What’s the best thing for a swimmer’s ear?
The best thing is not to get it. Really, we’re serious. This one of those things that should be preventable, if we just pay attention and use a little common sense.
Let’s start by considering the causes of the problem—technically known as otitis externa. This is an inflammation or infection of the ear canal, the one inch tube that leads to the ear drum. Behind the ear drum is the middle ear, the site of otitis media—the infection that plagues most of our young children at some point, and even those of us who pretend to be adults.
Otitis externa occurs in all age groups, but is most common during childhood (5 to 15 years) and is more likely to be experienced during the summer months. And for some reason, the pain frequently presents in the middle of the night, waking or preventing us from sleeping. While it can be due to inflammation or irritation (scratching, excessive cleaning, contact dermatitis) it is most frequently due to a bacterial infection. And the most frequent source of that bacteria is from water entering the ear and staying there. This can be from a pond, lake, swimming pool, ocean, or even your shower. Once in the ear, water, in combination with our body heat and the darkness of the ear canal, creates a perfect environment for bacteria to grow. If there is any break in the natural defenses of the skin in the canal, these bacteria can penetrate that lining and cause an infection, resulting in mild, moderate, or serious symptoms. There’s not much room in the canal for the soft tissue to expand, and any swelling quickly becomes very painful. A mild infection involves only minimal inflammation and swelling, and slight discomfort. This can progress to a full-blown serious infection, manifested by significant pain, swelling to the point of closing the ear canal, swollen lymph nodes around the ear, fever, and considerable pain. If you’ve ever had this, you know what we’re talking about, and it’s no fun.
Treatment is straightforward, and focuses on three important things:
- Cleaning the ear canal. This is the first step, and needs to be done carefully, and not at home. If your child has a history of tubes or a perforated ear drum, the rules change and you’ll need to see your pediatrician or ENT specialist. The ear canal should be directly visualized and any excess cerumen or debris should be carefully removed. The canal can also be irrigated with a 1:1 solution of water and hydrogen peroxide, warmed to body temperature.
- Appropriate topical medications—ear drops. These should contain an antibiotic that is active against the most common bacteria seen with these infections, and a steroid component for swelling and inflammation. Sometimes your physician will need to place a wick in the canal. This is sponge-like material, and once it’s inserted and soaked with the antibiotic drops, it will expand and allow the medication to reach the sides of the canal. This might need to be changed every couple of days, but once the swelling subsides, the wick will usually drop out on its own. Now about those ear drops. There’s a right way of doing this, and probably a bunch of wrong ones. The best technique is to have your child lie on their side for four or five minutes after the drops are instilled. Another option is to place a cotton ball in the ear canal for twenty minutes after the drops. We prefer keeping your child down for a couple of minutes, since a significant amount of the drops soaks into the cotton and never does any good. And make sure you use the right amount of drops. Follow the directions, since “under-dosing” is the leading cause of treatment failure.
- Control of pain. This is usually accomplished with acetaminophen or ibuprofen, along with carefully applied dry heat (a closely monitored heating pad).
You should see a big improvement in 36-48 hours. If not, you might want to give your doctor a call and have your child rechecked. But by two days, most of us are better.
Many parents will ask about an oral antibiotic, since this is an “ear infection.” In this case, oral antibiotics don’t help. The exception would be in the setting of a severe infection, with fever, facial swelling, and significant pain. Those cases are rare, and are usually treated in a hospital setting.
My Granny used to put sweet oil in my ear when I was a child and got an earache. It always seemed to help. What have you got to say about that?
Well, we don’t want to argue with Granny, but if the oil helped, you probably didn’t have an infection. Warmed sweet oil (usually this means olive oil) can provide temporary relief for ear pain, but it won’t clear an infection, and usually makes it difficult for us to get a good look at the canal and ear drum. If your child is having bad enough pain for you to consider doing this, that’s a good indication that you should have them examined.
Now, about the prevention of this problem. Since the most common cause of this is water in the ear canal, we need to keep that water from getting in there in the first place, or remove it should it find its way there. We’ve all gotten water in our ears at some point—swimming, showering—and we now how difficult it can be to get out. Tilting your head to one side and jumping up and down won’t do it. Nor will pounding on the side of your head. The water just trickles back. It’s got to come out, and here’s a quick and simple technique. Take a half-capful of rubbing alcohol, have your child lay on their side, pour the alcohol in the ear, and count to five. Flip them over and repeat. Works every time, and while some encouragement might be needed, this isn’t painful. (Remember, this shouldn’t be done if your child has tubes or a known perforation.) We need to do this any time our children have been swimming. Doesn’t matter whether it’s your pool, the ocean, or someone’s lake. Bugs are everywhere. Make this a habit, and you’ll avoid many, if not all, of those late-night summer-time cries of “Mommy, my ear hurts.”
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This is an excerpt from the new book I’m writing with pediatrician Dr. Robert Alexander. The book will address 100 questions from parents regarding their children’s health. Feel free to email us with questions: askthedox@yahoo.com
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