External Auditory Canal Microbial Flora Profiles in Swimmers and Non-Swimmers in Lombok
DOI:
10.29303/jbt.v26i4.13607Published:
2026-10-19Downloads
Abstract
The external auditory canal is normally dominated by commensal Gram-positive bacteria, but repeated water exposure may be associated with changes in its microbial profile. This study compared external auditory canal microbial flora between swimmers and non-swimmers in Lombok. This cross-sectional observational study included 60 participants (30 swimmers and 30 non-swimmers) selected by purposive sampling. Swimmers were aged ≥18 years and swam at least twice weekly for ≥30 minutes per session for at least three months at Wira Bhakti Swimming Pool. Right external auditory canal samples were collected using sterile Dacron swabs and cultured on Mueller-Hinton Agar, Mannitol Salt Agar, and Eosin Methylene Blue Agar. Presumptive identification was based on colony morphology and Gram staining. Gram-positive flora predominated (44/60; 73.3%), followed by mixed flora (9/60; 15.0%) and Gram-negative flora (2/60; 3.3%); Staphylococcus epidermidis was the predominant Gram-positive organism. Mixed flora was detected only among swimmers (9/29; 31.0%), whereas all non-swimmer samples showed monomicrobial growth (26/26), with a significant difference between groups (Fisher’s exact test, n=55, p=0.002). However, the distribution of Gram-positive and Gram-negative flora among monomicrobial samples did not differ significantly (p=0.498). Swimming status was associated with culture growth patterns, particularly the presence of mixed flora, but causality cannot be established.
Keywords:
External auditory canal Ear flora Swimmers Mixed floraReferences
Aleandri, M., Ambrosi, C., Lepanto, M., Conte, A., Marazzato, M., Longhi, C., Nicoletti, M., Zagaglia, C., Goldoni, P., Bussu, F., Anzivino, R., Gallus, R., Battista, M., Conte, M. & Palamara, A. (2019). Characterization of the ear canal bacterial flora present in hearing aids (HA) wearing subjects. Advances in Microbiology, 9: 616–628. DOI: 10.4236/aim.2019.97038
Brook, I. (2018). The microbiology of otitis externa. International Journal of Infectious Diseases, 73: 8–15.
Dahlan, M. S. (2024). Statistik untuk Kedokteran dan Kesehatan: Deskriptif, Bivariat, dan Multivariat Dilengkapi Aplikasi Menggunakan SPSS (Ed. ke-6). CV Metode Multiaksis Sopiyudin Dahlan. Jakarta.
Duan, T., Li, Z., Han, X., Hong, Q., Yang, Y., Yan, J. R., & Xing, C. (2024). Changes functional prediction of ear canal flora in chronic bacterial otitis externa. Frontiers in Cellular and Infection Microbiology, 14, Article 1434754. https://doi.org/10.3389/fcimb.2024.1434754
Forbes, B. A., Sahm, D. F. & Weissfeld, A. S. (2017). Bailey & Scott's Diagnostic Microbiology (14th Ed.). Elsevier.
Ghanpur, A. D., Nayak, D. R., Chawla, K., Shashidhar, V. & Singh, R. (2017). Comparison of microbiological flora in the external auditory canal of normal ear and an ear with acute otitis externa. Journal of Clinical and Diagnostic Research, 11 (9): MC01–MC04. DOI: 10.7860/JCDR/2017/24983.10556
Gorbach, S. L., Bartlett, J. G. & Blacklow, N. R. (2017). Infectious Diseases. Lippincott Williams & Wilkins.
Guss, J. & Ruckenstein, M. J. (2010). Infections of the external ear. In: Flint, P. W. et al. (Eds.), Cummings Otolaryngology – Head and Neck Surgery, pp: 1956–1961. Mosby Elsevier.
Hassanein, F., Masoud, I. M. & Fekry, M. M. (2023). Environmental health aspects and microbial infections of the recreational water. BMC Public Health, 23: 302. DOI: 10.1186/s12889-023-15183-z
Hauk, L. (2017). Cerumen impaction: an updated guideline from the AAO-HNSF. American Family Physician, 96 (4): 263–264.
Hlavsa, M. C., Roberts, V. A., Kahler, A. M., Hilborn, E. D., Wade, T. J., Backer, L. C., Yoder, J. S. & Centers for Disease Control and Prevention (CDC). (2014). Recreational water-associated disease outbreaks—United States, 2009–2010. MMWR. Morbidity and Mortality Weekly Report, 63: 6–10.
