A 9-year-old female with ear pain is brought into the emergency department by her mother. The family is from out-of-town and is visiting relatives on holiday. The mother is an emergency physician in her hometown. She reports that her daughter has been doing a lot of swimming while on vacation and that about two days ago she began to develop right ear pain. The physician-mother reports examining the ear and felt her daughter most likely had otitis externa based on history and exam. She placed her daughter on systemic and drop antibiotic therapy. The child has had no improvement in symptoms and was brought to the local emergency department for evaluation. The following image of the right ear was obtained.
The child has otitis externa (swimmer’s ear), an infection of the external auditory canal.
This is a typical presentation of otitis externa. Ear pain and discharge that develops after swimming. It is thought that excess exposure to water causes breakdown of the skin in the ear canal offering bacteria the chance to overcome the normal cerumen defense factors. The external canal will normally be swollen with the canal appearing red, painful to inspection, and often times (as in this case), obstructed by purulent discharge. Treatment is antibiotic drops. Although the patient had been on antibiotic drops, it was not a first-line antibiotic. In addition, the physician-mother did not have ear wicks available. The use of ear wicks is indicated as the antibiotic drops have to penetrate the edematous canal to reach the distal areas of the external canal.
The child was placed on a first-line antibiotic and was provided with ear wicks.
Here is a video of the ear exam:
Complete video of exam