External otitis: summer, "swimming pool" or "swimmer's" earache

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External otitis in children

L'otitis external is an inflammation of the ear very common in children.
Let's find out in detail what theotitis externa, what are the causes, symptoms, remedies and how to prevent it. 

In this article

  • Otitis externa: what is it 
  • Otitis esterna: the cause
  • Otitis externa: the symptoms
  • Otitis externa: the remedies
  • Otitis externa: how to prevent it
Read also: Otitis in children, how it is treated and how it is prevented

Otitis externa: what is it

If we say "otitis" we automatically think ofotitis media, which affects especially in the cold season. But earache is not only a winter ailment: it can even strike in summer, only that it is a completely different disease:otitis externa, Also called "swimming pool" or "swimmer's", because it generally occurs following a stagnation of water in the ear, more likely in those who spend a lot of time in the water, at the sea or in the pool. External otitis can affect anyone, but it tends to be more common in children between 7 and 12 years of age and in regular swimmers.

See also the video: Otitis: Symptoms and Treatment in Children

Read also: Otitis in children: symptoms and remedies

Otitis esterna: the cause

He explains it well Emiliano Milazzo, medical director of the Otolaryngology Operating Unit of the Marche-Nord Hospital. "As the name implies, otitis externa is aacute inflammation of the external auditory canal, due to ainfection - usually bacterial - which typically occurs following a stagnation of water in the ear, which in turn causes a maceration of the skin which determines the formation of an ideal environment for the proliferation of microorganisms ".

So nothing to do with otitis media, which affects the Eustachian tube and usually strikes in the cold season, concomitantly or as a consequence of a cold or a sore throat.

Read also: Strep throat sore throat: EVERYTHING YOU NEED to know

"External otitis occurs especially in summer precisely because in this season swimming in the sea or in the pool, combined with the hot and humid climate, can lead to stagnation of water in the ears, in turn responsible for maceration of the skin and proliferation of bacteria or, less frequently, viruses and fungi. "Among the bacteria most involved in the phenomenon are in particular Pseudomonas aeruginosa and Staphylococcus aureus.

In addition to stagnation of water, other conditions can also lead to irritation of the external auditory canal and, therefore, facilitate the onset of otitis. Between these, microtrauma caused by the use of cotton buds for cleaning (always not recommended!) or prolonged and constant use of earphones and the use of very aggressive cleaning products (shower gel, shampoo). Finally, it should be noted that otitis externa is more common in people suffering from skin diseases such as psoriasis or eczema (which can lead to peeling of the skin), who have diabetes or with a particularly narrow conformation of the duct itself.


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Otitis externa: the symptoms

The very first symptoms are typically the pruritus and the feeling of muffled ear. “To these - continues Milazzo - is added the pain, which can be felt above all by exerting pressure with the finger on the tragus (the protrusion located in the front part of the ear) or by slightly stretching the auricle outwards, or by swallowing or yawning ”.

If the child is quite small you will notice that he often touches his ear and avoids sleeping on the side where he is in pain. Plus, Mom might notice some on the pillow secretions.

Otitis externa: the remedies

The first thing to do in the presence of external otitis is avoid - at least for a few days - getting more water into the ear. It does not mean that the child, perhaps on holiday by the sea, can no longer get close to the water until the infection has passed: the important thing is that he does not wet his head or even put it under water.

In case of ear pain or the presence of secretions it is obviously necessary to contact the pediatrician, who will assess the situation. If it is precisely otitis externa, the indicated therapy is one local therapy with antibiotic (or with antibiotic and anti-inflammatory), to be instilled in the ear canal. Only in - rare - special cases will an antibiotic be recommended to be taken orally. "To relieve pain, however, it may be useful to administer paracetamol", explains Milazzo. Underlining that the pediatrician will also evaluate the situations in which a visit to the ENT may be appropriate, for example if secretions remain.

Read also: How to get children to take medicine

How to put the drops for external otitis

Local antibiotic therapy is recommended in the case of otitis externa, but - beware - not for otitis media. For it to be effective, the drops must be positioned in a very specific way: first you need to make the child lie down (but this also applies to adults) on his side, with the ear to be treated facing upwards. So the drops are applied until the ear canal is completely filled. Finally, you have to make sure that the baby remains in position for about 3-5 minutes. Generally, the treatment must be repeated a few times a day, for about a week.

Otitis externa: how to prevent it

To prevent infection, a few hygiene rules are essential:

  • rinse your ears with fresh water after swimming in the sea or in the pool and dry them well with a towel (which must always be for personal use). It can be helpful too finish drying with the hair dryer (low temperature and low speed);
  • wear a swimming cap when going to the pool;
  • avoid using cotton buds, which alter the bacterial film naturally present along the ear canal, also with protective functions. To remove the earwax that settles on the outside of the duct, simply a towel or handkerchief is enough, but in any case you must not overdo the removal, because earwax also has a protective function.
Also read: 10 questions about cleaning children's ears

When it's the fault of the earwax plug or the pressure change

In some cases the earache is not caused by an otitis, but by a more banal one plug of earwax, which, being by its nature hygroscopic (ie able to absorb water), when wet increases its volume causing pain. In this case the child feels a sense of muffling, as of a closed ear. In this case, the pediatrician can advise specific ear drops to dissolve the cap or send the child directly from the otorine, which will suck the cap.

In other cases, the feeling of "full ears" after the child has gone underwater may be simply due to rrapid change of pressure. "As happens when you go by plane, even going underwater determines a variation in the pressure inside the Eustachian tube, which children are not yet used to compensating" explains Dr. Milazzo. "To resolve the annoyance, restoring the right pressure, you just need to invite the little one to perform repeated swallowing for a few minutes or simulate blowing the nose".

Other sources for this article:

scientific article J. Wipperman, Otitis externa, in "Primary Care: Clinics in Office Practice" (vol. 41, 2022);
Atlanta CDC information material.

Questions and answers

What is external otitis?  

External otitis is inflammation of the external auditory canal, the canal that connects the earpad and eardrum.

Otitis externa: why does it come?

External otitis is favored by water and humidity, so much so that it is popularly called swimmer's otitis. Another risk factor is the combination of the use of cotton buds and the penetration of water into the external ear canal.   

How is external otitis treated?  

Depending on the situation, the pediatrician can opt for the administration of antibiotics, typically in the form of drops to be instilled directly into the ear.

How long does external otitis last?

When diagnosed early, otitis usually resolves within 5-10 days of starting treatment.

  • otitis
  • otitis in the summer
  • summer otitis
  • swimmer's otitis
  • swimming pool otitis
  • 3-5 children years
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