Jackman, A. H. (2020). The antimicrobial properties of human cerumen. Clinical Otolaryngology, 45 (6): 947–953. DOI: 10.1111/coa.13524
Lipska, J., Hamerska, J., Hamerska, L., Bocianiak, B., Antczak, J., Kajka, A., Fenrych, U., Wojtczak, K., Skupińska, O. & Ruta, D. (2024). Swimmer's ear: prevention, diagnosis, treatment, and management strategies for athletes. Quality in Sport, 18: 53330. DOI: 10.12775/qs.2024.18.53330
Maclean, K., Njamo, F. O. J. P., Serepa-Dlamini, M. H., Kondiah, K., & Green, E. (2022). Antimicrobial susceptibility profiles among Pseudomonas aeruginosa isolated from professional SCUBA divers with otitis externa, swimming pools and the ocean at a diving operation in South Africa. Pathogens, 11(1), Article 91. https://doi.org/10.3390/pathogens11010091
Michaudet, C. & Malaty, J. (2018). Cerumen impaction: diagnosis and management. American Family Physician, 98 (8): 525–529.
Moore, R. E., Luu, K. & Banks, J. T. (2022). Prevention strategies for swimmer's ear: a clinical review. Journal of Otolaryngology – Head & Neck Surgery, 51 (1): 14–25.
Nielsen, M. C. & Jiang, S. C. (2019). Alterations of the human skin microbiome after ocean water exposure. Marine Pollution Bulletin, 145: 595–603. DOI: 10.1016/j.marpolbul.2019.06.047
Pantazidou, G., Dimitrakopoulou, M. E., Kotsalou, C., Velissari, J. & Vantarakis, A. (2022). Risk analysis of otitis externa (swimmer's ear) in children pool swimmers: a case study from Greece. Water, 14 (13): 1983. DOI: 10.3390/w14131983
Rosenfeld, R. M. & Shin, J. J. (2015). Clinical practice guideline: acute otitis externa. Otolaryngology–Head and Neck Surgery, 152 (1): 1–14.
Sastroasmoro, S. & Ismael, S. (2016). Dasar-dasar Metodologi Penelitian Klinis (Ed. ke-5). Sagung Seto. Jakarta.
Severn, M. M., & Horswill, A. R. (2023). Staphylococcus epidermidis and its dual lifestyle in skin health and infection. Nature Reviews Microbiology, 21(2), 97–111. https://doi.org/10.1038/s41579-022-00780-3
Sjövall, A., Aho, V. T. E., Hyyrynen, T., Kinnari, T. J., Auvinen, P., Silvola, J., Aarnisalo, A. & Laulajainen-Hongisto, A. (2021). Microbiome of the healthy external auditory canal. Otology & Neurotology, 42 (5): e609–e614. DOI: 10.1097/MAO.0000000000003031
Wade, T. J., Sams, E. A., Beach, M. J., Collier, S. A. & Dufour, A. P. (2013). The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study. Environmental Health, 12: 67. DOI: 10.1186/1476-069X-12-67
Wiegand, S., Berner, R., Schneider, A., Lundershausen, E. & Dietz, A. (2019). Otitis externa. Deutsches Ärzteblatt International, 116 (13): 224–234. DOI: 10.3238/arztebl.2019.0224
Wijesekera, A., Xu Wen, A. C., Walker, A., & Anders, C. (2024). Effects of seasonal, geographical and demographic factors on otitis externa microbiota in Queensland, Australia. Australian Journal of General Practice, 53(11 Suppl), S27–S32. https://doi.org/10.31128/AJGP-02-24-7152
License
Copyright (c) 2026 Ivana Putri Fayola, Eustachius Hagni Wardoyo, Didit Yudhanto
This work is licensed under a Creative Commons Attribution 4.0 International License.
Jurnal Biologi Tropis is licensed under a Creative Commons Attribution 4.0 International License.
The copyright of the received article shall be assigned to the author as the owner of the paper. The intended copyright includes the right to publish the article in various forms (including reprints). The journal maintains the publishing rights to the published articles.
Authors are permitted to disseminate published articles by sharing the link/DOI of the article at the journal. Authors are allowed to use their articles for any legal purposes deemed necessary without written permission from the journal with an acknowledgment of initial publication to this journal.
