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Tuesday, June 4, 2013

Swimmer's Ear

photo source: Shutterstock

Summer's here and that means we will soon start seeing a lot of older kids with earaches.

Swimmer's ear differs from a middle ear infection. It is an inflammation of the skin lining the ear canal and is most common in older children and teens. Middle ear infections (otitis media) are caused by pus behind the eardrum and are most common in infants and younger children.

Swimmer's ear (AKA otitis externa) gets its name because it is commonly caused by water in the ear canal making a good environment for bacteria to grow, causing an infection of the skin. Water can come from many sources, including lakes, pools, bath tubs, and even sweat, so not only swimmers get swimmer's ear.

Anything that damages the skin lining the ear canal can predispose to a secondary infection, much like having a scraped knee can lead to an infection of the skin on your knee. Avoid putting anything in your ears, since it can scratch the skin of the ear canal. This includes anything solid to clean wax out of the ear. Excess earwax can trap water, so cleaning with a safe method can help prevent infection. A little wax is good though -- it actually helps prevent bacterial growth. For more on earwax, please see Ear Wax: Both Good and Bad.

Swimmer's ear can cause intense pain. Sometimes it starts as a mild irritation or itch, but pain worsens if untreated. It typically hurts more if the ear is pulled back or if the little bump at the front of the ear canal is pushed down toward the canal. Ear buds (for a music player) or hearing aides can be very uncomfortable (and increase the risk of getting swimmer's ear due to canal irritation). Sometimes there is drainage of clear fluid or pus from the canal. If the canal swells significantly or if pus fills the canal, hearing will be affected. More severe cases can cause redness extending to the outer ear, fever, and swollen lymph nodes (glands) in the neck. Swimmer's ear can lead to dizziness or ringing in the ear.

Prevention of swimmer's ear is possible for most people.

  • If your child has excessive wax buildup, talk with his doctor about how often to clean the wax. (Wax does help keep your ears clean, so you don't want to clear it too much!)
  • Never put anything solid into the ear canal.
  • Dry the ear canals when water gets in. 
  • Tilt the head so the ear is down and hold a towel at the edge of the canal. 
  • Use a hair dryer on a cool setting several inches away from the ear to dry it. 
  • If kids get frequent ear infections or are in untreated water (such as a lake), use over the counter ear drops made to help clean the canal. You can buy them at a pharmacy or make them yourself with white vinegar and rubbing alcohol in a 1 to 1 ratio. Put 3-4 drops in each ear after swimming. The acid of the vinegar and the antibacterial properties of the alcohol help to clear bacteria, and the alcohol evaporates to help dry the canal. DO NOT use these drops if there are tubes or a hole in the eardrum, if pus is draining, or if the ear itches or hurts.
  • If your child has a scratch in the ear or a current swimmer's ear infection, avoid swimming for 3-5 days to allow the skin to heal. 
  • Avoid bubble baths and other irritating liquids that might get into ear canals.
  • If your child has tubes placed for recurrent middle ear infections, talk with your ENT about ear protection during swimming. 
Treating swimmer's ear:
  • If you think your child has swimmer's ear, start with pain control at home with acetaminophen or ibuprofen per package directions. Heating pads to the outer ear often help, but do not put any heated liquids into the ear. 
  • Most often swimmer's ear is not an emergency, but symptoms can worsen if not treated with prescription ear drops within a few days. Bring your child to the office for an exam, diagnosis, and treatment as indicated. 
  • If the pain is severe, redness extends onto the face or behind the ear, the ear protrudes from the head, or there are other concerning symptoms, your child should be seen immediately at our office or another urgent/emergent care setting. 
  • Occasionally we will remove debris from the canal or insert a wick to help the drops get past the inflamed/swollen canal. Never attempt this at home!
  • The prescription ear drops may include an antibiotic (to kill the bacteria), a steroid (to decrease inflammation and pain), an acid (to kill bacteria), an antiseptic (to kill the bacteria), or a combination of these.  They are generally used 2-3 times/day. Have the patient lie on their side, put the drops in the ear and remain on that side for several minutes before getting up or changing sides to allow the medicine to stay in the ear. Symptoms generally improve after 24 hours and the infection clears within a week.
  • Oral antibiotics are usually not required unless the infection extends beyond the ear canal.
  • If pain is very severe, ask about prescription pain relievers when your child is being seen and evaluated. Most often they are not needed, but if they are it is best to get them at the time of your visit so risks of these medications and how and when to use them can be discussed.
  • If an infection causes more itch than pain or does not clear with initial treatment, we might consider a fungal infection, which requires an anti-fungal medication. 
  • No swimming until the infection clears. 
  • Kids (and adults) with diabetes or other immune deficiencies are more likely to get severely sick with any infection. Visit your doctor early if you suspect a problem.