08.06.2021 – 10:24
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Patients: What does ear pain and itching indicate?
Doctor: All summer long ear problems are one of the main concerns of our patients. One of them is also swimmer’s ear or external auditory canal infections. For anatomical study we should mention that the ear is divided into 3 parts:
The outer ear, where the earlobe and outer ear canal, the middle ear, and the inner ear are inserted.
When we talk about the swimmer’s ear, we are focusing on the external auditory canal. It contains glands that produce wax and fat, the balanced production of which leads to self-cleaning of the ear.
Why are there patients prone to getting chronic ear infections every year during the beach period and who are they?
Generally patients with chronic external duct disease, such as:
patients with chronic dermatitis,
patients with overproduction of wax production (production that comes as a result of itching of the ear by the feeling of hearing blockage after the introduction of water),
patients with chronic diseases, such as diabetes, as a result of decreased immune strength
This group of patients knows the history of the onset of the disease and its clinical signs and are the first to come to the doctor.
The infection develops with all its signs:
swelling of the canal walls,
production of purulent secretions,
These infections do not only occur in the summer season, there are also patients who get infections from the introduction and blockage of water in the ear during the shower. The ear canals are never the same anatomically, one can be narrower, with more curves up to the eardrum, where water can be blocked and this ear can be difficult to ventilate creating a tendency for a possible infection.
These patients, wanting to dry the ear with cotton swabs or other circumstantial means, open the gate to the onset of infection. This includes adults and children. This can happen in the shower, as well as on beaches, swimming pools, in waters that are not very clean, but sometimes even clean, as it is precisely the anatomy of the ear that creates the trend.
In patients with wax hyperproduction the introduction of water into the ear may be accompanied by immediate blockage and tinnitus.
Acute infections manifest for the first time in patients after the beach or swimming pools and begin with the itching sensation of the ear after the introduction of water in the ear, a few days, maximum one week after the beach and precipitates in pain and blockage of hearing, tinnitus. For us ENT doctors, the expression “The pain is great, but the disease is small” applies here.
The sooner you see a doctor after the first infection, the easier the therapy is. To cure the infection, a sterile swab with gauze or cotton is placed, which remains in the ear for up to 48 hours and is dripped with solutions composed of antibiotics and cortisone that reduce the swelling of the canal, treat the infection and soothe the pain. At the same time, the therapy can be accompanied by painkillers.
In people with compromised immunity and other systemic diseases, such as diabetes mellitus and in cases where local therapy with drops in the ear does not work, we start therapy with systemic antibiotics, mainly of the quinolone group as one of the microbial causes is Pseudomonus aeruginosa that with this group of antibiotics it fights very well.
I would recommend to patients who have external otitis, ie canal infections for the first time with the clinical signs I mentioned, to present directly to the ENT doctor.
We often get badly treated cases, for which we have to start therapy from the beginning. Remove cotton swabs from daily use, which do not clean the wax in patients with hyperproduction, but push it towards the ear drum which is only 2 cm away from the canal entrance, increasing the trauma that can lead to cracking of the drum traumatically which in turn can lead to surgical resolution.
There are spray preparations that can be used for daily ear hygiene, which are sold in our pharmacies. In many patients, especially those with chronic infections, wax hyperproduction, canal skin diseases such as atopic dermatitis or eczema, or even patients whose ears produce very little wax, we would recommend the use of stoppers during the shower or dyed cotton with oil that keeps water on the surface and does not allow the canal to get wet.
After the shower in low gradation, they can also dry the ear with a dryer if any minimal amount of water has entered. So, as we see, ear canal infections do not belong exclusively to the summer season, however the intensity is greater in this period.
All patients who have concerns with the external auditory canal, which may be pain, itching of the canal, burning, blockage, should make a follow-up visit to the otolaryngologist to get occasional advice. Dense use of boric acid in the population should be discontinued in people with dry ear, which does not produce even the minimum amount needed by the canal to protect itself, as it is associated with corrosion of the canal skin, constant itching and as a result infections chronic canal. Never use circumstantial canal itching, such as fingernails, pens, spears, car keys that can overlap the infection on one side or worse, in traumatic drum cracks that have chronic consequences that can require operational intervention to rebuild a new drum.
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