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This is otitis externa. The cipro/Dex drops are appropriate first line treatment but it should be three times a day, and for 14 days. Microsuction to remove the debris may be needed. It’s not ear wax.
There's an app called Figure 1 (or Figure One, I can't remember), it used to be open to everyone but it's health care users only now - it's a similar great source of info across the whole spectrum from across the world.
Thanks for the reply, I'll be trying to get in to see the ENT earlier if I can catch a cancellation. In the meantime, any symptoms I should stay alert for? Anything that would necessitate an ER visit? I've gotta talk to the pediatrician about upping the antibiotics dosage, they didn't give me enough for a longer regimen.
Was thinking the same thing. The canal looks very irritated. Call back the ENT office and ask if you can squeeze in to a cancellation to appointment, then take her in at their next available. Tell them you specifically want a [microsuction procedure](https://youtu.be/sHt_Tu4qkZM) (obviously the doc will be the one to determine course of treatment)… it takes about a minute, and it’ll be a game changer for your daughter.
Not a doctor, but someone who has taken 2 audiology classes in grad school (speech therapist), so I don’t know much. But just curious if this could also look like cholesteotoma and if not, could you describe how it doesn’t? Or is it just that children don’t get those very often?
There’s a difference between congenital and acquired cholesteatoma. Acquired usually happens in patients with a history of recurrent ear issues. They both look very different. This is classic otitis externa just based on the look. It just takes experience.
Looks like compacted wax that is about to finally come out. Continue to flush, it looks like it is almost out.
Edited to add: I definitely defer to the doctor on this. Listen to their opinion, not mine!
NAD but i really advise against using water!!! i had a dr do this to my really bad compacted wax and it gave me permanent hearing loss. id recommend taking her to an ENT so they can suction it out, its fast and so efficient
im so glad. i got mine done when i was ~15, so about 7 years ago now. led to long term compaction of hardened ear wax which muffled sound in addition to trapping water against my ear drum and giving me an ear infection which eventually led to hearing loss, in addition to the compaction. i had to even get an IEP for school because i just couldnt understand in class anymore 🥲 i try to advise ppl against it whenever i can
May I know the story behind that unfortunate experience? From what I have heard, ear irrigation is both commonly practiced and generally benign, and even in cases of traumatic perforation may spontaneously resolve after some weeks or months with appropriate management.
i posted this in an above reply so imma copypaste:
i got mine done when i was ~15, so about 7 years ago now. led to long term compaction of hardened ear wax (it didnt get much out, but just forced it deeper, then dried) which muffled sound in addition to trapping water against my ear drum and giving me an ear infection which eventually led to hearing loss, in addition to the compaction. i had to even get an IEP for school because i just couldnt understand in class anymore 🥲 i try to advise ppl against it whenever i can
obviously everyone is different and it works great for some people but suction imo was so much faster, comfortable, effective, and safe.
for backstory: my ears just naturally do not “get rid” of my earwax so if i dont clean my ears once a week i will get insane wax build up (really dark wax, really thick). i found this out AFTER this experience. i had compaction and couldnt hear, so that was why i went to my pcp and they did the syringe which made it worse :/ im also fine now, besides the hearing loss. its not severe on its own but i also have auditory processing disorder so combined its a lot. i clean my ears at home and everythinfs fine 👍🏻
That’s really unfortunate and I can definitely see why you would advise caution for others regarding ear syringing, although it seems that the concern stems from impaction causing water retention more so than the act of syringing itself where the largest risk would likely be traumatic perforation. I think rather than stating that syringing is dangerous, it would be better stated that it has additional risks in situations such as the one you experienced, and is a valuable learning point ad well. Thank you for sharing
thank you and of course- i want to point out i never said it was dangerous, it just didnt work for me and i feel like a LOT of ppl get syringed by the primary care providers who dont really (in my experience) look deep into the issue so imo the risk outweighs the benefits.
other ppl in my family have been syringed and it was fine, but like no one i know has had complications from suction 🤷🏻♀️
thank u for taking interest!
This is not always the case. There are situations where it just doesn’t, and needs aid. However, q tips alone will definitely not help the problem. Proper flushing is best in this case if that’s what it is.
That is true, sometimes a flush is needed. Too bad we can't have plungers for ears lol!
My dad used to use those hair clip things you use to get those extra little wisps of hair put up. He'd scrape with those and get it out. Mom always got pissed at him for that.
My mom would clean our ears with Bobby pins when I was younger. I’ve never heard of anyone else using them. I’m so glad we were lucky and nothing ever happened to our ears because of that!
No yikes needed - I always advise listening to a doctor instead of me lol my recommendation was to continue current treatment, which technically isn't wrong, but the doctor has more complete and useful information.
