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The Dr. is In- Updates & Earaches PDF Print E-mail


First an immunization update: A new version of the Prevnar (pneumococcal or strep pneumonia) vaccine is now available. The previous version – Prevnar7 or PCV7 – protected against 7 strains of the str. pneumo bug. The newer one – PCV-13 adds protection against an additional 6 strains. This bug is the 2nd most common cause of bacterial meningitis and also causes ear infections, sinus infections, pneumonia, and bloodstream infection (“bacteremia”). The vaccine is usually given as 4 doses between 2 and 12 months of age. We know that the PCV7 has resulted in a much-reduced number of ear infections in young kids since its introduction. It’s expected that PCV13 will add to that trend. It’s recommended that kids between 1 and 5 years of age who completed the PCV7 series receive 1 additional dose of PCV13. This is a smart idea so give your friendly pediatrician a call today to do this or ask about it.

Topic #2 is swimmer’s ear (otitis externa or “OE”).
This is an inflammation / infection of the ear canal which results in pain and tenderness of the external ear. The ear canal is a very small space with a relatively small opening at one end. The lining of the ear canal is very thin and easily damaged. Earwax – secreted by cells lining the canal - helps protect and lubricate this lining. In addition, earwax has an acidic pH which inhibits bacterial growth.

For obvious reasons, OE is more common in the warm months of the year when kids swim. Excessive moisture in the ear canal, from swimming or even from sweating in warm, humid weather neutralizes the acidic environment and washes away wax, leaving the ear canal vulnerable to infection. In addition, chlorine in swimming pools alters the pH level away from acidity. Other predisposing factors are eczema, too little earwax or too much wax. Micro trauma to the ear canal from Q-tips, bobby pins or any other small object a young child (or parent) might insert may result in breaks in the cellular lining of the canal and bacterial invasion. (Note to parents: earwax will usually work its way out without any help from you.)

Swimmer’s ear can be confused with middle ear infections (“otitis media” or “OM”). OM is an infection of the middle ear space, behind the eardrum; it usually occurs with cold viruses and causes fever. With OE, pushing on the small bump of cartilage just in front of the ear canal opening or pulling backwards on the ear should hurt. This is not the case with OM. In kids who are less verbal or younger, it may be hard to tell whether it’s OE or OM.

Treatment for swimmer’s ear includes prescription eardrops which reduce swelling and inflammation of the canal lining and stop infection. The drops must be given correctly and allowed to soak in. Staying out of the water until the pain and tenderness is gone is important as well.

Preventing OE is pretty simple;

• No digging around with Q-tips or other small pointy objects in the ear canal

• No flushing out the ears with water

• Thoroughly drying out the ears after swimming or bathing. This is best done with a blow dryer (careful! not too close please). OTC drops like “SwimEar” after swimming helps maintain acidity and kill bacteria. Or you can make your own drops with half rubbing alcohol - half white vinegar.

With more severe cases of OE, there may be a gooey discharge from the ear and more severe pain and tenderness. Your primary care MD may suggest a consultation with an ENT physician. Swimmer’s ear is rarely serious, but it can be quite uncomfortable. Now that you know how to prevent it, your kids can be like guppies all summer-long without worry.

Healthy Kidz Doc is written by a board-certified pediatrician who's practiced in Santa Cruz County since 1986. www.healthykidzdoc.yourmd.com


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