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

Will and Anna Esler, Ayla's parents, answered a few questions for us to help us learn more about Ayla and what the family has experienced over the past year.

How did you find out Ayla was deaf?

Ayla failed her newborn screening at the hospital, and after we took her back and she failed it again, we were referred to a great audiologist here in Amarillo who helped us begin to discern the depth of her loss. From there we started working with Early Childhood Intervention, who helped us learn what life is like for kids with hearing loss and introduced us to an amazing community of parents and kids with hearing loss. We also started working with Ayla’s speech therapist, has become a dear friend and has done so much for our whole family—she even came with us to Fort  Worth for Ayla’s surgery and her activation—and she’s helped us learn what Ayla’s loss and now her newfound hearing means for the whole family. After a few months in, we were connected to the amazing team at Cook Children’s, who have gone above and beyond to help our daughter hear. The care that we’ve received from them has been extraordinary, and we’re so grateful for them.

What was going through your mind when Ayla’s implants were activated?

Anna: Every child responds differently when their cochlear implants (CIs) are activated, and so we didn’t know what kind of reaction she would have. And even though I knew it would work, there was still some doubt in my mind, so when I saw her responding to sound I was overwhelmed by thankfulness to God and to everyone else who has been a part of this journey.

Will: Ayla has had a lot of family and friends praying for her, and we saw God answer those prayers when her devices were activated. Like Anna, I was excited and scared and nervous and hopeful all at the same time. I thought she would probably cry and scream when her CIs were activated—and she did do that later when it became overwhelming—but to see her hearing sound and enjoying it was just incredible.

What was it like getting to this point?

Being deaf isn’t bad, it’s just different, and so we had spent a lot of time preparing ourselves for what life would be like without Ayla hearing. We had to let go of some things, like her knowing the sound of our voices, the sound of music, the sound of laughter. We had to prepare ourselves to see her enjoy those things in a different way, through the vibration of them, to “hear” with her eyes. When we found out that cochlear implants were an option for her, sound became a reality for her again, and we are so grateful for that. 

How is Ayla responding now, what kinds of changes have you seen?

She still has challenges ahead of her—we have a year’s worth of catch up to play, and whereas most kids learn to hear naturally we will actually have to teach her to hear, to teach her that sound has meaning. But she’s already responding positively—sometimes she turns to sounds (which she had never done before), she dances to music, she’s starting to calm down when we sing to her if she’s upset. We really couldn’t be more thankful for the new opportunities our little girl has thanks to everyone in her life.

Ear, Nose and Throat Program at Cook Children's

We know it's about more than medical expertise and advanced technology. It's about working together to tackle even the most complex ear, nose and throat conditions. At Cook Children's, our expert pediatric specialists diagnose and treat many ear, nose and throat conditions. The Ear, Nose and Throat (ENT) staff also collaborates with other specialties within Cook Children's system to treat and rehabilitate children with speech and hearing disorders. Meet our team by clicking here. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-6850 or click here.

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!

“He snores just like his daddy.”

Are these things that you have said about your child? If so, you may want to ask your doctor if your child might have sleep apnea. Because pediatricians often forget to ask about snoring during checkups, it is not uncommon for the diagnosis of sleep apnea to be significantly delayed or even missed altogether.

It is probably more common than you think. I spoke with Natalie Roberge, M.D., an ENT (ear, nose and throat) doctor with Cook Children’s, who estimates that obstructive sleep apnea occurs in 1-5 percent of children.

Snoring alone does not make the diagnosis of sleep apnea. Here are some of the other symptoms that could be present:

1. Pauses in breathing. (If your child snores, it might be worth listening to them occasionally to see if you hear these).

2. Bed-wetting.

3. Mouth breathing (at night or during the day).

4. Daytime sleepiness.

After discussing symptoms and examining your child, the doctor may recommend a sleep study. During a sleep study, a child will be observed for many different characteristics of their sleep including: apnea, excessive movement and level of oxygen in the blood during sleep.

There are many causes of sleep apnea but according to Dr. Roberge, “The most common cause in children is large tonsils and adenoids. The next most common, potentially treatable cause is obesity. Other causes include craniofacial, genetic and neurologic disorders.” If your child has any of these risk factors, it is important to pay closer attention to his or her snoring and quality of sleep.

Sleep apnea is treated differently depending on the cause of the apnea. If large tonsils are the problem, the pediatrician and ENT might recommend having them removed. If the child is obese, addressing healthy lifestyle and decreasing excess weight may help to improve the apnea.

It is important to address apnea for many reasons. You can find many different conditions associated with sleep apnea such as bed-wetting, ADHD and other behavioral problems, as well as hypertension and other cardiovascular problems. The consequences of untreated sleep apnea can be missed because they are common in many children.

Despite the fact that it might be fun to tease your child about his or her snoring, it is important that we consider the serious consequences of snoring and sleep apnea. If you have questions, please discuss them with your pediatrician and they can recommend a referral to an ENT if it is necessary.

About our sleep lab

The staff in our Ear, Nose and Throat Center collaborates with other specialties within Cook Children's system to treat and rehabilitate children with speech and hearing disorders. At Cook Children's, we can diagnose and treat many ear, nose and throat conditions. Our expert pediatric specialists have access to many services within Cook Children's system to provide your child with the best care.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joined Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.