Otitis Externa
What is otitis externa (OE)?
While most people think of otitis externa as swimmer’s ear, there are actually a few different kinds of OE. The definition, then, is an inflammation (redness and irritation) of the ear canal.
How do I know if my child has OE?
Children with OE tend to have severe ear pain. It hurts worse if the outside part of the ear is pulled, and sometimes with chewing. Their hearing is often decreased due to swelling of the canal. They can have drainage from the ear that starts out clear, then becomes thick and yellow.
What causes otitis externa?
The cause of OE depends on the type your child has. The most common type by far is acute diffuse OE (aka. Swimmer’s ear), which is an irritation of the whole ear canal. It often starts with your ear canal being too moist, which causes the skin to break down and let bacteria in. If it goes on longer than six weeks, then it’s called chronic OE.
Acute localized OE is an irritation at an infected hair follicle.
Eczematoid OE occurs when a skin condition (eczema, psoriasis, etc) also starts in the ear canal.
Necrotizing/malignant OE is an infection not just in the ear canal, but also in the structures around it. This usually only occurs in adults whose immune systems aren’t working well.
Otomycosis is an infection in the ear canal by a fungus. It’s not very common in children.
How is OM treated?
Swimmer’s ear is treated with ear drops that contain an antibiotic and a steroid for a week. In the meantime we recommend that your child not swim or lay down in a bathtub during that time to keep the ear canal as dry as possible. Sometimes the swelling and debris in the ear canal doesn’t allow the medicine to stay in the canal where it’s needed. In those cases some of the debris will be cleared out, and we will place an ear wick. An ear wick is a tiny little sponge that we place in the ear canal that gets bigger when it gets wet-after we put ear drops on it. This will allow the drops to stay in the ear canal where they’re needed. It will fall out on its own in about 3 days.
Treatment for other forms of OE may include different ear drops, oral or IV antibiotics, or sometimes surgery.
Can OE be prevented?
In general, OE occurs when the ear canal is injured in some way. Skin in the canal breaks down when it is moist for long periods of time-from swimming, sweating a lot, being in a humid place. If your child gets OE often, then using a post swimming drop that helps dry the ear can help. You can also dry the ear by gently placing a cloth or tissue near the entrance of the canal. We don’t recommend putting anything in the ear canal, including cotton swabs because it can injure the ear. Ear plugs have been used for swimming by some, but they also can irritate the ear canal.
Another reason to not use cotton swabs in the ear canal to clean it is because ear wax is good for your canal. Not only does it form a moisture barrier, it also has a lower pH that discourages bacterial growth. Ear wax also slowly cleans up skin cells and other debris out of the canal as it moves out of the canal.
Bottom line.
Swimmer’s ear is a common ailment in the summertime. Your pediatrician can give you drops to heal it. If your child gets it often, there are steps you can take to prevent it.
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