That’s a question we hear quite a bit, especially during the summer months. So we thought we'd ask one of our experts.

In general, swimming with a middle ear infection (while under treatment) is not a problem, according to Natalie Roberge, M.D., an Ear, Nose and Throat (ENT) specialist at Cook Children’s.

However, a child should stay out of the water for some time while experiencing swimmer’s ear, also known as otitis externa.

Unlike the common middle ear  infection, swimmer’s ear is inflammation and/or infection of the ear canal.

Symptoms

The symptoms of swimmer’s ear usually start as itching of the ear, and quickly progresses to ear pain (especially if you pull on the earlobe). You may even notice a discharge or foul smelling odor from the ear. Swimmer’s ear is predominately seen in the summer months, mostly in children older than 2 years and often only affects just one ear.

“Swimming with an otitis externa is discouraged until three days after the pain and drainage have stopped,” Dr. Roberge said.

How do you get swimmer's ear?

There's a reason why your mother used to make you dry your ears when you got out of the pool or shower. Water sitting in your ears is the perfect environment to allow bacteria and fungus to grow. Wax prevents water from pooling in our ears and changes the acidity of our ear canals to stop microbial growth. Therefore children with little to no ear wax are at risk of developing swimmer’s ear. Conditions that trap water in the ear, such as excessive amounts of ear wax or foreign objects in the ear, may cause troubles. Swimmer’s ear also is seen in children with diabetes, chronic immunodeficiencies, or certain skin conditions (such as severe eczema, or psoriasis).

Prevention

As with many diseases an ounce of prevention is worth a pound of cure. Drying your child’s ears thoroughly by tilting the head and place a towel in the ear can significantly decrease the chance of infection. If your child is prone to swimmer’s ears the use of waterproof earplugs or a few drops of over-the-counter swimmers ears drops can help prevent. You can make your own swimmer’s ear prevention drops with equal parts of rubbing alcohol (isopropyl alcohol) and white vinegar (5 percent acetic acid). At the end of swimming dry your ears and place a few drops in both ears.

What about swimming with tubes?

In general, kids with tubes do not need ear plugs while swimming, unless it seems to bother the child or with lake swimming or deep diving. The exception to this: Swimming with draining ears in children with tubes should be discouraged until the drainage has stopped.

Both the American Academy of Pediatrics (AAP) and the Academy of Otolaryngology – Head and Neck Surgery Foundation published the following:

“Evidence from clinical trials shows no benefit or trivial clinical benefit from routine water precautions. Some children with tubes may benefit from water precautions in specific situations (lake swimming, deep diving, history of recurrent otorrhea, head dunking during bathing, or otalgia with water entry into the ear canal).”

We hope this answers a few of your questions and you have a safe and happy swimming season. #Lifeguardyourchild

Related Articles:

• Another ear ache. Is it time to see an ENT?
• Let's learn something: Ear infections and tubes
• 7 ear infection myths every parent should know

And yes folks, that means Q-tips. Look at what our medical director of Emergency Services has to say:

“Q-tips and cotton-tip swabs cause numerous ER injuries we see at Cook Children’s,” Corwin Warmink, M.D., medical director of Emergency Services said. “I know people hear this all the time, but children should not be putting cotton-tip swabs in their ears. They can cause damage and sometimes the damage can be severe.”

Natalie Roberge, M.D., an Ear, Nose and Throat specialist at Cook Children’s, says problems from placing cotton-tip swabs in the ear can include:

1. Pushing the wax further into the ear canal causing impaction.
2. Laceration/bleeding of the ear canal.
3. Increased risk of otitis externa from the trauma. It's called swimmer's ear, but really any trauma to the ear canal can lead to otitis externa.
4. Perforation of the ear drum. Some will not heal and require surgery. Rarely the middle ear ossicles will also be damaged.

So how do you get earwax out of your child's ear? 

Well maybe you don't.

Earwax is a normal, protective coating to the ear. Some kids make more than others.It doesn't need to be removed except in extreme circumstances and should not be removed by parents.

If you can see some earwax on the outside, it's OK to clean it off but there's never a need to place something in the ear canal to remove it.

