Child swimming

Summer and swimming go together—especially for kids, who can’t resist the call of pools and ponds—in the season’s sweltering temps.

“Water gets directly into ears, and that warm, moist environment causes bacteria to breed, making swimmer’s ear a common issue in kids,” says Jessica Glick, DO, a family medicine physician at Memorial Hermann Medical Group (MHMG) The Woodlands Primary Care.

After dealing with ear infections regularly when your children were tiny, you may think you know all there is to know about ear infections, swimmer’s ear or otherwise.

“There’s more to learn about the condition, though,” Dr Glick says.

Here are seven possible surprises:

Not all of your "outer" ear is easily seen

Swimmer’s ear, or otitis externa, inflames the ear canal. Only the external part of the ear canal is visible. Sight unseen, water can collect, softening the inner canal lining, creating an environment where germs can invade and multiply, Dr. Glick says. “That leads to infection, irritation or swelling. Some children are more prone to swimmer’s ears,” she says.

Red, itchy or scaly patches due to eczema, psoriasis or seborrheic dermatitis inside the ear raise the risk. So does injury to the ear canal from excess scratching or cleaning with cotton swabs in the ear.   

Swimmer's ear is not the same as the ear infections little ones get year-round

Indeed, swimmer’s ear differs from otitis media, the middle ear infection that five of six children have at least once before their third birthday—and one of the most common reasons parents take children to doctors. Swimmer’s ear happens when fluid builds behind the eardrum, a membrane separating the ear canal from the middle ear.

“Adults are less likely to get swimmer’s ear unless they have a chronic condition that lowers their ability to fight off infections,” she says.

You cannot catch an ear infection

Swimmer’s ear does not spread from person to person. Nor can the more common middle-ear infections. But since the latter tend to follow colds, sore throats or respiratory infections, you should get your child vaccinated for flu every fall, starting at age 6 months.

As early as 2 months of age, babies also should get a four-dose series of the PCV13 vaccine (13-valent pneumococcal conjugate vaccine). If kids are behind schedule, they still should get vaccinated.

Don't ignore swimmer's ear

You should not assume that this too shall pass. Swimmer’s ear may start with itching, muffled hearing or pain while chewing, and a child may complain, cry, scratch or rub their ears, Dr. Glick says.

If the condition worsens, a low-grade fever may develop and the ear canal may redden, swell or leak pus. Serious infections may spread to the outer part of the ear or nearby skin, leading to redness, swelling or warmth of the area. This is called periauricular cellulitis.

While it’s unlikely—and most often in the elderly, diabetic or immunocompromised—infection can spread to the skull base, soft tissue, inner ear or brain and potentially be fatal,” Dr. Glick says.

Preventive measures for swimmer's ear may sting and smell

Bacteria is less likely to grow if ears are dry. After swimming, you can use a few small drops in each ear of a homemade vinegar rinse—a blend of half white vinegar and half rubbing alcohol, Dr. Glick says. Your doctor also can prescribe an acetic acid drop, which will restore the pH balance that thwarts germs.  

Less smelly ways to dry ears include using the corner of a towel or having your child shake their head or tilt their head to the side so water can drain. You could finish with a hair dryer, used briefly, on the lowest setting and not too close to the skin. 

Further protect ear canals by never inserting cotton tip swabs. “We do not recommend inserting anything into the opening of the ear,” Dr. Glick says. “Earwax protects your ear from infection. If excess earwax is a problem, I’d leave that to the patient’s physician or health care provider to handle. You can clean the outside of the ear with a cotton tip, but not the inside.”

If your child has swimmer’s ear frequently, limit water activities to under an hour.

They’re not as likely to get swimmer’s ear if they’re in the water less than an hour. So, the excuse to skip baths to avoid swimmer’s ear doesn’t hold water. “Regularly bathing or showering is unlikely to raise the risk of swimmer’s ear,” Dr. Glick says.  

Some precautions may backfire

Wearing specially designed ear plugs during swimming can help, but regular use of ear plugs, hearing devices or ear buds can boost the risk of otitis externa. Swim caps and wetsuits also potentially can trap moisture in your ears, Dr. Glick says.

Kids will be back in the pool soon

To treat swimmer’s ear, your doctor may prescribe five to seven days of antibiotic drops to fight infection and lower swelling and pain. Unfortunately, kids also need to stay out of the pool during that time, Dr. Glick says. “Reassure them that after treatment is done, they can get back to enjoying water activities again.”

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