Ear - Swimmer's (Otitis Externa): Teen Version

What is swimmer's ear?

Swimmer's ear is an infection of the skin lining the ear canal. This problem is most common among swimmers or people that spend a lot of time in water. If you have swimmer's ear, you may have the following symptoms:

• itchy and painful ear canals
• pain when the ear is moved up and down
• pain when the tab of the outer ear overlying the ear canal is pushed in
• ear feels plugged up
• slight amount of clear discharge at first (without treatment, the discharge becomes yellowish).

What is the cause?

Swimmer's ear occurs when your ears have been in the water for long periods of time. When water gets trapped in the ear canal the lining becomes damp, swollen, and prone to infection.

You are more likely to get swimmer's ear from swimming in lake water, compared to swimming pools or the sea. During the hottest weeks of the summer, some lakes have high levels of bacteria. Narrow ear canals also increase the risk of swimmer's ear. Cotton swabs also contribute to the problem by causing wax buildup which traps water behind it.

How long will it last?

With treatment, symptoms should be better in 3 days and cleared up in 7 days.

How can I take care of myself?

• Antibiotic-steroid eardrops for severe swimmer's ear. (These require a prescription.)
  You need the eardrops prescribed by your healthcare provider.
  Run the eardrops down the side of the ear canal's opening so that air isn't trapped under the drops. Move the earlobe back and forth to help the eardrops pass down. Keep using the eardrops until all the symptoms are cleared up for 48 hours.
  Generally, you should not swim until the symptoms are gone. If you are on a swim team, you may continue, but use the eardrops as a rinse after each swimming session.
• White vinegar eardrops.
  For mild swimmer's ear, use half-strength white vinegar eardrops. Fill the ear canal with white vinegar diluted with an equal amount of water. After 5 minutes, remove it by turning your head to the side. Do this twice a day until the ear canal is back to normal.
• Pain relief.
  Use acetaminophen (Tylenol) or ibuprofen (Advil) for pain relief.

How can I prevent swimmer's ear?

The key to prevention is keeping the ear canals dry when you are not swimming. After swimming, get all water out of your ear canals by turning your head to the side and pulling the earlobe in different directions to help the water run out. Dry the opening to the ear canal carefully. If recurrences are a big problem, rinse your ear canals with rubbing alcohol each time you finish swimming or bathing to help it dry and kill germs. Another helpful home remedy is a solution of half rubbing alcohol and half white vinegar. The vinegar restores the normal acid balance to the ear canal.

Ask your healthcare provider if you should use ear plugs or a swim cap.

Common mistakes

• Do not put cotton swabs in ear canals. They increase earwax buildup. The earwax then traps water behind it and increases the risk of swimmer's ear.
• Rubbing alcohol is helpful for preventing swimmer's ear but not for treating it because it stings an infected ear too much.

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Ear Congestion

What is ear congestion?

If your child has ear congestion, he will probably feel:

• like his hearing is suddenly muffled
• crackling or popping noises in the ear
• a stuffy, full sensation in the ear

Your child will usually not have ear pain except in cases related to airplane or mountain travel.

Ear congestion usually lasts for a few hours or a few days at most. It may come and go. If the ear congestion lasts longer, it may be an ear infection.

What is the cause?

The most common cause of ear congestion is fluid in the middle ear due to a cold, hay fever, or over-vigorous nose blowing. Sudden increases in barometric pressure, which occur in descent from mountain driving or airplane travel, also cause ear congestion.

How can I take care of my child?

• Treatment
  Have your child chew gum, yawn frequently, and swallow while the nose is pinched closed. If he could have water in the ear canal from a recent shower or swim, help drain it with gravity by turning the side of the head down and gently pulling the earlobe in different directions. If he has hay fever he should also take his antihistamine medication. If your child is in pain, give acetaminophen or ibuprofen. It's OK for your child to swim.
• Prevention of ear congestion due to altitude change
  Have your child repeatedly "pop" the ears by yawning or swallowing during the 15 to 30 minutes of descent in an airplane. If this fails, your child should try to blow his nose against closed nostrils. A baby can be given water to drink or a pacifier to suck on. The child should not sleep during descent.
  Children who repeatedly have this problem should take an oral antihistamine and use a long-acting decongestant nasal spray 1 hour before travel.
  If severe pain occurs despite these precautions, ask the flight attendant for a hot towel to place tightly over the opening of the ear (the heat will expand the air in the middle ear and relieve the pressure on the eardrum).
  
  

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Ear Infection (Otitis Media)

What is an ear infection?

An ear infection is an infection of the middle ear (the space behind the eardrum). It is most often caused by bacteria. It usually is a complication of a cold and starts on the third day of the cold. A cold blocks off the tube that connects the middle ear to the back of the throat (the eustachian tube).

Most children will have at least one ear infection, and over one fourth of these children will have repeated ear infections. Children are most likely to have ear infections between the ages of 6 months and 2 years, but they continue to be a common childhood illness until the age of 8 years.

In 5% to 10% of children, the pressure in the middle ear causes the eardrum to rupture and drain a yellow or cloudy fluid. This small hole usually heals over the next few days.

If the following treatment is carried out your child should be fine. Permanent damage to the ear or to the hearing is very rare.

What are the symptoms?

Your child's ear is painful because trapped, infected fluid puts pressure on the eardrum, causing it to bulge. Other symptoms are irritability and poor sleep. Some children have trouble hearing. A few have dizziness. If the eardrum ruptures (tears), cloudy fluid or pus will drain from the ear canal.

How can I take care of my child?

