Acute otitis externa (Swimmer’s inflammation)
Anyone who has seen the anatomy of the ear in the chapter about otitis media, can understand that in this case it is a completely different process, happening in a completely different population of children (or adults).
This is an inflammatory / infectious process that involves the part of the external auditory canal (the same ear canal whose opening we all see, that ends in the eardrum) but does not involve the eardrum and middle ear.
How does Acute otitis externa occur?
The external auditory canal is lined with epithelial cells similar to any other external place in the body, including hair follicles and secretory glands. In this area, as everywhere else in the body, there is a normal flora consisting of bacteria and fungi that resides there regularly and maintain a delicate balance.
If for some reason the balance is disturbed, due to moisture (swimming pools, bath, excess moisture), dryness (lack of ear wax or dry canal), any infections or local trauma (especially following cleaning with cotton swabs or with one’s fingers), an inflammatory of infectious process can begin in the canal. This infection does not involve the middle ear at all, only the auditory canal.
What are the clinical signs of Acute otitis externa?
The main complaint is usually pain, especially when touching the auricle area, especially in an area called the tragus (see photo). The pain is sometimes disproportional. Sometimes even taking off the child’s shirt and lightly touching the area is very painful.
Usually this infection will happen in older children than in younger ones who mainly suffer from acute otitis media, but keep in mind that external ear infection can happen at any age.
Usually this infection is not accompanied by fever. Some children report hearing loss (due to a conduction problem).
Occasionally a small amount of white-yellow discharge can be seen oozing from the ear canal.
What are the main features of physical examination in the case of Acute otitis externa?
The doctor will focus mainly on pain when touching the area called the tragus. Just a reminder – acute otitis media is not painful to touch in this area, so sensitivity and pain will direct the doctor to the correct diagnosis.
Next, the doctor will look at the auditory canal (gently, may be a little painful) to see the canal involvement and rule out middle ear involvement. It’s important to check both ears, first the healthy ear.
Emphasis should be placed on less common conditions such as purulent otitis media with secondary irritation of the auditory canal. Read more about purulent otitis media At the following link.
What is the treatment for Acute otitis externa?
In most cases the treatment is local, with drops containing the correct antibiotic (one that covers the bacteria that cause Acute otitis externa) with steroids whose job is to lower the local edema and inflammation. There’s no need to be afraid of short-term local treatment with steroids, they play an important role in rapid recovery. The drops commonly used for acute otitis externa have a number of names. Drip a good amount of drops into the canal and leave the child on the side with the diseased ear facing up for about three to five minutes. More details on how to apply ear drops to children or infants here.
In severe cases, you can seek advice from an ENT (ear, nose an throat) doctor, who specialize in children. He can place a wick in the auditory canal, on which local antibiotics are dripped.
Do not forget pain relief with acetaminophen or ibuprofen as needed. Local treatment by ear drops for pain relief does not address the real problem at all, but can help the pain a bit.
The desired improvement usually comes in less than 24 hours.
If there is no improvement or the infection is accompanied by high fever or protrusion of the auricle, or if the child is suffering from an immunodeficiency, an early medical examination is advised.
Is Acute otitis externa a contagious disease and when can the child return to kindergarten?
Acute otitis externa is a non-contagious infection. The child can return to regular activity in his educational institution, when he feels well, even if he is still being treated with antibiotic drops.
How can Acute otitis externa be avoided?
Children (or ears) who have already had an acute otitis externa are prone to recurrence and therefore the trigger that led to the first inflammation should be avoided.
For example, do not clean the ears of children with cotton swabs. It just does not matter. In those families that are bothered by the fact that the child has a lot of ear wax, only the outer area can be cleaned without inserting any cleaning tool into the canal.
For a swimming pool or bath – earplugs can be used to prevent water from entering the ear canal. Clumsy but effective. There is another trick of dripping greasy ear drops (such as Phenazone and Amethocaine) or anything similar) into the ear before entering a water source.