Even if I see a lot of earwax during a checkup, I don't clean it out unless there is a concern for infection, a problem with hearing or there is discomfort from the wax.When it is time to remove it, we have a few options:

1. Drops to break down the wax. These can be bought over the counter but should not be used in patients that have a history of tubes or who might have an ear drum rupture.
2. Ear flushing - In the office, we can use a flushing of fluids to remove the wax from the ear.
3. Ear curettage - The most common and my preferred method is to use an ear currette to pull the wax out of the ear. This is done with extreme care because the child must be older or held properly to make sure they are safe.

I get asked a lot about earwax from parents. I hope this advice helps. 

Related to this topic:

• What's Earwax?
• Let's Learn Something: Ear Infections and Tubes
• 7 Ear Infection Myths Every Parent Should Know
• Another Ear Ache. Is It Time To See An ENT?

I should call this: "The Eustachian Tube - Dictator of Ear Happiness." More later on that.

Few things I want to put out there first:

1) There are two kinds of ear infections: middle ear infections (otitis media - the type you get tubes for) and otitis externa (outer ear infection, no tubes for this)

2) "Water in the ear" from a bath or pool typically does NOT cause middle ear infections! It CAN cause something called "otitis externa," or, "swimmer's ear," which is an ear canal/skin infection that may require ear drops to improve. I'm not going to talk about that kind of ear infection today. From here on out when I say "ear infection," I mean the middle-ear kind.

3) Ear infections are incredibly common. Do NOT freak out if your child gets one. Five out of six kids will have at least one by their third birthday (and most will have more than one).

4) A "red ear" does not mean a child has an ear infection.

5) A "baby messing with an ear" does not necessarily mean they have an ear infection.

6) A fever with your child's cold does not necessarily mean an ear infection is happening. The only way to know if your child has an ear infection is to have the ear drum examined by a medical provider.

Why do ear infections happen? Well....snot. And inflammation. Snot and inflammation from colds. Snot and inflammation from allergies. Snot and inflammation from just walking into the door of daycare or that play date.

The inflammation blocks a vital little guy called a eustachian tube. Look at the picture to the left. Find the eustachian tubes. See how they're a little exit canal for the inner part of the ear? They drain the ear. An infant's eustachian tube is smaller than an adults', and more horizontal. That causes problems. It just doesn't drain well.

It swells up, gets blocked off, and the snot in the middle ear has nowhere to go. Once the cold or allergies are better, it de-swells, opens up, and voila!, ear infection is gone. All the junk drains out. The baby's eustachian tube is different than an older kid's, or adult's. This fact along with the fact that babies and toddlers are snot machines and always putting things in their mouths - that's why they get more ear infections. We hope they "outgrow" this eustachian tube problem (and hands in mouth problem) by age 2-3.

It can take 3 weeks to 3 months for the fluid to drain out of the ear. And your kiddo may have an ear infection and you'd never know about it, and that's ok - because they usually get better on their own! Most ear infections are VIRAL! That means the fluid just has a virus in it, and it will all go away on its own thanks to our great immune systems.

When I look into a child's ear, I examine the ear drum to know if they have an infection or not. When there is no infection, an ear drum is translucent, kind of like a shower door. When it is infected, it is red, bulging out, and full of what looks like pus. Sometimes this is just viral fluid. But sometimes, while that eustachian tube is all swollen and blocked off, the liquid stuck in the inner ear gets bacteria in it. We can tell the difference by looking in there. And that is why some children need an antibiotic for some ear infections. To kill the bacteria while we wait for the eustachian tubes to un-swell.

So...who needs "tubes?"

There are a few things that cause kids to get lots of ear infections:

1. Being in a child care setting (lots of kids...lots of snot).

2. Secondhand tobacco smoke exposure (as if you needed another reason to quit).

3. Taking a bottle to bed (when the child lays down and drinks, the milk actually puddles in the area where the eustachian tube meets the nose/throat and causes swelling and bacteria to hang out back there - this habit also causes cavities - no bottles in bed, folks!!)

Some kids have really tiny eustachian tubes that stay really swollen all the time. If they're around other kids a lot, like day care, they get tons of colds each year, and that's normal. However their little eustachian tubes mostly stay swollen shut, sometimes for months at a time. And we see them in our office 1-2 times a month for repeated ear infections.

