Introduction
When we speak of water in the ear, we can speak of two fundamentally different phenomena. On the one hand, it can be a very common phenomenon that can occur when the ear comes into contact with water. This is probably known to almost everyone who has ever been in a swimming pool: after you emerge from the water, you notice that water has settled in your ear.
In contrast to this phenomenon, where water enters the ear from the outside, there is also the possibility that water can form inside the ear. To be more precise, this is not water at all, but rather an effusion fluid in the area of the middle ear. Nevertheless, this phenomenon, known as tympanic effusion (also called serotympanum, mucotympanum or seromucotympanum), is also colloquially referred to as “water in the ear”.
Water in the ear after swimming
Probably in by far the most common cases, water enters the ear from the outside. This happens mainly when diving in a swimming pool, but can also happen at home when showering or bathing. The penetrating water collects in the elongated external auditory canal and remains there.
The external auditory canal is the part of the ear that conducts sound inwards towards the eardrum. This is located at the inner end of the external auditory canal and thus protects the middle and inner ear behind it from water penetration. The fact that the ear canal is part of the sound conduction system explains why water in the ear impairs the hearing ability of the affected side.
Furthermore, the movement of the water in the ear canal is often noticeable. Usually, water remains in the external auditory canal without any underlying problem of the ears. However, some conditions may favour the inclusion of water.
These include so-called exostoses, which are small bone protrusions in the area of the external auditory canal. These have no disease value and may be congenital or may have developed only in the course of life. Although harmless in themselves, these exostoses can cause problems by constricting the auditory canal and can thus lead to the easier inclusion of water that has penetrated the ear.
The same applies to the cerumen obturans, an accumulation of large amounts of earwax (cerumen) in the ear canal. This causes the ear canal to become partially or completely blocked and water can accumulate. If water has entered the ear from the outside and remained there, there are various ways to get it out again.
For example, it can be helpful to tilt the head to the side. Sometimes this is enough to allow the water to flow outwards under the force of gravity. If this is not successful, the head can be shaken additionally, or jumped on one leg with the head tilted.
Other possibilities are to lie on the side of the affected ear, or to exert suction on the ear canal by closing the ear with the flat of the hand and pulling the hand away. In the vast majority of cases, these “home remedies” allow the stuck water to dissolve by itself. However, if all such attempts fail after a long time, a doctor must be consulted.
This doctor can gently rinse the ear, which can loosen trapped water. If there are large amounts of earwax, the measure can also help to treat the cause, as the cerumen is dissolved. Water penetrating from the outside can lead to an inflammation in the area of the auditory canal.
This is especially the case if water remains there for a long time or does not completely return to the outside. The water softens the ear canal skin and earwax. As a result, it becomes easier for pathogens to pass through the skin barrier in the area of the auditory canal and cause an inflammation at this point.
Since the external auditory canal is part of the so-called outer ear, the disease is called Otitis Externa (inflammation of the outer ear). Signs of such an inflammation can be pain, swelling and discharge of pus. The inflammation then requires medical treatment.
With regard to water infiltrating from the outside, a certain amount of prevention can be taken. This can at least reduce the probability of water getting trapped in the ear. Most importantly, it is important to avoid cleaning the ear canal with cotton swabs.Apart from the fact that the eardrum can also be seriously damaged, it is still possible to compress the earwax.
Instead of removing it from the auditory canal, the opposite effect is more likely to occur: the compact earwax collects in the auditory canal and makes it easier for water that has penetrated to remain there. To prevent water in the ear when swimming, waterproof earplugs are still available. Water that has entered the ear from outside is liquid that forms inside the ear.
Due to its clear appearance, it is similar to water. However, it is an effusion fluid, i.e. fluid that is released from the body and accumulates in a cavity. In this case the cavity is the so-called tympanic cavity of the middle ear.
The middle ear lies against the inside of the eardrum. Its function is to amplify the sound arriving from outside via the eardrum and to transmit it to the inner ear. This is where the sound is ultimately transmitted in nerve impulses that are sent to the brain.
Several factors are involved in the development of a tympanic effusion, but in principle it can be assumed that the ventilation of the middle ear is disturbed. Anatomically, there is a connection between the pharynx and the middle ear, the so-called (ear) trumpet (Tuba auditiva, tube or Eustachian tube). This connection is used by healthy people to equalize the pressure between the middle ear and the surrounding area when swallowing.
Various conditions can make this pressure equalization more difficult, resulting in a negative pressure developing in the area of the tympanic cavity in the middle ear. This ultimately promotes the development of tympanic effusions. Here it is important to distinguish whether the causes are only present for a short time or whether they persist for a longer period of time.
Acute causes are often swellings in the nasopharynx during acute infections. If chronic tympanic effusions exist in adults, possible causes include enlarged pharyngeal tonsils, anatomical malformations of the throat, sinusitis, recurring middle ear infections, as well as benign and malignant tumors in the pharynx area as possible triggers. In tympanic effusion, the fluid is not located in the external auditory canal, but in the middle ear.