• Antibiotics (For mild ear infections, antibiotics may not be needed.)
  Your child needs the antibiotic prescribed by your healthcare provider. This medicine will kill the bacteria that are causing the ear infection.
  Try not to forget any of the doses. If your child goes to school or a baby sitter, arrange for someone to give the afternoon dose. If the medicine is a liquid, store the antibiotic in the refrigerator and use a measuring spoon to be sure that you give the right amount. Give the medicine until the bottle is empty or all the pills are gone. (Do not save the antibiotic for the next illness because it loses its strength.) Even though your child will feel better in a few days, give the antibiotic until it is completely gone. Finishing the medicine will keep the ear infection from flaring up again.
• Pain relief
  Acetaminophen or ibuprofen can be used to help with the earache or fever over 102°F (39°C) for a few days until the antibiotic takes effect. These medicines usually control the pain within 1 to 2 hours. Earaches tend to hurt more at bedtime.
  To help ease the pain, you can put a cold pack or ice wrapped in a wet washcloth over the ear. This may decrease the swelling and pressure inside. Some providers recommend a heating pad or warm, moist washcloth instead. Remove the cold or heat in 20 minutes to prevent frostbite or a burn.
• Restrictions
  Your child can go outside and does not need to cover the ears. Swimming is fine as long as there is no perforation (tear) in the eardrum or drainage from the ear. Children with ear infections can travel safely by aircraft if they are taking antibiotics. Also give them a dose of ibuprofen 1 hour before take-off to deal with any discomfort they might have. Most will not have an increase in their ear pain while flying. While coming down in elevation during a airline flight or a trip from the mountains, have your child swallow fluids, suck on a pacifier, or chew gum.
  Your child can return to school or day care when he or she is feeling better and the fever is gone. Ear infections are not contagious.
• Ear recheck
  Your child should be seen by the healthcare provider in 2 to 3 weeks. At that visit, the eardrum will be checked to make sure that the infection is cleared up and no more treatment is needed. Your healthcare provider may also want to test your child's hearing. Follow-up exams are very important, particularly if the infection has caused a hole in the eardrum.

How can I help prevent ear infections?

If your child has a lot of ear infections, it's time to look at how you can prevent some of them. If some of the following items apply to your child, try to use them or talk to your healthcare provider about them.

• Protect your child from second-hand tobacco smoke. Passive smoking increases the frequency and severity of infections. Be sure no one smokes in your home or at day care.
• Reduce your child's exposure to colds during the first year of life. Most ear infections start with a cold. Try to delay the use of large day care centers during the first year by using a sitter in your home or a small home-based day care.
• Breast-feed your baby during the first 6 to 12 months of life. Antibodies in breast milk reduce the rate of ear infections. If you're breast-feeding, continue. If you're not, consider it with your next child.
• Give your child all recommended immunizations. The flu vaccine and the pneumococcal vaccine will protect your child from some ear infections.
• Avoid bottle propping. If you bottle-feed, hold your baby with the head higher than the stomach. Feeding in the horizontal position can cause formula to flow back into the eustachian tube. Allowing an infant to hold his own bottle also can cause milk to drain into the middle ear.
• Control allergies. If your infant always has a runny nose, a milk allergy may be the problem. This is more likely if your child has other allergies such as eczema.
• Check for snoring. If your toddler snores every night or breathes through his mouth, he may have large adenoids. Large adenoids can lead to ear infections. Talk to your healthcare provider about this.

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Ear Infection (Otitis Media): Teen Version

What is an ear infection?

An ear infection is an infection of the middle ear (the space behind the eardrum). It is often caused by bacteria. It usually is a complication of a cold and starts on the third day of the cold. A cold blocks off the eustachian tube (the passage connecting the middle ear to the back of the throat).

In 5% to 10% of ear infections, the pressure in the middle ear causes the eardrum to rupture and drain a yellow or cloudy fluid. This small tear usually heals over the next few days. Ear infections are uncommon after 10 years of age, but can occur in anyone. Permanent damage to the ear or to the hearing is very rare.

What are the symptoms?

Your ear is painful because trapped, infected fluid puts pressure on the eardrum, causing it to bulge. Other symptoms are irritability and poor sleep. You may have trouble hearing or be dizzy. If the eardrum ruptures (tears), cloudy fluid or pus will drain from the ear canal.

How can I take care of myself?

• Antibiotics (For mild ear infections, antibiotics may not be needed.)
  You need the antibiotic prescribed by your healthcare provider. This medicine will kill the bacteria that are causing the ear infection.
  Try not to forget any of the doses. Even though you will feel better in a few days, take the antibiotic until it is completely gone. Finishing the medicine will keep the ear infection from flaring up again.
• Pain relief
  Acetaminophen or ibuprofen can be used to help with the earache or fever over 102° F (39° C) for a few days until the antibiotic takes effect. These medicines usually control the pain within 1 to 2 hours. Earaches tend to hurt more at bedtime.
  To help ease the pain, you can put a cold pack or ice wrapped in a wet washcloth over the ear. This may decrease the swelling and pressure inside. Some healthcare providers recommend a heating pad or warm, moist washcloth instead. Remove the cold or heat in 20 minutes to prevent frostbite or a burn.
• Restrictions
  Going outdoors is not a problem and you don't need to cover your ears. Swimming is fine as long as there is no perforation (tear) in the eardrum or drainage from the ear. You can travel safely by air if you are taking antibiotics. While coming down in elevation in an airplane or while in a car coming down from the mountains, swallow fluids or chew gum. You can return to school when you are feeling better and the fever is gone. Ear infections are not contagious.
• Ear recheck
  See your healthcare provider in 2 to 3 weeks. At that visit, your eardrum will be checked to be certain that the infection is cleared up and no more treatment is needed. Your healthcare provider may also want to test your hearing. Follow-up exams are very important, particularly if the infection has caused a hole in the eardrum.