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Swimmer's Ear
photo credit: theayurway.com

Swimmer’s Ear is highly common in children during the summer months.

Children with autism spectrum disorder or sensory processing disorder (SPD) are known to experience auditory sensitivity. They may not like loud sounds or may not like their ears touched.

The interoceptive sense is the sense responsible to alert to the sensation of pain.  This sense may be impacted in children with SPD.  This may present as an extremely high pain tolerance.

Children with a dysregulated interoceptive sense may not complain of an earache.  However, for children who are normally hypersensitive to sounds, one sign of an ear related problem you may notice is that they may have decreased auditory sensitivity to loud sounds.  Because children with autism or SPD are atypical in this area, it is even more important during the summer months for parents to take a proactive stance with regard to Swimmer’s Ear.

What is Swimmer’s Ear?

Swimmer’s ear, clinically coined, Acute Otitis Externa (AOE), is an inflammation or infection of the external auditory canal that may or may not include the outer portion of the ear, called the Pinna.

AOE is very common and is increasingly seen in hot weather, during summer vacations. AOE affects about 1 out of 123 individuals each year.(1)  Children aged 5-14 tend to be the most impacted.

AOE affects swimmers because their ears are frequently exposed to water creating a moist and warm environment for germs to thrive.  Children with allergic conditions such as eczema, rhinitis and asthma are at an increased risk.

Additional Risk Factors for the Development of Swimmer’s Ear

• Absence of ear wax, called cerumen
• High humidity and increased temperature
• Local injury, especially from the use of cotton-tipped swabs
• Use of hearing aids and headphones
• Narrow, curved, or tortuous auditory canals, allowing for retained moisture
• Ear piercings

Ear Wax has a Purpose

Ear wax is nature’s healthy defense of the external auditory canal. Ear wax is acidic and thus inhibits bacterial or fungal growth while protecting the skin of the canal from breakdown.

Many individuals have issues with ear wax, including pediatricians, who often use various tools to remove it. This can actually lead to irritation and drying of the canal.  This drying and irritation can result in skin breakdown increasing the risk of bacteria or fungal growth.

Swimmer’s Ear develops in swimmers because of excessive water exposure. Excessive water reduces cerumen, leading to canal dryness and itching. Often times, kids will insert objects into their ear canal to reduce the itching.  This results in increased inflammation and infection.

Big Ouch! Swimmer’s Ear is Painful

Swimmer’s Ear is extremely painful. It develops rapidly with the following symptoms:

Itching and/or earache

Fullness with/without hearing loss

Clear and odorless discharge

Tenderness of pinna and/or tragus, especially when pressure is applied to the area
pinna = outer ear
tragus = small pointed eminence of the external ear

Wide spread swelling and redness of ear canal

Regional swelling of lymph nodes

Supportive Measures for Swimmer’s Ear

No Swimming!

Avoid swimming until infection is resolved, which takes about 10 days to 2 weeks.

Pain Relief

Since Swimmer’s Ear is extremely painful, short term narcotics are not unreasonable for the first 48-72 hours.  After 72 hours, it is best to switch to an anti-inflammatory or acetaminophen.

Protection

Protect the ear from all water exposures.  Keep the ear dry during showers, shampoos, etc.  To do so, place a small cotton ball in the ear and apply petroleum jelly to the cotton ball to keep the cotton from getting wet.

Comfort

Apply warm compresses to the ear for 10-15 minutes three times daily to help alleviate the discomfort.  Make your own warm compress.  Fill a sock with salt and tie it off.  Wrap the sock in aluminum foil and place in the oven at 275 degrees for about 15 minutes.  Remove from the oven, remove from foil, check to ensure it’s not too hot and place on affected ear.

Consider a soft diet as this is helpful to minimize pain with jaw movement.

Avoid Object Near Ear

During the healing process, do not use hearing aids, earplugs, or headphones until the infection clears.

Potential Complications with Swimmer’s Ear

Temporary hearing loss is possible.  If hearing loss does not resolve, ask for an audiometric evaluation.

Chronic AOE lasting longer than 6 weeks.

Cellulitis (infection of surrounding skin tissue) requires an oral antibiotic.

Be Sure to Follow Up as Ordered

For moderate to severe cases of swimmer’s ear, head back to the pediatrician within 48-72 hours. If there is no relief within that time frame, request a consult to an ear-nose-throat specialist. A second follow up appointment a week later is recommended to ensure healing is on the right course. As swelling subsides, hearing should be restored.

Prevention is Key

Acute Otitis Externa, otherwise known as Swimmer’s Ear is highly preventable.  Be sure to keep the ears as dry as possible.  Consider using a low-volume hair dryer after each shower.

Always avoid putting foreign objects in the ears. Cotton-tipped swabs are a leading cause of AOE and should never be used in the ear canal.

For patients with chronic OE, custom ear molds can be made by audiologists to protect ears from frequent water exposure.

However, should AOE develop, rapid diagnosis and treatment are necessary to prevent an escalating infection.  A visit to the pediatrician is the best place to start to treat severe discomfort, especially in children who may not report an initial sign of an earache.  Prevention measures are the key!

References

(1) “Estimated Burden of Acute Otitis Externa — United States, 2003–2007.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 May 2011. Web. 31 Mar. 2016.

(2) “Swimmer’s Ear.” Mayo Clinic. N.p., 9 July 2013. Web. 31 Mar. 2016.

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Using her background in health care administration, education and marketing, Tiffani created Special-Ism, an educational resource for parents, teachers, and clinicians of children with various isms. Currently, Tiffani serves as the Editorial Director at Special-Ism, focusing on solutions to the isms for all children at home, in the classroom and community.