Pediatric Associates of Richmond

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Swimmer’s Ear

After days spent happily splashing around the pool, all of a sudden your child begins to complain that her ear is starting to hurt. A case of swimmer’s ear! How does it occur, how can you treat it and how can your prevent it?

Swimmer’s ear, which we call ‘otitis externa’ is different from the type of ear infection young children often suffer from in the winter, a condition called ‘otitis media’. While otitis media is an infection behind the ear drum in the middle ear, otitis externa is an infection of the skin lining the ear canal itself.   The condition starts when water gets into the ear and doesn’t properly drain. Since the ear canal is warm and moist, it is an easy place for bacteria and fungus to invade. While an otitis externa can happen at any time of the year, it is particularly common in the summer due to warm, humid air and the amount of time kids spend hopping in and out of the water. Otitis externa can affect kids of any age, but is most common in school-aged children.

Once the infection starts, the skin begins to get red and swollen, causing pain. Sometimes pus is visible. Your child may complain initially of itching, or mild pain. As the infection worsens, the outside of the ear may look slightly red or swollen. Pain increases. Occasionally the area behind the ear may also be inflamed. Some cases may even result in your child having a fever.

Otitis externa is unlikely to get better without treatment. If your child begins complaining of ear pain that worsens when the ear is touched or wiggled slightly, please call our office. You can help ease the discomfort by giving your child ibuprofen or acetaminophen. Sometimes warmth, such as a heating pad, can also help. Be mindful, however, of using heat near the delicate skin of the ear.

Once otitis externa is diagnosed, we will often prescribe topical drops as treatment. These drops are either topical antibiotics alone, or combined with a corticosteroid. These drops are typically used for 7 days, although the symptoms are typically improved in 48 to 72 hours. As with any antibiotic prescribed to you, be sure to use it as prescribed and for the length of time prescribed in order to prevent resistance. Instill the drops to fill the canal, and have your child lay with that ear facing up for a few minutes after the drops are administered.   If the canal is very swollen, the drops may need some time to drip into the canal. Warming the bottle slightly by rubbing it in your hand may make the drops easier for your child. You may also gently wiggle the ear lobe in order to help the drops make their way down the canal.

Once treatment is started, it is important to keep the ear canal dry to allow healing. This means no time in the pool or on the water slide until the course of treatment is completed. Baths and showers are fine but avoid getting water into the ear if possible and gently towel dry afterward.

Generally, the infection improves rapidly with treatment. However, in some cases the ear canal is so significantly swollen that the drops can’t drain into the ear canal to fight the infection. If your child has been using drops for 72 hours with no improvement, we may need to insert a small sponge material called a ‘wick’ which will allow the drops to reach the infected area. Some cases of otitis externa require treatment with oral antibiotics, as well. Fortunately, this is not common.

To prevent future episodes of swimmer’s ear, it is important to keep the ear canal dry. Cerumen, or ear wax, has an important role in protecting the skin of the ear canal from water and damage. Either too little cerumen or too much, and there is a risk of infection. Digging in the ear with cotton swabs, fingers or other objects causes irritation that can also predispose the ear canal to infection. Simple home remedies can be useful in drying the ear and hopefully avoiding infection. Alcohol based ear drops, which are available at pharmacies, can be used after swimming. You can also make a similar preparation at home using equal amounts of isopropyl alcohol and white vinegar. Use of bathing caps has been shown helpful to prevent otitis externa. This may be particularly important for children competing on swim teams, who are diving and splashing water into their ears during meets. Ear plugsmay or may not be of benefit. Improperly fitted ear plugs may cause irritation rather than prevent infection.