Ear Infections

Dear Dr. Z.,

Why do my kids seem to get more ear infections during the summer?


Most parents are frustratingly familiar with “earaches.” Second only to wellness child checkups, ear infections are the most common reason for trips to the pediatrician. While most “middle ear infections,” or acute otitis media, occur during the winter months, “swimmer’s ear,” or otitis externa, is much more common in the summer months.

Most cases of middle ear infections are accompanied by a viral upper respiratory infection, like the common cold. These viruses that cause the common cold infect the Eustachian tube. The Eustachian tubes connect the back of the nose to the middle ear. The normal progression of a middle ear infection is as follows: after a few days of a stuffy nose, sore throat, etc., the tissues surrounding the Eustachian tubes will start to swell, then the tubes get blocked, the fluid backs up in the middle ear, and this leads to a middle ear infection.

Unlike middle ear infections, swimmer’s ear has no association with the common cold. Swimmer’s ear is an infection with inflammation of the outer ear typically caused by the retention of moisture and water in the ear canal.

Causes

Swimmer’s ear is an inflammation of the outer ear and ear canal. In most cases, we can shower, bathe, and swim without problems because we are protected by our ear’s shape (which tips fluid out) and by its lining (which has acidic properties that prevent the excess growth of bacteria and fungus). When our ears are exposed to excess moisture however, water can remain trapped inside the ear canal. Our natural tendency to spend more time around the pool, is the reason why we get more outer ear infections during the summer. The lining and inside of the canal eventually becomes less acidic, allowing an infection to take place. Even without exposure to water, the use of objects such as cotton swabs or other small objects to clean the ear canal is enough to cause small breaks in the skin, allowing the same infection to occur. Both cases result in inflammation of the external ear and ear canal, allowing water to remain in the canal and further complicating the initial infection. The most common bacteria that cause this infection are Pseudomonas aeruginosa and Staphylococcus aureaus, the main fungal pathogens are Candida albicans and Aspergillus species.

Signs and Symptoms

Pain is the predominant complaint of ear infections. Most signs and symptoms of swimmer’s ear usually appear within a few days of exposure to the water source or foreign object and may include:

  • Pain on movement of the outer ear, usually made worse by lying on that side of the head at night
  • Swelling in the ear canal
  • Swelling in the lymph nodes of the neck on the same side, most commonly directly behind the ear
  • Feeling of fullness or stuffiness in the ear
  • Puss draining from the ear
  • Decreased or muffled hearing
  • Scaly or flaky skin in the ear canal or outer ear

Because the ear and throat are often interconnected, sore throats are also quite common.


Diagnosis

Upon exam, your doctor will most likely ask you a number of questions to obtain the history surrounding your condition. Your doctor will then most likely tug gently on your earlobe to elicit any pain and then examine the inside of your ear, using a lighted otoscope. If you do have drainage, your doctor may take a culture sample to determine if your infection is bacterial or fungal in nature

Treatment

Middle ear infections are usually treated with oral antibiotics. Whereas, swimmer’s ear is usually treated with topical eardrops containing antibiotics. Your doctor may choose to clean the outer ear of any drainage or flaky skin as this allows the medications to work more effectively. If you are concerned you have an ear infection, don’t hesitate to visit your local medical home for an evaluation.
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