This is the first in a series of posts to explain some common medical problems to patients in a hopefully easy-to-understand manner.
Otitis externa (or “swimmer’s ear”) is an inflammation of the outer portion of the ear canal. It is different from a middle ear infection (“otitis media” or the typical “ear infection” that typically afflicts children) because otitis externa affects only the ear canal (see the red area in the picture below) while otitis media is a collection of pus behind the eardrum (see the yellow area in the picture below) that does not affect the ear canal.
Patients with otitis externa often have significant pain in the outer ear and may have swelling and/or drainage from their ear canal. One of the easiest ways to tell whether a patient has swimmer’s ear is the “tragal tug” — pulling outward on the cartilage of the ear (like your mother used to do when she was mad at you). Pulling on the ear will cause traction on the skin within the ear canal. When the skin inside of the ear canal is inflamed and is stretched, it will hurt. Therefore, patients with swimmer’s ear will usually have significant pain when their ears are pulled. The pain from inner ear infections usually doesn’t get much worse with the tragal tug — unless otitis externa is also present.
Mild cases of otitis externa can sometimes be treated by putting Burow’s Solution into the ear canal a few times a day. When a patient is diagnosed with otitis externa, drops containing antibiotics and steroids are often prescribed. It is a good idea to check the ear drum for signs of perforation before putting medications into the ear. If some medications get into the inner ear (the yellow area above), they can cause dizziness, ringing in the ears or even hearing loss. For example, Cortisporin Otic and other aminoglycosides have the potential to damage the vestibula with prolonged use. Quinolone/steroid combinations are less likely to cause such damage.
The Ear Wick
If you put drops into the ear canal and then stand upright, then the drops all collect on the bottom of the ear canal. Eventually, they either get absorbed or they drain out of the ear canal. Additionally, if the ear canal is swollen shut or nearly swollen shut, the medications may not get to the affected areas in the ear. An ear wick solves both problems.
An ear wick is a piece of sponge (or sometimes a piece of cotton) that is inserted into the ear canal. Topical medications are then put onto the ear wick and then capillary action pulls the medication further into the ear canal. The wick helps to keep the medications in the ear and helps to hold the medication along all surfaces of the ear canal.
As the ear heals, the wick usually falls out on its own. If not, a medical professional can easily remove it.