Pain, Pain Go Away!
How to stop swimmer’s ear from ruining your child’s pool time this summer.
by Jourdan Crouch
PARENTGUIDE News July 2006

“Who wants to go swimming?” This simple question makes kids squeal with glee each sultry summer season. But fun in the sun can be quickly cut short by a nasty, painful infection known to most as swimmer’s ear. More than 6.2 million cases of otitis externa are diagnosed in the U.S. each year, and this figure has more than doubled over the past ten years. In addition, New York City is one of the top ten cities in the nation where swimmer’s ear is most found.

What can you, as a concerned but busy parent, do about it? With a little time and effort, you can help keep your children’s ears dry and nearly infection-free so that the entire family will have a more enjoyable, carefree summer in the water.

“No one is completely safe from Recreational Water Illnesses” (RWI— infections caused by organisms that contaminate water in pools, lakes, hot tubs and water parks), says Alan Greene, M.D., a leading pediatric professor at Stanford University. Most people don’t even know about them, he says. The term “RWI” didn’t exist until the Centers for Disease Control coined it in 2001, and the broad definition encompasses a variety of water-bred bacteria that spawn swimmer’s ear, diarrhea and rashes. Pseudomonas aeruginosa, the bacteria which causes swimmer’s ear, lives in both water and soil and feeds off such products as suntan oil. But what about chlorine? Even if a pool has been treated recently with the powerful disinfectant, it takes a few days for the chlorine to kill every germ that has made the pool its home.

Swallowing water is the most obvious way that the contaminated liquid is ingested, and often young children do it without thinking. Excessive water exposure in the ear canal can also cause infection because bacteria slips inside the warm, wet surface and infects the area when it stays damp for hours at a time. Therefore, it is imperative that we do our best to keep the ear dry after time in the water.

Sometimes it may take up to a week for the swimmer’s ear symptoms to show up, but when they do, they usually come on with full force. Itchiness, redness and extreme pain of the outer ear are all common symptoms, and many children complain about chewing or laying their head down on the infected ear. Swelling and pus-like discharge can also occur. Nothing ruins a summer vacation or an upcoming swim team competition quite like an onset of swimmer’s ear, and your child shouldn’t have to be the victim of this icky, itchy infection.

“It’s just horrible that kids are having fun in the water but then hurting as a result,” Greene says. Once a victim of swimmer’s ear himself during childhood, Greene vividly remembers his own ear-splitting pain. He hopes that his efforts as a pediatrician and spokesman will help save other young swimmers.

He has created an acronym containing four rules for smart swim parents— appropriately called SWIM. Shower right before swimming; Wear sunscreen and apply frequently; Involve yourself with your children while they swim by watching them at all times and teaching them not to swallow water; and Make sure ears are dried thoroughly after swimming. Tilt the head and move the ear around to break the vacuum seal that keeps the water inside. Also try cleaning out the outer ear with a soft surface and avoid sticking objects into the ears that may scratch the ear canal. The body’s production of ear wax naturally cleans out dirt deep within the ear and Q-tips actually trigger the body to make more wax, says Greene. Home remedies such as the use of rubbing alcohol or white vinegar drops or using a blow dryer on low or cool can be helpful options for prevention, but should never be used as treatment.

As with all infections, the only way to truly eliminate risk is to use antibiotics, and new, evidence-based guidelines have been published by an expert panel of doctors about the preferred options. Topical antibiotic ear drops are the therapy of choice because they are safe, provide prompt relief and do not promote resistant bacteria. Oral antibiotics, however, are still prescribed in approximately 40 percent of all cases, and experts such as Greene are strongly pushing for this number to drop. When a child swallows an antibiotic, he or she receives 100-1,000 times more dosage than with a topical treatment, and the dose travels throughout the body and often brings on unnecessary side effects. This also creates a bacterial resistance within the body which leads to an increased chance of occurrence in the future.

“There is absolutely no reason for doctors to prescribe oral antibiotics anymore,” Greene says. He and other experts believe that once-a-day, pre-measured drops, such as FLOXIN® Otic, are the most accurate and effective at treating the infection on the spot, as well as easier to remember to take.

As the most popular summer sport and the second most popular form of exercise, swimming plays an important role in the lives of all Americans. But being smart and safe around the water can not be forgotten. A recent national survey found that 33 percent of family vacations were ruined or made less enjoyable due to ear infections, and 36 percent of kids could not participate in swimming activities. Don’t let this nasty ear infection ruin what is left of your kids’ pool time this summer.

Jourdan Crouch is an assistant editor.