The seaside vacation had been fun, but the 9-year-old couldn't say the same about the trip back home. The boy had practically lived in the water during the wonderful week at the beach. Now he was apparently paying the price as he dealt with a case of excruciating left ear pain.
The family had just driven in from the coast and brought their son to the office for an exam. I listened to my patient's lungs and checked for swollen neck glands, then examined his "good" ear, which had a normal canal and eardrum. I checked the left ear last, and even my gentle tug on the outer ear caused the boy to wince in pain.
While the child's left eardrum was free of infection, the left ear canal was swollen, flaked, red and coated with a thin liquid discharge. I placed a wick -- a slender piece of material that expands like a sponge when wet -- in his ear canal and applied some medicated drops. The cool liquid seemed to give the young patient some relief.
Swimmer's ear sounds like a trivial infection, but this ear canal inflammation -- also known as acute otitis externa -- can be a very painful condition, often reducing patients to tears. A recent study by the Centers for Disease Control and Prevention finds that AOE is also financially painful, accounting for 2.4 million U.S. health care visits per year with an annual direct cost of nearly half a billion dollars.
The highest rate of AOE-related visits occurs among kids aged 5 to 14 years. AOE is linked to water exposure and warm, humid environments, so it's not surprising this common ear condition peaks in the summer months and is most often seen in the Southern states.
In their Pediatrics in Review journal article "Otitis Externa," Drs. Kimberly Stone and Janet Serwint explain that moisture in the ear canal causes swelling and skin breakdown, allowing bacteria such as pseudomonas and staphylococcus to multiply in the ear.
Treatment of AOE consists of pain management with acetaminophen or ibuprofen, and less often, prescription narcotics. Oral antibiotics are usually not needed since topical antibiotic drops -- both with and without a steroid component -- are effective therapies.
When drops are used, the pediatric authors recommend the patient lie down while the parent drops the medicated liquid in, filling the affected ear canal. The outer ear should be moved back and forth to get rid of air bubbles and allow the drops to enter and stay in the ear canal. The child should not get up for three to five minutes after drops are applied.
To help prevent swimmer's ear, experts at the CDC recommend that kids try to keep their ears dry by using swim caps, ear plugs or custom ear molds. After swimming, bathing and showering, a child should use a towel to dry both ears thoroughly.
Tilting the head allows water to drip out on each side, and tugging on the earlobe while tilting helps release any trapped water. If water is still felt in the ear canal after all these maneuvers, the swimmer can turn a hair dryer on at the lowest heat and fan settings and hold the appliance several inches from the ear to finish drying out the canal.
After swimming, application of over-the-counter alcohol-based ear drops or a homemade one-to-one mix of rubbing alcohol and white vinegar can also help dry the ear canal. These alcohol drops are not a treatment for swimmer's ear and should not be used if the ear is already infected or draining, or if the child has ear tubes or a perforated eardrum.
The CDC reminds parents that ear wax helps protect the ear canal from infection, and discourages the use of cotton-tip swabs, fingers, paper clips or other creative tools to remove water or wax from children's ear canals.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.