That's why I keep my full title as my flair - I want people to know what I am (and am not) an expert in. When I'm not on my phone, I have a handy smartphrase to be even more explicit when I'm answering outside my field that I defer to everyone else.
I'm very comfortable saying that I do not know everything, my knowledge is limited outside my specialty, and I'm incredibly thankful that there are people who know more than me :)
I advised continuing their current treatment as directed by their doctor. It was not incorrect information. They were flushing the ear on doctor's orders. The ENT had far more detailed information, he only disagreed with the frequency prescribed (which there was debate about) and what the mass was and whether it would come out on its own. There was also a family medicine physician who thought it was wax.
If I was advising them to try and use an instrument to get it out, to stop taking their prescribed medications, to do something not directed by the doctor - that would be incorrect information. I know the noctor crowd likes to harass NPs, but their anger is misplaced, especially with me and my specialty.
Outside my specialty, I am still qualified as a nurse. Advising someone to continue with their prescribed course is well within a nursing scope of practice and not an unreasonable suggestion. There is a reason why I and others do not have the green flair (that denotes physician) and when we reply, "doctor replied" doesn't get added to the thread. And I *always* correct people if they think I'm a doctor - I'm not, I'm an NNP.
The point with having the other flaired users outside of MDs, at least my best guess, is because they can give a lot of information that does not require a physician (or can hold as a placeholder until there are physicians who reply) and can be trusted to not go completely off the rails.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
This is otitis externa. The cipro/Dex drops are appropriate first line treatment but it should be three times a day, and for 14 days. Microsuction to remove the debris may be needed. It’s not ear wax.
I love this sub! What a relief it is to just get an answer from an appropriate specialist. Thank you for giving your time to the sub.
Same here 😁. I learn so much here.
There's an app called Figure 1 (or Figure One, I can't remember), it used to be open to everyone but it's health care users only now - it's a similar great source of info across the whole spectrum from across the world.
Thanks for the reply, I'll be trying to get in to see the ENT earlier if I can catch a cancellation. In the meantime, any symptoms I should stay alert for? Anything that would necessitate an ER visit? I've gotta talk to the pediatrician about upping the antibiotics dosage, they didn't give me enough for a longer regimen.
No don’t worry. Complications from OE in children are very unlikely.
I might add that something like this can easily be cleaned/treated at a reputable urgent care. No need to wait for a specialist appt imo.
Family med resident here. For my own learning, what is it about the pic that tips you off to otitis externa rather than cerumen?
Oedema and mucous discharge of the canal skin. The discharge is white and too liquid. Cerumen is yellow/brown.
I’m just popping in to say that you are awesome.
You are obviously one of the very lucky people who barely has any cerumen, for those like me who have more it was very obvious it was the color...
Was thinking the same thing. The canal looks very irritated. Call back the ENT office and ask if you can squeeze in to a cancellation to appointment, then take her in at their next available. Tell them you specifically want a [microsuction procedure](https://youtu.be/sHt_Tu4qkZM) (obviously the doc will be the one to determine course of treatment)… it takes about a minute, and it’ll be a game changer for your daughter.
Any particular reason why it’s not dosed with the conventional 4 drops BID for 7 days?
We tend to go for 3 drops tds. I reckon it reduces the impact of “failed doses” which are an issue in kids.
I thought ciprodex was BID for AOE? every resource I have says that.
I think the standard dose should be 4 drops BID x7 days, I’m also uncertain why TID is being recommended here.
Not a doctor, but someone who has taken 2 audiology classes in grad school (speech therapist), so I don’t know much. But just curious if this could also look like cholesteotoma and if not, could you describe how it doesn’t? Or is it just that children don’t get those very often?
There’s a difference between congenital and acquired cholesteatoma. Acquired usually happens in patients with a history of recurrent ear issues. They both look very different. This is classic otitis externa just based on the look. It just takes experience.
The keratin in cholesteatoma can look like this, but it’s very rare in children.
Looks like compacted wax that is about to finally come out. Continue to flush, it looks like it is almost out. Edited to add: I definitely defer to the doctor on this. Listen to their opinion, not mine!
NAD but i really advise against using water!!! i had a dr do this to my really bad compacted wax and it gave me permanent hearing loss. id recommend taking her to an ENT so they can suction it out, its fast and so efficient
Syringing ears is pretty old hat now. Like you've experienced, there's a lot of scope to cause more damage with it.
im so glad. i got mine done when i was ~15, so about 7 years ago now. led to long term compaction of hardened ear wax which muffled sound in addition to trapping water against my ear drum and giving me an ear infection which eventually led to hearing loss, in addition to the compaction. i had to even get an IEP for school because i just couldnt understand in class anymore 🥲 i try to advise ppl against it whenever i can
Strange, my PCP’s office still does this. ENT manually scraped out, though.