This explains why affected patients have different symptoms than those that may occur after bathing. If a tympanic effusion exists in the context of an acute infection, stabbing ear pain may occur. Other common symptoms are crackling noises in the ear when swallowing and reduced hearing.
In case of an existing tympanic effusion, dizziness or whistling in the ears (tinnitus) may also occur. In the case of chronic tympanic effusion, there is usually no ear pain. The leading symptom is a feeling of pressure in the area of the affected ear or ears.
In addition, hearing loss also occurs in chronic effusion, which can also worsen over time. The first step is the medical consultation. The patient describes his symptoms and their development over time.
After the conversation, the doctor proceeds to the physical examination. If a tympanic effusion is suspected, this includes an inspection of the ear using a so-called otoscope. This is a funnel that is connected to a light source and inserted into the ear canal.
This allows the external auditory canal and the eardrum to be assessed. In the case of a tympanic effusion, the experienced physician can usually make the diagnosis by this procedure, which only takes a few seconds, since characteristic changes of the eardrum are revealed. An ear microscope can also be used for evaluation.
Further examinations are aimed at diagnosing a possible existing hearing loss. A hearing test (audiogram) is performed for this purpose. In addition, an existing negative pressure in the middle ear can be diagnosed by means of a probe that is inserted into the ear canal (tympanometry).
The therapy of a tympanic effusion depends on its cause. If it is an acute infection in the nasopharyngeal area, for example during a flu, the tympanic effusion usually disappears as the infection subsides. Nose drops and expectorant medication can be used for a short period of time to help reduce the swelling.
For some infections, the use of antibiotics can be useful. The patient can also learn certain maneuvers that are intended to help ventilate the tympanic cavity.If the effusion does not subside over time, it may be necessary to perform a paracentesis. This is a small procedure that is usually performed under local anesthesia.
A small incision is made in the eardrum via the auditory canal. The effusion can be removed through the hole. If there are anatomical changes that interfere with the ventilation of the middle ear, these are usually corrected surgically.
If paranasal sinusitis is the probable cause, it must be treated. Therapy is then carried out with decongestant nasal drops, mucolytic drugs and possibly antibiotics. The prognosis for tympanic effusions depends on the cause.
Since almost all people had one at least once as a child and most of them do not have any problems later on, it can generally be stated as good, however. There are no reasonable possibilities for the prevention of a tympani effusion. At best, it can be urged to take the described symptoms seriously and to introduce yourself, or the child, to the doctor.
With early therapy, speech development disorders can be prevented in the child. However, even in adults, especially in the case of chronic tympani effusion, there are possible long-term complications in the ear that can be avoided by early therapy. Due to certain anatomical preconditions, children have a significantly increased risk of developing tympanic effusions compared to adults.
This is also reflected in the figures: it is assumed that up to 90% of people have suffered from tympanic effusion at least once in their childhood. Of particular importance with regard to the cause is the so-called polyps in children. The term is wrong in the actual medical sense, because in this case it is not a matter of a developed proliferation, but rather of an enlarged anatomical structure, the pharyngeal tonsil (Tonsilla pharyngea).
In children, the pharyngeal tonsil enlarges in the course of the natural confrontation of the child’s immune system with invading pathogens. This can result in the pharyngeal tonsil increasing in size to such an extent that it restricts nasal breathing by partially closing the child’s throat. As in adults, in this case a disturbance in the ventilation of the tympanic cavity can lead to a tympanic effusion.
If a tympanic effusion occurs in children, short and possibly recurring earaches are a common symptom. Furthermore, there is hearing loss in the affected ear or in both ears. However, children often do not notice this or do not express the change to their parents.
It is also difficult to detect hearing loss in small children, as they may not be able to express themselves at all. Since language is learned through hearing, bilateral tympanic effusions, which can last for months, are a serious problem for children and infants. In these cases, language development disorders can occur.
This makes it all the more important for parents to pay close attention to their child’s behavior. Delayed language development, unusually loud speech, but also unspecific changes, such as deterioration at school, should be reported to the pediatrician. These can be symptoms that indirectly indicate chronic tympanic effusion.
Timpani effusions have a strong tendency to recede in the child and are usually treated with a two-week antibiotic treatment first. Children can also inflate balloons to improve the ventilation of the tympanic cavity. If the treatment is not sufficiently successful, an operation (paracentesis) should be considered.
This minor procedure is performed in children, in contrast to adults, under short general anesthesia. An incision is made in the eardrum to allow the effusion to drain away. The insertion of so-called tympanic tubes, which remain in the eardrum for several months, may be considered.
This can improve the ventilation of the middle ear. Nowadays, however, this is usually dispensed with first. If an enlarged pharyngeal tonsil is responsible for the tympanic effusions, surgical removal of the tonsils should also be considered.