I guess a "rule" I follow is that if a child gets 5-6 bacterial ear infections in a year, or more than 3 months of constant fluid in the ear, I will send them to the Ear-Nose-Throat doctor to get tympanostomy tubes (or just "tubes", as most people know them) put in. This brilliant procedure creates a little "canal" for the fluid to escape from the inside of the ear. They fall out in about a year, when we hope they've "outgrown" the problem.

Sometimes, I send a kid to ENT if I've put them on 3 or more rounds of antibiotics and they're still having fevers and still in pain and I just can't get that dang fluid to go away. Who wants a kid on antibiotics for that long!? Another reason to see the ENT is if the fluid is making it hard for a child to hear. When a small child can't hear, they can't learn to speak. I've seen kiddos get ear tubes and within 1 week they are talking up a storm! It's amazing.

However, surgeries and anesthesia comes with risks. If you're worried your child has had too many ear infections, talk to us. We will let you know if we think it's time to see the ENT.

Wow...this was long. I hope it helped you learn something about one of the most common ailments we see in the office!

Parenthood is hard, and this scenario is one all too familiar to parents of young children. According to the National Institutes of Health, “ear infections (otitis media) are the most common reason why parents bring their children to the doctor.” Why is that, you ask? Let’s talk about how the body works for a moment.

Think about how many changes take place from birth through the first year. Children often gain 15-30 pounds, their brains expand, their limbs stretch out, their torso extends, and that’s just what we can really see. The ear, nose, and mouth all grow and expand too. A tube called the eustachian tube, running from the middle part of the ear, right behind the ear drum, to the back of the throat also grows and changes direction. As a matter of fact, it shifts from lying almost horizontally (even with the ground) to lying diagonally (tilting), but it takes a few years. During that time, fluid doesn’t drain as well as it does in adults. Fluid buildup from allergies, upper respiratory infections, sore throats, or viral colds may end up sitting in the space right behind the ear drum, keeping it moist and warm. This is the perfect environment for infection-causing bacteria to grow.

What if it’s just one or two ear infections? When is it time to see the ear, nose and throat doctor to take care of that fluid? I asked one of our trusted ENTs, Natalie Roberge, M.D., to weigh in on this one for some guidance.

“It is time to think about seeing the ENT when a child has had 3-4 antibiotics or more for ear infections in a six-month period, especially if the fluid does not clear in the ears between the infections or if there is speech delay. Consulting an ENT is also recommended if the fluid behind the ear drum does not clear up after 3 months, even if the child has not had any infections or antibiotics. Some children need to be evaluated sooner if there is significant speech or developmental delay.”

What happens if I wait to address the frequent ear infections? I talked to Bari Pham, audiologist for Cook Children’s to field this one!

“Frequent ear infections, or even just having chronic fluid in the middle ear, can have a significant impact on a child’s brain growth. Consistent access to sound is necessary to develop neural pathways that support listening and speech development. If we deprive the brain of auditory information the child is at risk for delays in speech and language skills, literacy skills and academic struggles.”

Frequent ear infections can hinder speech and language development. Think about it: Sound moves freely through air, but add water or fluid, and the sound slows down. It becomes muffled, and the intensity (or the loudness) gets turned down. So what exactly does that mean for speech?

Sounds can be easily confused, especially the high frequency or “sharp” sounds we make with our mouths. Take the “t” sound for example. It’s made with a short burst of air, inside our mouths (so it’s not visible from the outside), and we don’t add our voice like we do for a vowel sound such as “ee.” It’s a high frequency, and sometimes, very quiet sound. It’s easily missed with fluid in the middle ear.

One of our own ICU nurses (who happens to be my awesome sister), is a patient of Dr. Roberge’s and reflects on a similar situation with her son. “{His speech} is muffled. It’s not clear, and I think the ear infections prevented him from saying more.” She gives the following advice to fellow parents: “Make sure to follow what your doctor recommends as far as making appointments and keeping follow-up appointments. Don’t be opposed to frequent rechecks. It can only help!”

So you’ve followed the directions of your medical professionals. Your child’s speech is still not clear, and they still seem to lack understanding. Now what? Speak with your pediatrician about a speech and language evaluation with your friendly speech-language pathologist. We’re happy to help!