• Otitis externa is the medical term for inflammation of the lining of the external ear. “Otitis” refers to inflammation of the lining of the ear and “externa” refers to the external part of the ear.
• Acute otitis externa is usually a result of a bacterial infection.
• Chronic otitis externa is less painful, but is more difficult to treat. It is most commonly due to fungal infections. Chronic swimmer’s ear may be more common in children with eczema and allergies.
Signs and Symptoms of Swimmer’s Ear
• The first symptom is usually itching and irritation of the external ear.
• As the condition progresses the ear becomes painful and swollen.
• Occasionally there may be a light discharge from the ear. If present, the discharge is usually clear and not very thick.
• The child may also complain of a blocked sensation in the affected ear, especially if there is swelling and a discharge.
• On examination, the patient will report pain when pressing on the tragus and pulling the ear lobe or auricles.
• The ear canal will appear red and inflamed when viewed through the otoscope.
• Occasionally the hearing may also be affected, however this resolves as the symptoms resolve.
• As the water enters the ear and becomes trapped in the ear, it causes the lining of the external ear to swell and become inflamed.
• Ear canals should be dry with a healthy amount of wax production to trap foreign particles and keep the earcanal free of pathogens.
• When the ear canal is wet and swollen it is more prone to infections. Secondary infections resulting from swimmer’s ear are usually bacterial or fungal infections.
Swimmer’s ear is not a contagious condition and children with swimmer’s ear therefore do not need to be kept away from other children. The child may be booked off school if the condition is particularly painful and is affecting the child’s ability to concentrate and carry out his or her activities.
• The diagnosis of swimmer’s ear is based on history and exposure to water, as well as clinical presentation and examination.
• In complicated cases that are not resolving, doctors may take a swab of the ear to identify the pathogen involved.
Complications
• A secondary bacterial infection may be a complication of swimmer’s ear. The most common bacterial causes of an outer ear infection are streptococcus and staphylococcus bacteria.
• Signs of a bacterial infection of the external ear include:
* Severe pain in the ear
* Severe swelling of the ear which may even extend to the side of the face
* A thick, purulent or yellow discharge from the ear
* Local swollen lymph nodes
* Fever and chills
* Pallor
* Nausea & Vomiting
• Fungal infections of the external ear may also occur as a result of trapped water in the ear. Fungi thrive in warm, dark and wet conditions. The predominant symptoms in these cases are severe itching and irritation as well as pain.
• Rarely the infection may spread elsewhere in the body.
Treatment
• Supportive treatment for swimmer’s ear is important and involves pain management. For children the most commonly recommended analgesics is ibuprofen.
• Applying warmth can also soothe the pain and inflammation and increase the drainage of the discharge. A warm facecloth or hot water bottle can be used, but caution must be taken not to burn the ear or skin.
• Swimming may slow the recovery time and children are usually advised to keep their ears dry until the symptoms have resolved.
• The inflammation is usually self limiting and in uncomplicated cases the symptoms should resolve within 3 to 7 days.
• Secondary bacterial infections are treated with antibiotics and secondary fungal infections are treated with antifungal medication.
• Antibiotics may be administered orally or in the form of ear drops.
• Ear grommets or a ruptured ear drum are contraindications for administering medicine, such as antibiotic ear drops, into the ear.
• It is also important that children with swimmer’s ear do not use ear buds or any other item in the ear to scratch or rub the ear. Ear buds can compact the wax, forming clumps of ear wax which can trap water, and can further irritate the ear canal.
Prevention
• The best way to prevent swimmer’s ear is to avoid getting the ears wet.
• Children with repeated swimmer’s ear who do not want to avoid swimming may benefit from using ear plugs whilst swimming. Special ear plugs are available for use during swimming to keep the water out of the ears. Children may also be advised to refrain from swimming under the water and must be taught to dry their ears properly after swimming.
• Children should not use ear buds to clean their ears.
• After water exposure children should try turning their heads so that the ear is facing downwards (ear to shoulder). This position can be held for a few minutes to encourage the water to run out and should be done on both the left and right sides. To improve the drainage of water out of the ear the auricle of the ear can also be pulled gentle in different directions whilst the ear is facing downwards. Ears should then be dried properly with a towel.
• Grommets, or ear tubes, are sometimes inserted into children’s tympanic membranes to allow the drainage of the middle ear. These children may be at risk of swimmer’s ear and complications such as otitis media if they spend a lot of time underwater. It is advisable that these children use appropriate ear plugs whilst swimming to prevent water from entering their ears.
• Swimming in polluted or dirty water can increase the risk of ear infections. Children should be advised
against swimming in unclean or contaminated rivers or damns, especially if they are prone to swimmer’s ear.
• Using 3 drops per ear of a 50/50 alcohol and white vinegar mixture before and after swimming can help reduce the risk of swimmer’s ear. Alcohol and vinegar restore the pH balance of the ear, have antiseptic properties and increase the rate of evaporation of water in the ear canal.
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