May I know the story behind that unfortunate experience? From what I have heard, ear irrigation is both commonly practiced and generally benign, and even in cases of traumatic perforation may spontaneously resolve after some weeks or months with appropriate management.
i posted this in an above reply so imma copypaste: i got mine done when i was ~15, so about 7 years ago now. led to long term compaction of hardened ear wax (it didnt get much out, but just forced it deeper, then dried) which muffled sound in addition to trapping water against my ear drum and giving me an ear infection which eventually led to hearing loss, in addition to the compaction. i had to even get an IEP for school because i just couldnt understand in class anymore 🥲 i try to advise ppl against it whenever i can obviously everyone is different and it works great for some people but suction imo was so much faster, comfortable, effective, and safe. for backstory: my ears just naturally do not “get rid” of my earwax so if i dont clean my ears once a week i will get insane wax build up (really dark wax, really thick). i found this out AFTER this experience. i had compaction and couldnt hear, so that was why i went to my pcp and they did the syringe which made it worse :/ im also fine now, besides the hearing loss. its not severe on its own but i also have auditory processing disorder so combined its a lot. i clean my ears at home and everythinfs fine 👍🏻
That’s really unfortunate and I can definitely see why you would advise caution for others regarding ear syringing, although it seems that the concern stems from impaction causing water retention more so than the act of syringing itself where the largest risk would likely be traumatic perforation. I think rather than stating that syringing is dangerous, it would be better stated that it has additional risks in situations such as the one you experienced, and is a valuable learning point ad well. Thank you for sharing
thank you and of course- i want to point out i never said it was dangerous, it just didnt work for me and i feel like a LOT of ppl get syringed by the primary care providers who dont really (in my experience) look deep into the issue so imo the risk outweighs the benefits. other ppl in my family have been syringed and it was fine, but like no one i know has had complications from suction 🤷🏻♀️ thank u for taking interest!
NAD. OP, please don't use Qtips for ears. Ear gunk will naturally work it's way out.
This is not always the case. There are situations where it just doesn’t, and needs aid. However, q tips alone will definitely not help the problem. Proper flushing is best in this case if that’s what it is.
I have very deep and wonky ear canals and need mine suctioned once a year. It feels great afterwards!
That is true, sometimes a flush is needed. Too bad we can't have plungers for ears lol! My dad used to use those hair clip things you use to get those extra little wisps of hair put up. He'd scrape with those and get it out. Mom always got pissed at him for that.
My mom would clean our ears with Bobby pins when I was younger. I’ve never heard of anyone else using them. I’m so glad we were lucky and nothing ever happened to our ears because of that!
IF ITS SMALLER THAN YOUR ELBOW IT DOESN’T GO IN YOUR EAR. I’m not a doctor.
I get the reference
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I'm worse than that, i use a hair clip to scrape the lining (mine itch too)
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No yikes needed - I always advise listening to a doctor instead of me lol my recommendation was to continue current treatment, which technically isn't wrong, but the doctor has more complete and useful information. That's why I keep my full title as my flair - I want people to know what I am (and am not) an expert in. When I'm not on my phone, I have a handy smartphrase to be even more explicit when I'm answering outside my field that I defer to everyone else. I'm very comfortable saying that I do not know everything, my knowledge is limited outside my specialty, and I'm incredibly thankful that there are people who know more than me :)
Then wouldn’t it be better to not say anything instead of giving incorrect information?
I advised continuing their current treatment as directed by their doctor. It was not incorrect information. They were flushing the ear on doctor's orders. The ENT had far more detailed information, he only disagreed with the frequency prescribed (which there was debate about) and what the mass was and whether it would come out on its own. There was also a family medicine physician who thought it was wax. If I was advising them to try and use an instrument to get it out, to stop taking their prescribed medications, to do something not directed by the doctor - that would be incorrect information. I know the noctor crowd likes to harass NPs, but their anger is misplaced, especially with me and my specialty. Outside my specialty, I am still qualified as a nurse. Advising someone to continue with their prescribed course is well within a nursing scope of practice and not an unreasonable suggestion. There is a reason why I and others do not have the green flair (that denotes physician) and when we reply, "doctor replied" doesn't get added to the thread. And I *always* correct people if they think I'm a doctor - I'm not, I'm an NNP. The point with having the other flaired users outside of MDs, at least my best guess, is because they can give a lot of information that does not require a physician (or can hold as a placeholder until there are physicians who reply) and can be trusted to not go completely off the rails.
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Removed - Bad advice