Earache after swimming? We can help!

Vacationing this weekend, I spent many hours in the water, both in the pool and at the beach.  After my first day I noticed that my ear was hurting a bit, which has prompted this blog entry on swimmer’s ear, or otitis externa.

Swimmer’s ear is an infection of the outer ear, primarily within the external auditory canal or ear canal.  This is a bony and cartilaginous structure which extends from the pinna, or ear you can see on the side of the head, down to the eardrum.  It is separated from the middle ear space by the eardrum. 

Infections in the ear canal are common.  They frequently come after a period of time at the beach, lake or in the pool.  The first presenting signs include pain, fullness in the ear, hearing loss, and drainage.  These infections can be very painful.  Frequently though, these infections do not get attention until they are severe.  Occasionally, over-the-counter ear remedies are tried.  These include medicated pain drops, alcohol, peroxide, and anti-inflammatory pain relievers.  These remedies can exacerbate the pain, particularly if the products contain alcohol. 

With these infections, the ear canal swells and, as a result, debris accumulates.  This makes the environment darker and moister and the infection continues to worsen.  The treatment of choice for otitis externa is ototopical antibiotic drops.  I prefer a drop with a steroid in it to help with the inflammation.  Occasionally, the drops are unable to make it into the ear canal.  This is a problem in that the drops actually have to make it into the ear canal to work.

This is where your otolaryngologist, or ENT, can help your child!  When the ear canal is too swollen to apply the antibiotic drops, sometimes this requires a debridement, or cleaning of the ear canal.  If the ear canal is still too swollen, a wick may be placed to help transfer the drops down the swollen ear canal.  This usually stays in for 3 days and is then removed for the remainder of the duration of antibiotic drop treatment.  If the infection is severe enough, with extension onto the face or into the bone of the ear, oral or possibly intravenous antibiotics may be required.  This is very uncommon. 

Remember swimmer’s ear when your child has ear pain after swimming.  This is common and is usually well treated with ear drops.  Avoid putting cotton swabs in the ears and do not wait too long to seek treatment.   Your ENT can help if routine treatment does not solve the problem.  For more information about this and other ear pathology visit the Children's Ear, Nose and Throat Associates webpage. 

I only use it on the outside…

When I ask parents on their initial visit with me if they use cotton swabs, this is frequently the response I get.  They insist that they only use cotton swabs on the outside of the ear and that they NEVER go into the ear canal.  I have even heard this and ended up pulling several cotton swab heads out of the ears. 

The reason people frequently use cotton swabs is to remove earwax, or cerumen.  Cerumen is normal in the appropriate amount.  It functions to protect the ear canal as a mechanical barrier and an anti-bacterial layer.  Normally, cerumen is worked naturally out of the ear canal with normal movements of the jaw and ear canal.

Occasionally, cerumen gets stuck in the ear canal.  This can cause problems on multiple levels.  The biggest concern is for resulting hearing loss.  A significant cerumen impaction can result in a 30-40 dB hearing loss.  Prolonged cerumen impactions can become severe enough to cause erosion of the ear canal.  A significant cerumen impaction can also allow water to get trapped in the ear canal.  This moist, dark environment is a perfect breeding ground for yeast, mold, and bacteria which can setup a significant infection of the ear canal, or otitis externa.

Cotton swabs frequently facilitate these deeper cerumen impactions as instead of removing the wax, they actually plunge the wax further down the ear canal.  Furthermore, they can cause microtrauma to the skin of the ear canal resulting in small injuries which can more easily become infected.

“But how do I clean my child’s ears?”  This is one of the more common questions I hear in the office.  The truth is, we should not have to do much to clean the ears; they are quite good at cleaning themselves.  Occasionally the cerumen will become too thick or dry to work out of the ear canal.  In these instances, using a drop or 2 of mineral oil in the ear canal once per week can soften the earwax and help get it out of the ear canal.  If this is not enough, your ear, nose and throat doctor can use specialized suctions and instruments to get the cerumen out SAFELY!

“What about over the counter remedies?”  There are numerous things sold over the counter that can be used to clean the ears.  Beyond mineral oil, I would not recommend any of these.  Ear candles, in particular are dangerous, with common injuries including burns and rupture of the eardrum.  In fact the FDA has expressed concerns over these as well.  However, there are no randomized studies of ear candles in the management cerumen impactions.  Other ear drops and remedies are not recommended unless used under the direct supervision of your doctor. 

So remember, nothing smaller than your elbow in your ear.  Cerumen impactions can cause significant issues for your child, so be aware of this as a source of hearing loss, ear pain, and infections.