Reference:
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (Ch. 59, pp. 1935-1963)
Also known as swimmer’s ear. It is an infection of the skin lining along the ear canal. It is often caused by a dermatosis (psoriasis, eczema, seborrheic dermatitis), and even allergic reactions.
- Incidence: common in pre-school and school-age children.
- Causative agents: Staphylococcus aureus, Pseudomonas sp., or sometimes the fungus Aspergillus can enter the ear canal from a scratch, injury, or if the ear is wet for a prolonged period of time. Systemic conditions (vitamin deficiency, endocrine disorders) may also be a cause.
Clinical Manifestations
Itching, pain in the ear canal, small amounts of clear discharge, and occasionally a fever and/or hearing loss, cellulitis, and lymphadenopathy.
- Diagnostic Examination:
- The auricle and ear canal appears red and swollen. The ear canal may appear to have eczema (scaly shedding of skin).
- The outer ear is tender.
- The eardrum may be obstructed because of swelling of the outer canal.
- Growing culture from the clear discharge may identify the causative bacteria or fungus.
Treatment
The goal is to cure the infection.
- Clean the canal of drainage to allow topical medications to work effectively.
- Antimicrobial or antifungal otic medications may be used. For bacterial infections, a combination of antibiotics and corticosteroid otic drops are used to fight infection, reduce itching, and reduce inflammation. It is used abundantly (4 or 5 drops at a time) in order to reach the end of the ear canal.
- In severely obstructed ear canals, a wick may be used to facilitate the instillation of medicine.
- Analgesics may be used for severe pain for the first 2 to 4 days.
- A Warm Compress may reduce pain.
- Keep the ears clean and dry, even during showering, shampooing, or bathing. Do not swim.
Nursing Management
Prevent infection. Recurrence is highly likely unless the patient allows the external canal to heal completely.
- Inform the patient to avoid cleaning the external auditory canal with cotton-tipped applicators to avoid events that traumatize the external canal, such as scratching.
- Avoid getting the canal wet, even when bathing. A cotton ball covered in a water-insoluble gel (e.g. petrolatum jelly) can act as a barrier for the ear.
- Do not swim for 7 to 10 days after diagnosis.
- Antiseptic otic preparations after swimming can prevent infection (contraindicated in history of tympanic membrane perforation or on-going infection).