This is the 64^th article written by the Pediatric Group, P.A. for Princeton Online

As described in our previous article entitled "The Old Swimming Hole", water in the ears can cause an external ear infection (not the kind that follows a cold), called "swimmer's ear"-- a painful swelling and inflammation of the skin in the ear canal. This condition is caused by water washing in and out of the ear canal, causing the skin to chap. Water from any source (pools, lakes, baths, showers, etc.) that gets into the ear can be a triggering factor. The skin of the ear canal develops minute cracks, which allow micro-organisms that inhabit the ear canal to invade the skin, inciting the inflammatory process. Wax accumulation in the ear can trap water in the ear, predisposing a person to this infection.

Because of the specific characteristics of the germs involved in otitis externa, oral antibiotics are not generally effective in treating the infection. The mainstay of treatment is prescription ear drops and pain relief medication while avoiding water exposure. In order for the drops to be effective, they must coat the skin in the ear canal. This entails having the child tilt his/her head to the side during drop instillation and assuring that the drops descend into the ear canal. Drops that sits at the opening of the ear canal without disappearing down into the canal are useless. Occasionally, before instilling the drops, the ear must be carefully irrigated by the physician before the drops are used to removed any wax, pus or other debris which can impair the effectiveness of the drops. As well, a middle ear infection, requiring oral antibiotics, can coexist with an otitis externa. Hence, a doctor's visit is recommended before a prescription is offered.

The usual course of treated swimmer's ear is gradual reduction of the pain over two to three days. The prescription ear drops and prohibition of water exposure should continue (two to four times per day depending on which drops are prescribed) until the ear is pain-free, even when the ear is tugged and pressed, for at least three days in a row. At that point, swimming and bathing without a shower cap can be resumed. Of course, as in any other condition, if the anticipated improvement is not forthcoming, or the symptoms worsen, a repeat visit to the doctor is warranted.

We advise following the course of treatment with good ear hygiene (a dilute peroxide solution called Debrox® can be used to dissolve ear wax) with occasional gentle and careful cotton swab cleaning of the visible portion of the external ear canal. Needless to say, a young child should not be trusted to use cotton swabs in his/her own ears for fear of deeper penetration and injury to the canal or the ear drum.

This annoying condition can often be prevented by instilling a 50/50 mixture of white vinegar and rubbing alcohol in a child's ear when the day's swimming is done. Vinegar retards growth of bacteria and fungi while alcohol helps dry the ear canal by evaporation. For parents who prefer not to mix their own preventative drops, commercial preparations containing acetic acid (vinegar) can be purchased over-the-counter under the names SwimEar®, AquaEar® or Ear Dry®. The over-the-counter drops should not be used until the infection is cleared or if a child has tympanostomy tubes, a perforation or pre-existing pain. Call your physician if you have questions regarding illnesses contracted while swimming.