  • Swimmers - use the neoprene head strap Ear Bandit (available in many pharmacies) or swimming cap to hold ear plugs tightly in the ear canal.
  • After swimming, exercising or showering, rinse the ear canal with a few drops of a home-made drying solution. This can be prepared by mixing 2-3 tablespoons of white vinegar in a pint of rubbing alcohol. The vinegar, a weak acid, kills many bacteria while the alcohol serves as both a drying agent and an antibiotic. Avoid this solution if you have an eardrum hole or ventilation tube in place.

Yeast infections of the ear canal

This is a different type of infection because the antibiotic ear drops that are often prescribed to stop a bacterial ear canal infection are now the cause of the problem. Yeast infections of the ear canal, called otomycosis, often has a distinctive appearance to the doctor and usually can be diagnosed on examination of the ear. Sometimes it is necessary to get an ear culture to recognize it.

Symptoms

  • Blocked, often very itchy ear
  • Usually less painful because the ear canal is less swollen
Treatment
  • Yeast infections can be more difficult to treat than bacterial infections. They require patience, persistence and meticulous care of the ear canal. This may require several visits to your doctor.
  • Cleaning of the ear canal by your doctor. Yeast infections tend to create a lot of gooey debris. It helps to clean this out routinely. It reduces the amount of yeast and allows the medicine to work better. This is not really possible without the capability to see safely into the ear canal and to have the needed suction equipment of the doctor.
  • Antifungal ointments. This is performed by the doctor only.
  • Gentian violet can be painted inside the ear canal by the doctor
  • DermOtic: a prescription ear drop
  • Antifungal ear drops. This requires purchasing Lotrimin solution in the athlete’s foot section of the pharmacy. Follow your doctor’s directions.
  • Acetic acid solution. This acidic fluid will suppress yeast infections, but is usually more effective after the infection has been well-controlled.
  • Strict water avoidance.
  • If you wear a hearing aid, the less it is in the ear canal, the better the chances of return to normal.
  • Avoid ear plugs in ear canal.

Ear Itchiness

This very annoying problem can be associated with flakey skin of the outer ear and ear canal.  It is usually due to a mild dermatitis of the ear canal skin, such as eczema or psoriasis. Avoid scratching the ear canal with Q-tips, bobby pins and other objects that might scratch the ear canal skin. Mineral oil may help, but your doctor may be able to suggest an anti-inflammatory solution that will help, such as DermOtic.

 

Exostosis of the ear canal

    

    

An exostosis is a bony growth within the deep ear canal.  Often there are more than one.  They are harmless, but if they continue to grow, they can trap water, wax or skin which can block the ear or cause an infection.

The cause of an exostosis is likely that cold water stimulates the bony of the canal to grow.  Exostoses are common among cold water swimmers, divers and surfers.

If needed, the exostoses can be removed under general anesthesia. The best way to avoid them is to wear ear plugs and consider a hood, such as SurfMuff (SurfMuff.com) or EarBandit (EarBandit.com)

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Surfers wearing a type of hood called Surf Muff

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