Swimmers Ear

Treatment and Prevention of Swimmer’s Ear (Otitis Externa)

Swimmer’s ear is an infection of the skin lining the outer ear canal, which is usually seen in association with swimming. Prolonged contact with water (mostly swimming pools and fresh water) causes the lining of the canal to become damp, swollen and prone to infection. It is seen most commonly in the summer, especially following heat waves when the warmer water temperatures decrease chlorine levels in swimming pools and increase bacterial and fungal growth in the water. These bacteria or fungi then invade the skin of the ear canal and cause the characteristic pain, swelling, redness, itching and sometimes discharge from the ear. These infections can be tremendously painful, and may sometimes spread to the surrounding ear, scalp and face.

Treatment

is generally carried out using antibiotic ear drops, which may also contain an anti-inflammatory steroid agent. The drops should be slowly run down the side of the ear canal (with the child lying down, the infected ear up) allowing the canal to fill from the bottom up without trapping air. The earlobe should then be gently moved back and forth to evenly distribute the medication. Keep the child lying in that position for three to four minutes for optimal medication effect. If desired, a loose wad of cotton can then be placed for a few minutes so the drops don’t leak out. We generally recommend treating both ears simultaneously, because often there is at least low-grade infection in the other ear, even if it doesn’t hurt. If the inflammation spreads to the surrounding tissues, an oral antibiotic may be prescribed in addition to the drops.

Pain control

is usually achieved using acetaminophen or ibuprofen at appropriate doses. The pain usually decreases dramatically in 24-48 hours, but may linger for several days. If your child is still experiencing significant pain two days into treatment, please call the office.

Generally, your child should not swim until the symptoms of pain and swelling or fullness are gone . They can cool off in a pool or take a shower if they can keep both ears dry. If the child must swim (swim team, swim lessons, heat wave…) use the antibiotic ear drops each time after swimming. Be aware that such wetting of the ear canal may prolong the duration of the pain, but shouldn’t cause any serious complications.

Prevention of swimmer’s ear involves breaking the combination of heat, wetness, and bacteria or fungi. Since we can’t do much about the weather, try to keep the ear canals dry when your child is not swimming. When swimming is over for the day, get all the water out of the ear canals by turning the head to the side and pulling the earlobe in different directions to help the water run out, then dry the opening carefully. Then place four to five drops of rubbing alcohol (or a commercial ear drying agent) in each ear and let it run out.

Such drops should never be used in a child with ear tubes or perforated eardrums . If the infection was acquired in a pool, make sure that the chlorine and acidity levels are optimal. Sometimes a chlorine “shock” is in order to decrease bacterial counts.

Don’t use earplugs to prevent swimmer’s ear—they still allow water to enter the canal and may make the problem worse by pushing ear wax into the canal or irritating the skin.

Don’t insert cotton swabs or Q-Tips into the ear canal because they may cause trauma or push wax into the canal.

Don’t use rubbing alcohol or ear-drying agents if your child has ear pain or swimmer’s ear—they will burn and hurt!

Call our office

if your child starts acting very sick, if the ear pain becomes unbearable or very severe, if the ear pain is not significantly decreased 48 hours into treatment, if the child develops fever greater than 100 degrees, or if you have any concerns or questions.

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