When the temperatures rise, the time is right for a dip in the pool. Unfortunately for many children, the time also is right for otitis externa, better known as swimmer’s ear.
   The condition — primarily characterized by redness of the outer ear and ear pain (made worse by wiggling the ear lobe) — is an inflammation of the external ear canal. The problem is prevalent, affecting about one in 100 to 250 Americans annually, mostly children. Swimmer’s ear is caused by bacteria. Water that remains trapped in the ear canal (when swimming, for example) may provide a source for the growth of bacteria.
   Dr. Peter S. Roland, an ear, nose and throat specialist on the medical staff at Children’s and chairman of Otolaryngology at UT Southwestern, participates on a panel of experts to create and maintain treatment guidelines for front-line treatment of swimmer’s ear.
   “The most important feature of these guidelines is that they are entirely evidence-based, meaning that they have been scientifically demonstrated in the medical literature,” Dr. Roland said.
   Dr. Roland is one of a dozen physicians on a national panel representing multiple disciplines that treat swimmer’s ear, including otolaryngology, pediatrics, emergency medicine, family practice, internal medicine and infectious diseases.
   “Swimmer’s ear is a very common and often very painful condition. It’s important that the most effective treatments be identified and widely disseminated,” said Dr. Roland, who also is a professor of Neurological Surgery at UT Southwestern. “These guidelines are designed to assist all physicians who treat swimmer’s ear.”

New guidelines for diagnosis, treatment
The guidelines below were published in the April 2006 edition of Otolaryngology-Head and Neck Surgery.

The panel’s findings and recommendations include:

• Initially treat the condition with antiseptic or antibiotic ear drops, which inhibit bacterial growth. The drops usually relieve the pain within a day and clear up the condition within a week. Patients should also be shown how to put in the ear drops to ensure they are effective.
• Do not administer oral antibiotics unless other conditions are present, such as diabetes or some immune diseases, because studies indicate those medications are less effective and have more side effects.
• Ear candles have not been shown to be effective and can have adverse side effects, including burning or perforating the ear drum. Ear candling, often found in new age shops, involves putting a cone-shaped device — usually a fabric soaked in wax to harden it — into the ear to remove impurities with smoke.
• To avoid swimmer’s ear, keep moisture out by using ear plugs or by drying the ears with a hairdryer, and avoiding water that may be polluted.
• Ear, nose and throat specialists caution against putting fingers or other objects in the ear, including cotton swabs, which can damage the ear or push material deeper into the canal.

Risk Factors
The American Academy of Otolaryngology says that swimmer’s ear is more common in children and young adults, but can affect any age. People with itchy ears, flaky or scaly ears, or extensive earwax are more likely to develop swimmer’s ear, according to information published by the Academy, and allergic conditions such as eczema, allergic rhinitis or asthma may also be factors.
   Many different factors can increase your child’s chance of developing swimmer’s ear. As the name implies, one of the factors is excessive wetness as with swimming, although it can occur without swimming. Other possible causes of this infection include the following:

• Being in warm, humid places
• Harsh cleaning of the ear canal
• Trauma to the ear canal
• Dry ear canal skin
• Foreign body in the ear canal
• Lack of cerumen (ear wax)
• Eczema and other forms of dermatitis
• Symptoms

The following are the most common symptoms of swimmer’s ear. However, each child may experience symptoms differently. Symptoms may include:

• Redness of the outer ear
• Itching in the ear
• Pain, especially when touching or wiggling the ear lobe
• Drainage from the ear
• Swollen glands in the neck
• Swollen ear canal
• Conductive hearing loss

Resources
The symptoms of swimmer’s ear may resemble other medical conditions or problems. Always consult your child’s physician for a diagnosis. For more information on how swimmer’s ear is diagnosed, treated and prevented, click here.