Swimmers' Ear

What do you get when you combine kids with hot weather and non-stop swimming? The answer is Swimmer's Ear, also known as Otitis Externa. In my office the conversation goes something like this:

Mom: "I think he has an ear infection."
Me: "Does your ear hurt?"
Swimmer: "Yes, my right ear. It hurts to touch it or lay on it. Plus I can't hear out of it very well"
Me: "Have you been swimming a lot?"
Mom: "We were just on vacation at a lake"
Me: "Do you have a runny nose or a cold?"
Mom & Swimmer: "Not really"

This is repeated multiple times a day in my office, all summer long. I see it even more often when the weather is hot, like it is right now. Some days I see so many kids with Swimmer's Ear that I have dreams about it. Really, I do.

Swimmers' Ear, or Otitis Externa, is completely different from what most people think of when they say "I think my child has an ear infection." Swimmers' Ear is an infection of the ear canal, which starts at the hole in your ear and ends at the ear drum. The skin in the ear canal becomes red and swollen, and can even produce pus. Anything that moves the ear canal (touch, pressure, and sometimes even chewing) can cause pain.

Swimmers' Ear is usually associated with getting the ear canal wet and is more commonly seen in people who put their heads under water (school age children and up). The name Otitis Externa would also apply to other skin conditions and infections in the ear canal. For my purposes, however, I am focusing on the most common condition caused by getting the ear canal wet.

The standard ear infection (or Otitis Media) takes place behind the ear drum (tympanic membrane). The usually hollow, air-filled chamber becomes full of fluid and pus. This hardly ever has anything to do with swimming (the tympanic membrane protects the middle ear chamber from water outside the ear), tends to be associated with congestion and nasal drainage, and is more commonly seen in younger children and infants. Many parents worry that their baby or toddler's otitis media is caused by swimming lessons or by getting the baby's ears wet during bathing. This is not very likely.

Swimmer's Ear happens when the normal protective barriers in the ear canal are broken down. A healthy environment in the ear canal is dry, acidic, with a light protective coating of wax. When the canal is constantly wet the skin becomes soft, the pH in the canal becomes alkaline, and the wax is less protective. Bacteria like to grow in the skin in this wet, alkaline environment.

First the ear will get itchy, and feel funny. Scratching or digging at the ear may follow. The ear canal becomes inflamed and will look red. Then it swells and produces pus. It can be very painful.

There are several approaches to preventing Swimmer's Ear. You can try to keep the ear dry, using ear plugs or petroleum jelly coated cotton balls. In my experience kids don't put up with that for very long. You can dry out the ears after swimming, by tapping the side of the head to let the water out, using a cool blow dryer 12 inches from the ear, or placing 3 to 4 drops of isopropyl alcohol in each ear canal when swimming is done (or several times through the day if it's an all day long swim). You can make a mixture of 50% isopropyl alcohol and 50% white vinegar (to both dry the ears and re-acidify them) to use throughout the day or after swimming (3 to 4 drops in each ear). You can buy your own dropper at the pharmacy, or just drip the drops in from a medicine syringe. Instead of that homemade mixture you could use commercially available drops (such as auro-dri, or swim-ease).

Treatment of Swimmer's Ear involves a prescription for antibiotic ear drops to be used 2 to 3 times a day for a week to ten days. You will first need a doctor's appointment to determine what kind of ear infection your child has, and how severe it is. It would be unusual for this diagnosis to be made, or treatment prescribed without first seeing your child in the office. Your child will need to keep her ears dry during the initial part of this treatment.

Very early in the course of this illness you might be able to get things under control at home simply by keeping the ears dry and using the commercially available drops, or the mixture of isopropyl alcohol and white vinegar mentioned previously. If that does not work in a few days, or your child gets worse, then you should make an appointment in our office.

On a side note, the worst cases of Swimmer's Ear that I have seen have all been in teenagers. I have always wondered if they are trying to tough it out, or just don't have time for a doctor's appointment. Also, it doesn't seem to matter if you have been swimming in a lake or a pool, or just dunking your head under water in the bath tub. In my experience the type of water is not the important part, it's just the presence of moisture in the canal that matters.

Remember that wax in the ears is protective. No one should put cotton swabs (or anything other than drops) into their ear canals at home.

Please remember that the purpose of this blog is to provide you with more information and insight into how I personally think about health and illness. I am not trying to personally diagnose or treat your child. For that you need to discuss the problem with your medical professional. Other sources of information on the web could include www.uptodate.com/patients, or childrenshealth.org.

"Blood owies" or What do I want for my patients?

What are "blood owies"? you ask. Keep reading, I'll get to that later. What do I want for my patients and my own children? I want many things for them, so this could be a difficult question to answer. However, there is one thing I come back to, over and over. I want my patients to grow up feeling confident and in control over their bodies and minds. I want them to know that their bodies are strong and capable of fighting disease, and that they have control over the choices that help keep them healthy.

Of course parents help children BE healthy. We love them, feed them, and keep them safe. We give them a sense of right and wrong. We try to influence their choices. Most of all we love them. I believe that parents play a crucial role in helping children FEEL healthy, too.

So what does that mean, anyway? A little anecdote might help you understand what I am talking about. At my daughters' daycare the kids used to have a saying for their little cuts and scrapes that happened throughout the day. A skinned knee that didn't bleed was just an "owie", really no big deal. But a skinned knee that BLED was a "blood owie", which was very impressive to all.

I would receive tales of "blood owies" when the kids arrived home each summer day. It was a major event, as if the life force of the affected child was draining onto the ground. This kind of owie seemed to have a mystical power in my daughters' lives. Rose, our daycare provider, and my dear friend, normalized these "blood owies" for my children. She always had a hug and a band-aid ready, and she seemed to always convey to them that this was no problem, and would get better fast with that band-aid. I would look at the ravaged knee with the princess band-aid perched on top, hide a shudder and smile big at how great the owie looked now. My injured daughter would walk away feeling strong and proud of herself.

Of course most illnesses are more serious than a skinned knee! But how great would it be if we, as parents, could help our children be confident in knowing that most aches, pains, colds, flu, viruses, rashes, bug bites, etc. are common and happen to lots of people who get over them with no problem.

Preschoolers and adolescents, especially, seem to notice lots of bumps and aches all over their bodies. Don't you, too? Our children need us to explain these things to them. They don't know if these things are important, or not. "Too bad your tummy hurts, maybe you have to go potty?", or "I'm sorry to hear you have a stomachache, do you think you had too much milk? Or that you are worried about your exam?" "That happens to me sometimes, it usually just goes away after a while." "Let's try some pain reliever, and go to bed early tonight, maybe you're just tired."

But what if you miss something this way? Aren't some stomachaches and other symptoms important? Yes they are sometimes important, I'm not advocating ignoring symptoms. What I am saying is that I think the parent should be the one guiding the attitude about the illness.

The ultimate message that I want kids to receive is that their bodies and minds are amazing, strong, resilient, normal, and capable of healing. And that their parents will help them stay that way. As a pediatrician I definitely have a role in shaping this attitude, but I think parental influence is greater. Think about this. Let me know what you think.