My ears are currently killing me and have inspired today’s post on otitis externa. I got it from my habit of swimming for exercise, and it’s being exacerbated by putting a stethoscope in my ears 25 times a day. While I am miserable right now, I’m trying to look on the bright side. At least I have more empathy for my suffering patients who can’t tell me how much pain they are in.

The type of ear infection I have is really common in kids, but parents are often surprised to realize that it is different from a typical “ear infection.” The ear is separated into 3 distinct areas: the outer ear, middle ear, and inner ear.

When people talk of an ear infection, they are usually referring to an “otitis media” (otitis means ear and media means middle), so middle ear infection. Those are the infections where there is fluid or pus behind the ear drum (usually the result of a complication of a cold). These infections are treated with oral antibiotics (because the infection is behind the ear drum and drops can’t get to the infection).

The infections of the outer ear are referred to as “otitis externa” (otitis means ear and externa means outer). This is when the ear canal itself gets infected and inflamed. This usually happens as a result of some irritant/infection touching the ear canal. The most common cause is the water from swimming pools. This is why otitis externa is often referred to as “swimmer’s ear.” However, in kids, there are often many other causes of otitis externa. Namely, kids like to stick things in their ears. The objects then get stuck and start to irritate and infect the ear canal or just injure it altogether.  Repeat offenders in my office are Q-tips, pencil lead, pencil erasers, and rubber balls (don’t know why the last one keeps showing up).

Whenever a kid comes into my office and complains of an earache, I always ask if they stuck anything in it. 99% of the time, the answer is “no.” When I look and see a foreign body, I again ask, “Are you sure you didn’t stick anything in there?” The answer is still 99% of the time, “no.” (Which always surprises me, it’s like they don’t think I can see it). When I pull out the object, the look is always the same-horrified awe. It’s like I magically made the object appear. Usually the parent and I then die of laughter at that point. While the child has the momentary guilt of getting caught in the lie, there is huge relief that comes from knowing the pain is finally going to get better.

Signs and Symptoms:

1. Ear pain (worsened when the outer ear is touched or pulled gently)
2. Pain on pushing the tragus (the little tab like flap that sticks out just in front of the ear canal)
3. Pain in the ear with chewing or moving the jaw
4. Severe cases may have drainage from the ear

Diagnosis and treatment of otitis externa will require a visit to the doctor:

1. Examination of the ear (with removal of foreign body if necessary)
2. Prescription antibiotic drops (usually a couple times a day for about a week)
3. Keep the ear dry. (Either allow ear to dry on own or use a drying agent or drop. Try to avoid using Q-tips.)
4. Stop the offending agent (swimming, sticking stuff in the ear, etc.)

The pain with otitis externa can be pretty extreme (believe me, I know). So give your child some ibuprofen if he/she complains. Usually, within a couple of days on the drops, the pain is markedly improved.