The ear canal is a small tube that ends with the eardrum or tympanic membrane. Normally, it contains many types of bacteria and a layer of cerumen, or ear wax. The ear canal, in order to stay free of infection and irritation, maintains a very specific environment that is dry and mildly acidic. If this environment is disrupted with water exposure, the skin is subject to breakdown and irritation which leads to infection, inflammation, and pain. However, overly aggressive cleaning of the ear canal with cotton swabs and using objects that are placed into the ear canals (hearing aids, for example) are also associated with the development of this condition.

The symptoms of external otitis are explained by the location of the irritation. Usually, children will complain of gradually increasing ear or head pain located on the involved side. Also, the pain is profoundly worsened by manipulation of the pinna (the ear) or the tragus (the small piece of the ear that covers the entrance to the canal). The pain can become so severe that he or she may be unable to eat, sleep, or become comfortable. A discharge from the ear canal may also be noted.

Treating external otitis is relatively straightforward, and involves a combination of keeping the ear dry (no swimming for 7 to 10 days), taking care of the infection with topical antibiotics, and restoring the acidic environment. External otitis is not normally treated with oral antibiotics and prevention products (over the counter drops) are usually not effective in reducing symptoms once severe. Occasionally, the infection and swelling are so severe that a small piece of cotton is placed into the ear canal (an ear wick) to increase the ability of the drops to contact the infected areas. Finally, pain control using stronger pain medications is sometimes necessary.

Avoiding external otitis can be difficult, especially if your child is prone to these infections. When swimming, ear plugs are beneficial but difficult to keep in place. After swimming, you may also use a hair dryer (on the “cool” setting held 12 inches from the ear) after shaking water from the ear to dry the ear canal.

Finally, you can then place a few drops of a solution of rubbing alcohol and/or dilute vinegar (diluted 1:1 with water) into the ear canal to remove the final bit of water and restore the acidity. Commercially prepared drops are available over the counter at most pharmacies that serve the same purpose. Also, cleaning the ears only on the outside and not using cotton swabs or in-ear headphones can also be helpful.

Dr. Wes Stubblefield graduated from the University of Alabama School of Medicine (UAB) with his medical degree in 2004, and then trained at Vanderbilt Children’s Hospital in pediatrics, finishing in 2007. He returned to Alabama in 2007 and joined Dr. Ellen Royal and Dr. Richard M. Freeman at their pediatric practice in Auburn. Dr. Stubblefield is board certified in pediatrics, is a Fellow of the American Academy of Pediatrics, and currently serves as the local area representative for it’s Alabama Chapter. He is married to Jennifer and they have one daughter, Peyton.