Zellers

The ear is divided into three separate compartments - the inner, middle, and outer ear. The inner ear contains the balance organs and the nerves vital to hearing. The middle ear contains the bones that link the eardrum to the inner ear. The eardrum separates the middle and outer ears. The outer ear is simply the earlobe and a short tube leading to the eardrum.

Infection of the inner ear is called labyrinthitis, which can be serious. Infection of the middle ear is called otitis media. It can cause temporary hearing loss and can progress to the inner ear if ignored. Infection of the outer ear is called otitis externa or swimmer's ear. It's rarely serious.

All forms of ear infection are most common in children, but adults are more susceptible to swimmer's ear than they are to middle or inner ear infections. While children under the age of 6 account for most cases of otitis media, older children tend to get swimmer's ear.

There are no incidence statistics for swimmer's ear because it's usually just a passing earache that is often not reported to the family doctor. It's known to be most common in summertime, largely because that's when children are most likely to go swimming.

Swimming isn't the only way to get swimmer's ear. You can also be infected if hairspray or other liquids get into the ear canal. The bacteria (and occasionally fungi) that cause swimmer's ear don't necessarily live in the water. Many of them are already in the ear canal or are picked up in everyday life. However, water or other foreign liquids in the ear can provide an ideal breeding ground for them.

You can also trap bacteria in the ear by using cotton ear swabs. The skin of the ear canal slowly moves outward like a conveyor belt, carrying shed fragments of skin away from the eardrum. Pushing a cotton swab into the ear goes against this process, and causes dead skin and earwax to build up. Occasionally, scratching the ear canal can also promote infection. This tends to trap moisture in the ear. Moist skin and tissue create a friendly environment for bacteria and allow them to multiply, causing infection.

It's been found that people with the following conditions get swimmer's ear more easily:

• allergies
• diabetes mellitus
• eczema
• psoriasis
• seborrheic dermatitis (in which dandruff is the most common symptom)

The main symptoms of swimmer's ear are severe pain or itching in the ear and tenderness in the earlobes.

The tissue in front of and below the ear may become swollen and tender. There's often a lot of earwax and skin debris in the ear canal. More severe bacterial infection sometimes causes yellowish pus to drain out. This may have an unpleasant smell. Fungal infections can create a grey-white pus.

Pus, wax, and skin debris may block sound waves from reaching the eardrum, causing temporary reduced hearing. This isn't a sign of ear damage. As a rule, you shouldn't worry about the infection spreading to the middle or inner ear, as the eardrum won't let fungus and bacteria to pass. The middle ear is usually only infected through the tubes that connect it to the throat (the Eustachian tubes). The eardrum itself is not as delicate as most people think.

Complications of swimmer's ear are extremely rare, except in people with diabetes. One of the ear's main ways of defending against bacteria is the acidity of earwax. Unfortunately, earwax in people with diabetes is often quite alkaline. A low level of acid in earwax encourages particularly severe infections that can spread into the surrounding bone. This is called malignant otitis externa, and it's usually only seen in people with diabetes or weak immune systems.

A doctor will check to see if pulling the earlobe gently or pushing the tragus, the small flap of ear just in front of the canal opening, causes pain. If these symptoms are present, you can be pretty sure it's an external infection (swimmer's ear) and not otitis media. Fungal swimmer's ear, which occurs infrequently, is generally less painful.

A lab culture will be made to identify the particular organism only if the first treatment prescribed doesn't seem to be working.

Many swimmer's ear infections can be stopped early by maintaining the acidity level of the ear canal by putting a few drops of Burow's solution, vinegar, rubbing alcohol, or hydrogen peroxide into the ear canal, then letting it drain out. Some over-the-counter eardrops will cure swimmer's ear.

Swimmer's ear can also be treated with prescription eardrops containing an antibiotic with or without a corticosteroid medication. First, the debris is cleared out of the ear canal, and then the eardrops are put in. In severe cases, if the canal is partly closed by inflammation, a wick can be inserted to draw the eardrops in. The wick expands and holds the medication close to the infected area in the ear.

You can prevent swimmer's ear in children who are coming out of the water by draining the ears. Using an eye drop dispenser, suck the debris and water out of the ear canal. It's normally painless, and stinging is often a sign that some infection or inflammation is already present. This is much more effective than wearing earplugs. Ask your pharmacist for advice. If you or your child gets recurrent infections, or if these measures do not work, visit your family doctor.

Remember, it's always a good idea to dry the ears thoroughly after showering or swimming. A hair dryer set on the lowest setting can be used. Never direct a shower jet directly into the ear canal.