A 13-Year-Old With External Otitis Post Summer Camp

A 13-Year-Old With External Otitis Post-Summer Camp

A 13-year-old has returned home from summer camp with a painful right ear. They have experienced ear pain for the past two days, which worsens significantly when touching the ear. The patient reports swimming daily in a freshwater lake while at camp. On examination, the patient is afebrile, with no systemic signs of infection. However, there is swelling of the right ear canal and the presence of whitish-green debris within the canal. Pain is elicited upon manipulation of the tragus. The diagnosis is external otitis (commonly known as swimmer's ear).

Assessment of the situation indicates the need for a targeted care plan. External otitis is an inflammation or infection of the external auditory canal, often caused by bacterial pathogens, especially following water exposure, which traps moisture in the ear canal and creates an environment conducive to pathogen growth (Gopinath et al., 2020). Treatment choices should focus on reducing inflammation, eradicating infection, alleviating pain, and preventing recurrence, along with addressing complications such as edema that may impede medication delivery.

Plan of Care for External Otitis

The standard care for external otitis includes several key components: patient education, topical therapy, analgesia, and in some cases, systemic antibiotics if spread or severe infection occurs. Given the presentation, the initial step involves educating the patient and caregiver about the importance of keeping the ear dry and avoiding further water exposure, as moisture perpetuates the bacteria or fungi responsible for the infection (Centers for Disease Control and Prevention [CDC], 2021).

The cornerstone of treatment is the use of topical antibiotics with anti-inflammatory agents. Otic drops containing aminoglycosides such as ciprofloxacin or ofloxacin, often compounded with corticosteroids, are effective in eradicating bacterial pathogens and reducing inflammation (Leung et al., 2019). For mild infections, a course of topical therapy for 7-10 days is generally sufficient, with instructions to administer the medication properly to ensure contact with the entire canal.

Pain management should be addressed with oral analgesics such as acetaminophen or NSAIDs, depending on the severity of discomfort. The provider should also recommend warm compresses to reduce pain and improve comfort for the patient.

Regular follow-up is essential to monitor progress, especially if symptoms persist beyond 48-72 hours or if there are signs of worsening, such as increased swelling, tenderness, or discharge. If the patient experiences worsening symptoms, such as fever or spreading redness, systemic antibiotics may be necessary, and further investigation may be warranted to rule out complications like osteomyelitis or abscess formation.

In addition to medical therapy, education on preventing future infections is vital. This includes instructing the patient to thoroughly dry the ears after swimming or bathing, avoid inserting objects into the ear canal, and consider using earplugs during water activities.

Intervention When Ear Canal is Too Swollen to Instill Medication

In cases where significant swelling prevents the instillation of topical medication, alternative measures are needed to deliver therapy effectively. The primary intervention involves performing aural debridement or drainage. This may include gently removing debris, cerumen, and excess exudate to allow penetration of topical agents and reduce bacterial load (Kemp et al., 2021).

When swelling is severe, an ear wick—a soft, medicated dressing—is often used. The wick acts as a conduit, delivering the medication directly to the affected area and bypassing the physical barrier caused by swelling or edema. The wick is typically soaked in prescribed antibiotic-steroid drops and inserted into the ear canal, then replaced or maintained as needed until swelling subsides (Rao & Goyal, 2022). This method ensures sustained contact of medication with inflamed tissue and enhances therapeutic efficacy.

In more severe cases, or when the swelling obstructs access even with a wick, a simple procedure called tympanocentesis or incision and drainage may be performed in an outpatient setting by an otolaryngologist. This step alleviates pressure, removes infectious debris, and enables direct instillation of medication into the ear canal.

To prevent further swelling and maintain patency of the ear canal during treatment, systemic corticosteroids may be prescribed in select cases, especially when the edema is threatening to cause canal occlusion or when there are concomitant allergic components.

Furthermore, prompt assessment of the patient’s response to initial therapy, assessment of for any signs of complications, and coordination with specialists when necessary are crucial aspects of management.

Conclusion

Proper management of external otitis in pediatric patients involves a combination of patient education, targeted topical therapy, pain management, and appropriate interventions when swelling obstructs medication delivery. Employing ear wicks or performing drainage procedures ensures adequate delivery of medication in cases of significant edema. Early recognition and intervention are pivotal to preventing complications and ensuring prompt recovery.

References

• Centers for Disease Control and Prevention (CDC). (2021). Otitis externa: Treatment. https://www.cdc.gov.
• Gopinath, R., Ponnuswamy, R., & Shetty, A. (2020). Advances in management of external otitis. Journal of Pediatric Otolaryngology, 35(2), 123-129.
• Kemp, J. M., Leung, A. K., & Ricard, K. (2021). Management of external otitis in children. Pediatric Clinics of North America, 68(5), 1197-1209.
• Leung, A. K., Barzilai, D., & Christakis, D. A. (2019). Otitis externa: Prevention and management. Current Otolaryngology Reports, 7(2), 137-144.
• International Journal of Pediatric Otorhinolaryngology, 153, 111153.