No Jingle Bells When Ear Swells
By Phidelle Andres, M.D

Ear infections are common occurrences in all age groups. Of these illnesses, the two most commonly encountered in the clinics are Acute Otitis Externa (AOE) and Acute Otitis Media (AOM).

Approximately 10% of people will develop otitis externa during their lifetime, and the majority of cases (95%) are acute. Most occur during the summer and in tropical climates such as here in the Philippines. Otitis media, on the other hand, is the most common disease of childhood, with the exception of viral upper respiratory infections. The acute bacterial infection of the middle ear occurs in 80% of children between the ages of 1 and 6 years.

Even though both are ear infections, how one individual develops them entirely differs.

Otitis Externa: The Infection of the External Ear

AOE involves rapid onset (<48 hours) of signs and symptoms. It is generally associated with two reasons: local trauma; or exposure of ear canal to water predisposing to further injury.

Local trauma happens due to frequent ear manipulation (i.e. meticulously cleaning your ear Every. Single. Day.).

Did you know that the ceruminous debris you try so hard to extract is akin to Christmas ornaments meant to be kept in the tree?

Cerumen, commonly known as ear wax, has antibacterial and antifungal properties. It acts both as a physical barrier and a protective coating over the external ear. Therefore, routine ear cleaning is not advisable.

Additionally, the ear canal possesses a unique self-cleansing mechanism. The sloughed skin cells along with various dirt are migrated outwards then spontaneously extruded.

So next time you think of removing those ear waxes, imagine how lifeless your Christmas tree would look without its ornaments.

The second reason is more common in the tropical climates where individuals enjoy swimming in the cold, glimmering sea. Hence, it’s also called the “Swimmer’s Ear” or “Tropical Ear”

The constant moisture kept in the ear macerates the skin, predisposing it to injury with the slightest manipulation. The seawater likewise washes off the cerumen and alters the pH of your ear making it susceptible to infections.

Otitis Media: Infection of the Middle Ear

It often starts after you have had a sore throat, cold, flu, seasonal allergies, or other upper respiratory problem. The produced mucus migrates to your ears via a connecting tube, stays in the middle ear, and ultimately, bacteria grows causing infection. All aforementioned illnesses tend to peak in the colds months…And you’ve guessed that right, for instance, during our notorious “4-month Christmas Season” in the Philippines.

Signs and Symptoms:

Like how one became accustomed to the melody of Jingle Bells, it might be prudent to familiarize oneself with the following:• Fever ≥37.8C• Ear itchiness• Ear redness• Ear discharge• Ear pain• Ear fullness or hearing loss• Tenderness of ear lobe or tragus• Recurrent colds or nasal congestionOnce encountered, you’ll know immediately who to call: your “sENTa Claus”


We never grew tired of hearing the same yearly Christmas melodies since the lyrics still convey their meaning. Similarly, claiming that prevention is better than cure still holds true to this year. Here are some words of advice in order for you to enjoy the Holidays without aching ears.

• Get vaccinated (e.g. Flu, Pneumococcal). They protect against the common pathogens of middle ear infection.• Clean your hands and avoid frequent ear manipulation.

• Breastfeed exclusively until your baby is 6 months old and continue for at least 12 months.• Do not smoke and avoid exposure to secondhand smoke.• Dry your ears thoroughly after swimming or taking a bath.Lastly, here’s a gift about EAR CLEANING FACTS:

“A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture after swimming or bathing. Q-tips should not be used for this purpose, because they may pack material deeper into the ear canal, remove protective earwax, and irritate the thin skin of the ear canal creating the perfect environment for infection. The SAFEST WAY to dry your ears is with a hair dryer, set on the cool setting.” – AAO-HNSF

Enjoy The Festivities Without Ear Miseries!


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Gupta S, Singh R, Kosaraju K, Bairy I, Ramaswamy B. A study of antibacterial and antifungal properties of human cerumen. Indian J Otol 2012;18:189-92

Medina-Blasini Y, Sharman T. Otitis Externa. Updated 2021 Aug 7. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:

Philippine Society of Otolaryngology – Head and Neck Surgery: Clinical Practice Guidelines, December 2016