Ear Infections 101 - A Parent's Guide to Avoiding Swimmer's Ear

     If only my friend Nici had a dollar for every time I’ve texted a medical question, she’d never have to work another day (or enunciate “otolaryngologist” at another cocktail party). But since she lives states away from Colorado, I’m reduced to texting her frantic questions for advice and parental peace of mind.

     For example, there was the time we went to Iowa for a family event: “Nici! I accidentally slammed poor Colin’s pinky in a door (with photo). Does it look like he needs urgent care?” Or when a neighborhood friend’s son took a knee to the face: “How do you know if his nose is broken?” 

     And then there’s the most prominent topic: my boys’ ears (mostly Brody’s): “Is it ok to let Brody go to the pool? He seems fine after his ear drum burst three weeks ago.”

     Inevitably, these texts come during or immediately after a swimming-intensive vacation.

     No coincidence, Nici says, because the ear canal is already full of bacteria and yeast, not to mention shedding skin cells. Then you throw in moisture.

     “That’s an opportunistic scenario for the yeast and the bacteria that’s already in there,” she says.

     Add in the fact that children’s ear canals are smaller than those of adults—and that most kids would swim all day if given the option—it’s typical for them to develop swimmer’s ear. An infection of the ear canal that does not pass through the eardrum, it’s painful enough that most kids can articulate the affected ear(s).

     “There are some kids who can swim in the pool all summer and not get an ear infection,” she says. “But if your child gets one from just looking at the pool, you can take preventative measures.”

     If your children are like mine and vulnerable to ear problems, here is a simple precautionary checklist that I’ll be following before the next pool season or snorkeling adventure begins:

  • Use an ear rinse. Add a 50/50 mixture of water and vinegar to a squeeze bottle; squirt in ear and gently massage the outer-ear area; allow liquid to trickle out. The mixture is benign enough that parents shouldn’t worry about overuse. But at a minimum, Nici says, it’s best to rinse ears before or after water activity.

     A concoction that is slightly anti-bacterial and anti-fungal, she says, the rinse provides protection and cleansing without side effects. “If you use it 50 times a day, it’s not going to hurt anything.” In fact, if Nici sees the same patient every 6 months for this same ailment, she recommends implementing ear rinses as a regular hygienic practice. “I say, ‘Put the rinse in your shower or bath, and irrigate the ears as part of your bathing routine,’” she says. “Squeeze it in, squish it around and let it rinse off.  Then you don’t smell like salad dressing the rest of the day.”

     Or try an over-the-counter alternative, Domeboro, available at most pharmacies. 

  • Respect the earwax. Most adults by now have heard the dangers of removing earwax, especially from children’s ears. Not only is this sticky substance critical to the ears’ health because of its pH (slightly acidic), which keeps the canal’s natural bacteria and yeast in check, but also because it guards the canal itself. “Parents who remove the wax are taking away a protective barrier and can actually scratch the skin, which is another way to invite infection,” she says

     You can still use cotton swabs, she says, but only to remove wax that is visible around the opening of the ear canal. “Don’t go farther than what you can see,” Nici says. In other words, she says, “Don’t insert the swab or device into the ear, or you’ll risk wedging the wax against the eardrum, which can cause other problems.”

  • Supplement aquatic activities with water-drying drops. I’ll be honest: I get confused between the condition called “swimmers ear” with water-drying aids like “Swim-EAR.” Because, if you think about it, the product—alcohol-based drops that remove excess water from the ear—isn’t used to treat actual swimmer’s ear, an infection of the outer ear.

Bottom line, Nici says, is to use products like these after water activities only. “Put it in the ear canal to dry up water so it doesn’t get trapped in the ear wax and set up the ear for infection,” she says. These products are also safe to use in concert with an ear rinse. (Visit product links below.)

  • Watch for contraindications. If after any of these treatments your child experiences pain, redness or swelling around the ear canal, muffled hearing, or abnormal discharge, contact your health-care provider.

Eustachian Tube Dysfunction

My oldest son, Brody, is far more prone to middle-ear infections than his brother, resulting a few times in a ruptured eardrum, as noted in one of my fretful texts to Nici. Also called a perforated eardrum or a tympanic-membrane perforation, these ruptures are common if a middle-ear infection goes undetected, building pressure against the eardrum until it bursts.

“Once the eardrum is ruptured, the child actually feels better,” says Nici.

That’s little consolation for parents like us, who felt awful in Belize when we noticed blood on Brody’s pillow—clear evidence of a perforation. He’d only complained the night before of an earache, followed soon after by a low-grade fever. And by the next morning, his eardrum had ruptured.These infrequent but upsetting events have always happened either during or on the heels of a vacation involving airplane flights and, of course, hours of swimming.

The most likely culprit, Nici says, is Eustachian Tube Dysfunction (ETD), a chronic blockage of the passageways linking the middle-ear space—or the area behind the eardrum—to the back of the throat. These tubes are meant to equalize pressure and drain away toxins from the middle ear.

But with a child like Brody, who has always struggled to clear his ears on flights and in water, he is susceptible developing a middle-ear infection that can lead to eardrum ruptures. And he’s all the more susceptible while on a trip. Why?

Because vacation provides the perfect recipe. Start by combining significant changes in air pressure while flying or swimming. Then mix in ample opportunity invite water-borne bacteria into the nose and throat. Last, throw in irritated Eustachian tubes that can’t operate properly. Voila! You have a formula for infection.

But why Brody and not his brother?

“Certain kids are going to be prone to it,” Nici says. “For instance, kids with lots of allergies or sinus issues, or who have difficulty popping their ears, are set up for ETD any time they travel.”

First, treat allergies with an antihistamine, which eases symptoms like runny nose, congestion and sneezing. Second, use a saline nasal rinse. “Saline is huge,” she says, because it helps decrease tissue swelling; rinses pollens and irritants; and dilutes secretions inside the nose and sinuses so the body can more readily flush out toxins.

“Some patients have year-round allergies, some only seasonally,” she says. “I tell them to irrigate the sinuses regularly throughout the allergy season. And at the very least, they should irrigate during vacation, as well as a couple days before and after.”

But since every child is different, Nici says, ETD is difficult to diagnose without a physician examining the ear. So to offer a general guide, if your child experiences three or more ear infections within a year, you should discuss it with your general healthcare provider.

“Talk to your primary-care doctor and let them decide if additional consultation is necessary,” she says.

Nici teaching Brody how to swim in a Nicaraguan pool, 2011.

In addition to being my best friend since we were children—attending school together from kindergarten to graduation—Dr. Nici Bothwell is a Board Certified ENT Surgeon who practiced formerly in the military. She recently earned another important designation, “Mom,” with the birth of son Conner in May 2014.