How to treat swimmer's ear

[Clark Fletcher]

Obviously I don't know what happened in your particular case. I do feel obligated to point out that (with one unlikely exception) an outer ear infection ("swimmer's ear") does not extend to the inner ear, compromise blood flow to the cochlea, or cause a permanent and total loss of hearing. The exception is something called malignant otitis externa, which is a disease occasionally seen in elderly diabetics where infections spreads to the bone of the skull base and can affect the inner ear. Not a typical complication of swimmer's ear.

Can you share more about your case?

Hey @doctormike. I'd be happy to share as much as I can recall from the injury. First, the ear infection was not diving related. It was about five or six years ago, before I started back diving again. I just thought I should stress the importance of getting checked at the first sign of trouble with your ears.

As I mentioned, I went to bed one evening feeling fine (i.e. no pain or discomfort in my ears). When I woke up the next morning, I was completely deaf in my right ear. I scheduled an appointment with my regular physician and was diagnosed with an ear infection and was told that the ear drum was not perforated. My physician prescribed a treatment with antibiotics which cleared up the infection. However, my hearing never improved. During that entire time, I never experienced any pain in my ear.

Subsequently, I scheduled an appointment with an ENT Physician who checked me, ran a few tests, and declared that my auditory nerve had been damaged. I'm not sure exactly how he determined that. From there I think much of it was speculation as to exactly what caused the damage but, he surmised that swelling in my ear had cut of blood flow to the auditory nerve resulting in permanent damage to the nerve. Honestly, I don't remember if he specifically mentioned where in the auditory canal the swelling might have occurred. He prescribed a steroid treatment hoping that it may result in some healing of the auditory nerve. However, he was not optimistic that it would help as it was now several weeks after the hearing loss occurred. Apparently, steroid treatments are typically only successful if they are administered within the first week of the hearing loss. He did, as a precautionary measure, schedule me for a CT of the head. He told me that sometimes a tumor on the auditory nerve can result in a sudden loss of hearing as I had experienced. I knew that to be true because a friend of mine's mom had experienced exactly that. The CT showed no tumor.

Again, all of that started about five years ago. To date, there has been no overall improvement in my hearing. From time-to-time I can detect a faint buzzing in my right ear. For example, if I listen to music with earphones and remove the earphone from my GOOD ear, I can detect a buzzing in the bad ear. Other times I can do the same thing and there's no sound at all.

That's about all I can remember. If you have any questions, let me know.

 

[doctormike]

Thanks, Clark...! Sorry you had to go through that. I think that there is some misunderstanding here, and I just want to clear this up for divers concerned about swimmer's ear.

What you describe sounds like sudden sensorineural hearing loss (SSNHL). This is a condition that happens when the inner ear (the cochlea) just stops working. No one knows why this happens, but one theory is that this is an autoimmune process where the body's antibodies attack the inner ear tissues, which is why steroids are often tried. They don't always work, but there is some evidence of helping if they are started early. In rare cases, the blood supply to the ear may be compromised (as in a stroke, or inner ear DCS), but this is not something that is caused by problems in the ear canal.

This condition has nothing to do with the outer ear, or the middle ear for that matter. Swimmer's ear is a condition with inflammation and swelling in the outer ear canal, which has no connection to the cochlea or the rest of the inner ear.

 

[Clark Fletcher]

What you describe sounds like sudden sensorineural hearing loss (SSNHL). This is a condition that happens when the inner ear (the cochlea) just stops working.

So, if what I'm experiencing is SSNHL, is it possible that the auditory nerve is not damaged and that a cochlear implant might correct my hearing problem?

Edit: OP, sorry for getting off topic.

 

[doctormike]

No, SSNHL can be either the cochlea or the nerve. I sort of oversimplified it in my last post, but not a lot is understood about the pathophysiology. That's why it's called sensorineural - sensori is cochlea and neural is nerve. These two things both cause the same type of hearing loss. Cochlear implant is really for people with no hearing in both ears. It doesn't switch on normal hearing, it's provides signals that you then train your brain to interpret as sound. If you have normal hearing in the other ear, probably not a CI candidate (although I don't do them myself).

 

[Saniflush]

Hey, knitting needles were invented... I don't recommend putting those in your ears either..!

Well duhhhhh. That's what q-tips are for.

 

[tridacna]

Mike,

What is YOUR recipe for ear beer?

Thanks.

 

[taimen]

I use boric acid/ethanol eardrops (available over the counter in my part of Europe) after swimming/diving. 2-3 drops before bed is enough to keep swimmers ear away.
If I start getting swimmers ear symptoms, I may use fluticasone nose spray into the ear canal twice a day for 2 days, continuing the boric acid/ethanol drops 3-4 times/day. Prolonged use of steroids like fluticasone is harmful, this is actually off label use of a prescription drug and so on, so take this advice with a grain of salt.

 

[doctormike]

Good question! "Ear beer" has to do two things - you want to dry the ear (alcohol) and you want to drop the pH (vinegar). The most common ear bacteria (Pseudomonas) doesn't do well in acidic environments.

So you don't need a lot of vinegar, since all you need to do is drop the pH, but vinegar is mostly water, so using a lot of it keeps the ear wet. I tell people to get a pint bottle of rubbing alcohol, pour out a few tablespoons and replace them with vinegar, and if you have some glycerin, a few drops of that can keep your ears from getting over dried.

This is an easy thing to make, even in remote tropical locations.

Lately, I have been using this, as recommended by my instructor Wayne... it actually helps keep me from getting swimmer's ear, especially in fresh water like Dutch Springs.

 

[doctormike]

If I start getting swimmers ear symptoms, I may use fluticasone nose spray into the ear canal twice a day for 2 days, continuing the boric acid/ethanol drops 3-4 times/day. Prolonged use of steroids like fluticasone is harmful, this is actually off label use of a prescription drug and so on, so take this advice with a grain of salt.

There is no possible way that nasal steroids can have any effect on swimmer's ear. They are sometimes used for people with middle ear problems (barotrauma) to improve Eustachian tube function, but even that has not been clinically proven.

Flonase is actually over the counter now, pretty safe drug, not a lot of steroids absorbed into the system. The main side effect is nosebleeds.

 

[taimen]

I use the nasal spray into the ear canal. The nasal spray is readily available over the counter.