To Swim or To Surf… Your Ears Want to Know!

To the beach or the pool, you ask? We say both, but take care of those ears!

There is a common misconception that Swimmer’s ear and Surfer’s ear are similar ailments, so we talked to Santa Cruz, CA family physician Hossein Hassani about dispelling that myth.

Swimmer’s ear, Hassani says, is an infection in the outer ear canal, most commonly caused when water is trapped in the external auditory canal, presenting a good medium for bacterial grow. This infection of the ear canal, otitis externa, is a common problem especially for children who spend a lot of time in the water.
Otitis Externa captured with the CellScope Oto

Otitis Externa captured with the CellScope Oto

Pain upon yawning or swallowing may indicate swimmer’s ear. If you gently wiggle the ear or press in front of the ear canal and the pain increases, there is a good chance there is an infection. Treat accordingly and avoid getting water in the ear until his treatment is done. To help prevent swimmer’s ear, after bathing or swimming, make sure to get all the water out of the ears by turning his head to each side,  dry gently with a towel, or use alcohol drops.
Hassani continues to explain that surfer’s ear, on the other hand, is excess cartilage growth in the external auditory canal due to prolonged exposure to cold water. Also referred to as exostosis or abnormal bone growth, it is most commonly seen in surfers who tend to spend hours in the ocean water. Irritation from cold wind and water exposure causes the bone surrounding the ear canal to develop new bony growth which constrict the ear canal. The ear canal is actually blocked by this condition, meaning that both water and wax can become trapped and give rise to infection.
Surfer's Ear taken with the CellScope Oto

Surfer’s Ear taken with the CellScope Oto

Surfer’s ear is a progressive condition, making it important to take preventative measures early, preferably whenever surfing. The condition is not limited to surfing and can occur in any activity with cold, wet, windy conditions (Kitesurfers, beware!).
Swimmers and surfers be warned, and take preventative measures and keep those ear canals as dry as possible. In case of an infection, consult your physician.

Ears 101: Ear Infections

Last week, we introduced the Ears 101 series and explored the basic anatomy of the ear. This week we are going to talk about those pesky ear infections! Namely, we want to know what do people actually mean when they talk about an ear infection?

The phrase “ear infection” is used commonly and without much distinction, but there are actually two different varieties of ear infections: otitis media and otitis externa. Otitis media refers to inflammation in the middle ear, whereas otitis externa is inflammation in the external ear canal (see anatomy basics). For now, we will explore otitis media since it is the type most people are speaking about when they say “ear infection.”

So, we’ve learned that otitis media is inflammation in the middle ear, but what is behind the inflammation?

Usually, the culprit is either bacteria or fluid build-up in the middle ear. There are two main distinguishable subtypes with their own unique symptoms to lookout for:

1. Acute otitis media (AOM), the most common type of ear infection, is caused by bacteria entering into the middle ear through fluid build-up in the eustachian tube.

Signs and symptoms of an AOM include: redness and pain, a bulging tympanic membrane, fever, and fussiness or trouble sleeping in younger children. Both adults and children can get an AOM, but they occur more frequently in children. Commonly, an AOM develops after a cold, sore throat, or an upper respiratory infection.

A photo of an acute otitis media (AOM) captured by the CellScope Oto.

A photo of an acute otitis media (AOM) captured by the CellScope Oto.

2. Otitis media with effusion (OME) is referred to as the silent otitis media because often patients don’t exhibit any symptoms. An OME exhibits inflammation without infection and is characterized by fluid build-up (or effusion) in the eustachian tube, which can be thin or thick and gooey. The thick fluid is oddly referred to as ear glue.

Signs and symptoms of an OME include the feeling of stuffiness in the ear or “being underwater”. There is usually no pain associated with an OME and it can come before or after a bout with AOM.

A photo of otitis media with effusion (OME) captured by the CellScope Oto.

A photo of otitis media with effusion (OME) captured by the CellScope Oto.

Now that we’ve cleared up the mystery behind the words “ear infection” and uncovered the different subtypes of otitis media, we can move on to tackle the burning question, “what causes ear infections?” in the next installment of Ears 101.

Have an ear question you’d like answered? Submit your questions in the comments.

Disclaimer: This information is meant for educational purposes only; none of the above information should be viewed as medical advice, diagnosis or treatment.

ReelDx Ear Case Study No. 2

Hear it here. Our second case study from ReelDx is in!

If you missed Case Study No. 1, you can view it here.

The Patient

A 9-month-old girl with a cough, fussy and is not eating or drinking. She was seen by providers the day before but was brought back into the Emergency Department because her symptoms persisted. The patient is on day 1 of a course of Amoxicillin.

The Work Up

Dr. Spiro from ReelDx took the patient’s history, conducted a physical exam, and then used the CellScope Oto for the otoscopic exam.

