Swimmers Ear page cerumen by mikeholy


									                     The Doctor Is In                                                                           BY DR. DAVID HILL

                     Swimmer’s Ear

      et me clear up any confusion right        How does the infection progress?               What can you do for swimmer’s

L     now by saying that swimmer’s ear
      does not make you a better swim-
mer. In fact, if you are using your ears to
                                                   When water sits in the ear canal it can
                                                remove the protective oil and cerumen,
                                                allowing the lining of the canal to
                                                                                                  For symptomatic swimmer’s ear antibi-
                                                                                               otic ear drops are first-line therapy. There
swim you should probably refine your             become boggy and swollen. The swelling         are several different brands, but all are
stroke. Swimmer’s ear is a painful infec-       blocks oil and cerumen glands, setting up      effective against the bacteria that cause
tion of the outer ear that occurs when the      a vicious cycle. The weakened ear tissue is    most cases of swimmer’s ear. Antibiotics
ear canal becomes waterlogged. But with         vulnerable to infection by bacteria            are often combined with topical steroids
a few precautions, most swimmers can            Staphylococcus aureus, Pseudomonas aerug-      to reduce inflammation. Drops are placed
glide happily through the summer.               inosa or fungi Aspergillus niger. The body’s   in the affected ear two to four times a day,
What is the outer ear?                          immune system responds, producing              usually for seven to ten days. Pulling back
   Swimmer’s ear is called otitis externa       more pain and swelling. In severe cases        gently on the pinna helps the medicine
because it involves the outer ear. The          the ear canal may become completely            penetrate the ear canal. When swelling is
most obvious part of the outer ear is           blocked. Untreated infections may spread       too severe for the drops to penetrate, your
called the pinna or auricle. The little but-    to surrounding bone or soft tissue includ-     doctor may need to insert a wick in the
ton in front of the ear is the tragus. Like     ing the salivary (parotid) gland or the jaw    ear canal. The most severe cases call for
the pinna and tragus, the outer third of        (temporomandibular) joint.                     oral antibiotics. Ideally, your child will
the ear canal is made of cartilage. The         Who gets it and when?                          stay out of the water until he or she has
skin lining the canal has hair follicles, oil      Predictably swimmer’s ear is most com-      improved.
glands, and glands that form ear wax            mon in the summer, but it may occur            What if the drops don’t work?
(cerumen). The bottom of the ear canal          year-round, especially in warmer, more            Swimmer’s ear usually responds to
is lined with tiny fissures that may carry       humid climates. Risk factors include           therapy within a couple of days. One
infection into surrounding tissues. The         swimming, excessive sweating, trauma to        cause of prolonged inflammation is an
canal (and therefore the outer ear) ends at     the ear canal, and loss of cerumen. People     allergy to the antibiotic neomycin con-
the surface of the eardrum (tympanic            with long, narrow ear canals are at high-      tained in some ear drops. In these cases
membrane). Swimmer’s ear is distinct            er risk as are those who wear hearing aids.    changing antibiotics does the trick.
from otitis media, a collection of pus          Not all water is the same; lake water with     Sometimes prolonged drainage and pain
behind the eardrum.                             high bacteria counts may be worse than         result from a middle ear infection (otitis
What’s up with ear wax?                         ocean or pool water. Water with a higher       media) with a perforated eardrum. These
   Cerumen plays dual protective roles.         pH (less acidic) may also increase the risk    cases usually respond to oral antibiotics.
First, it forms a physical barrier against      of infection. In 90% of cases only one ear     Severe diabetics and immunosuppressed
insects, dirt, and trauma. Second, ceru-        is affected.                                   patients may get fungal infections that
men is mildly acidic and contains               How can I prevent swimmers ear?                respond to different classes of topical
enzymes to suppress the growth of bac-             Swimmers have a few options to pre-         antibiotics.
teria and fungi. Wax normally migrates          vent infection. First, they can dry the ear    What other conditions mimic
out of the ear on its own; removing it          canals after swimming by blowing them          swimmer’s ear?
with a foreign object not only leaves the       with a hair dryer on the coolest setting.        The ear canal may be the site of a boil.
ear canal unprotected but risks trauma to       Hold the dryer about a foot from the ear       These are quite painful and usually
the canal or eardrum.                           for one minute. They may also rinse the        require surgical drainage and oral antibi-
What are the symptoms of swim-                  ear canal after swimming with ear drops        otics to resolve. Skin conditions like seb-
mer’s ear?                                      containing weak acetic, sulfuric, or pro-      orrhea and eczema can cause flaking and
   Swimmer’s ear begins with itching of         pionic acid. These solutions are available     scaling of the ear canal and decrease ceru-
the ear canal, often accompanied by a           in most pharmacies, but a homemade             men production. Not only can these con-
sense of fullness in the ear. The canal may     solution of 1:1 vinegar and rubbing alco-      ditions appear similar to swimmer’s ear,
become painful, especially with move-           hol works as well. Ear plugs can be a has-     they can leave the ear canal vulnerable to
ment of the pinna or tragus. As the infec-      sle, but they seem to work if they effec-      actual infection. They are best treated
tion progresses your child may complain         tively keep out moisture. One study of         using topical steroids and acidifying
of hearing loss or pain with jaw move-          seven different types of ear plug found        agents.
ments. The ear may even become red and          that Vaseline-soaked cotton balls were         Dr. David Hill is a board certified pediatri-
swollen. Swimmer’s ear alone shouldn’t          most effective and easiest to use.             cian at Cape Fear Pediatrics. He and his wife
cause a fever unless the infection is quite                                                    have three children.

38 August 2006 Wilmington Parent

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