The Diagnosis

Acute Otitis Media (AOM), Otitis Media

What We Learned

An AOM can be challenging to diagnose. Is is suggested that providers follow the diagnosis guidelines recommended by the American Academy of Pediatrics. The wait- and-see prescription can be used in some cases and is accepted by families.  Since this patient was already on a course of antibiotics, Dr. Spiro recommended to continue the treatment and use Ibuprofen for pain as needed. Dr. Spiro cautions against switching antimicrobials because frequent changes can increase the likelihood of an adverse reaction, like a rash or diarrhea.

The patient’s right ear captured by the Oto. The patient was diagnosed with AOM.

The patient’s right ear captured by the Oto. The patient was diagnosed with Acute Otitis Media.

Check out both ear videos and full case write up on the ReelDx library.

Keep those case studies coming, Dr. Spiro!

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The Case of the Popcorn Kernel

It’s not unusual for kids to stick things in their ears, but sometimes the discovery of such an object is still a bit of surprise to all those involved. This case comes from Dr. Carl Peluso of Elmbrook Pediatrics and it is a story about an earache, the CellScope Oto and one curious child.

Think of this: Dr. Peluso examining a young girl at a Well Child Care visit, when the patient’s mother asked if he could also look at her son’s ear since he complained that morning of right ear pain. After the daughter’s exam was finished, Dr. Peluso moved on to inspect the boy’s ears. Upon examining the boy’s right ear, Dr. Peluso noticed something was obscuring his visualization of the eardrum.

Foreign body in the lumen canal.

Foreign body in the lumen canal.

“Right away I realized it was not cerumen (ear wax) and decided to try to remove it in the office. I tried a pair of tweezers without success and was about to give up, but then I remembered we had a set of alligator forceps that might do the job,” shared Dr. Peluso.

Using the CellScope Oto, Dr. Peluso was able to show the little boy what he was trying to get out of his ear. This made him comfortable enough to let Dr. Peluso try once again with the “cool” forceps. After one more try, he was able to get a good grip and pull it out whole. Much to everyone’s surprise it was a colored popcorn kernel!

The foreign body is identified; it's a colored popcorn kernel!

The foreign body is identified; it’s a colored popcorn kernel!

“I thought that would be the end of it,” said Dr. Peluso, “but a follow up video revealed he had an underlying Acute Otitis Media as well.”

The Tympanic Membrane after the kernel was removed.

The Tympanic Membrane after the popcorn kernel was removed.

Neither the mother nor the young boy could remember when he might have put the kernel in his ear, but Dr. Peluso thinks it is likely that it had been there a while and only started to become uncomfortable when the boy developed the bulging tympanic membrane.

“It was neat to be able to see a before and after video and to share it with the patient’s mom who thought it was cool too!” said Dr. Peluso.

Many thanks to one of our Pioneer physicians and two-time contributor to the Tympanic Times, Dr. Carl Peluso. Thanks for sharing!

Interested in becoming a Pioneer? Learn more here!

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Announcing a New Partnership with ReelDx

REEL Dx Dark Blue We are happy to announce that we have teamed up with ReelDx to increase visibility of our respective products! ReelDx is a Portland, OR based company that uses real patient video cases to help students and professionals alike master the art of medicine.

Dr. Spiro, co-founder and Chief Medical Officer of ReelDx had this to say about the partnership, “CellScope’s innovative yet easily accessible technology is changing the way physicians gather and share quality images for diagnosis. We see a perfect synergy between our companies and are excited about this new partnership.”

ReelDx producing doctors will now be able to use the CellScope Oto to capture high quality video ear exams, which will be highlighted in the cases featured on the ReelDx platform. You will also see some of the ReelDx Oto videos and links to new case studies showing up here on the Tympanic Times Blog. Be on the look out for great content coming your way soon from the doctors at ReelDx!

We leave you with a great video taken by Dr. Rosenbloom from ReelDx of a patient with Acute Otitis Media (AOM).

Ear Pic of the Week: A Well Visit AOM

Dr. Jessica Kaplan, a favorite San Francisco pediatrician in Noe Valley who has been known to say that ‘the CellScope Oto’ has replaced her traditional otoscope’ shared her AOM Case file with us this week.

Image captured by Dr. Jessica Kaplan of the left ear of an 18 month old with Acute Otitis Media

Image captured by Dr. Jessica Kaplan of the left ear of an 18 month old with Acute Otitis Media

This tympanic membrane pic of an 18 month old in group care who had been well for many months, although had an infant history of several episodes of bronchiolitis and wheezing, presented on well child exam with no complaints. The child had been mildly congested and upon inspection of the ear canal, Dr. Kaplan found this ear ailment. She first instructed the family to give the child oral antihistamines but the ear findings persisted. The child was ultimately treated with antibiotics and the acute Otitis Media was resolved.

Thank you, Dr. Kaplan for snapping a pic with your CellScope Oto and sharing information about the case.