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How to avoid ear infections while swimming?

Swimming is a great physical activity to keep fit, especially for children who love spending time in the water. But it can also cause swimmer’s ear or otitis externa, a bacterial infection caused by water left in the outer ear canal for an extended period of time. This water provides a moist environment for bacteria to grow.

While anyone can develop swimmer's ear, it is more prevalent in children. Do take note that swimmer’s ear is not the same as middle ear infection, a condition also common in children.

The good news is that swimmer's ear is not infectious and can be treated rather easily. In this article, I will explain the signs and symptoms of a possible ear infection from swimming, how to prevent your child from having it and treatment options.

Symptoms of swimmer’s ear

  • Pain when pressure is placed on the tragus, the part of the outer ear that sticks out and sits alone in front of the ear canal
  • Pain when outer ear is tugged
  • Itchiness inside the ear
  • Swelling and redness inside the ear
  • Excessive fluid drainage from the ear
  • Discharge of pus
  • Muffled hearing

Besides these symptoms, if your child complains of severe pain in the neck, face or head, it could mean that the infection has advanced. If your child also has ear pain together with a fever or swollen lymph nodes, you should see a doctor immediately.

Since this article is targeted towards swimmer’s ear in children, I also want to add that younger children who can’t speak may find it difficult to voice out any of the symptoms listed above. For younger children, keep an eye out for behaviours including:

  • Constant pulling or tugging near their ear
  • Crying especially when touching their ear
  • Crying or being fussy more than usual
  • Having trouble sleeping
  • Having fluid coming out of the ear
  • Fever (but this is pretty rare)

Why are children more susceptible to swimmer’s ear?

Swimming is usually the biggest risk factor for swimmer’s ear — and children can spend hours splashing and frolicking in water! This isn’t to say that you should cut short your child’s swimming time — just ensure you find a pool that’s adequately chlorinated. Swimming pools with high levels of bacteria are more likely to spread bacteria.

In addition, the ear canals of children are typically narrower compared to adults. The narrower the ear canal, the higher chance of water being trapped inside. I often see parents cleaning their child’s ears very frequently to get rid of any dirt or bacteria. While there is nothing wrong with this, keep in mind that showering or even cleaning your ears too often can leave the ears open to infection. As such, I usually advise patients to avoid cleaning excessively.

Children who wear hearing aids, frequently wear headphones or have skin conditions like eczema are also more susceptible to developing swimmer’s ear. For such cases, perhaps you might want to take breaks in between time spent in the water or immediately dry the ear after swimming.

Ways to prevent swimmer’s ear

Keep ears as dry as possible when swimming
Use a swimming cap or custom-fitted swimming plugs. You can easily find swimming earplugs for children from audiologists, ENT specialists or over-the-counter. I recommend custom-fitted ones as they guarantee your child’s ears won’t get wet and won’t fall out or leak easily. The only downside is that they cost more and you might have to replace them as your child will outgrow them eventually.

Dry ears properly after swimming or showering
Use a towel to dry the ears well. If your child complains of water in his ears, follow these steps:

  • Tilt the head back and forth to allow water to get out of the ear canal
  • While the ear faces down, pull the earlobe in different directions to drain out water
  • Hold a hair dryer several inches from the ear to allow air to move within the ear canal. Make sure the heat and speed settings are on low.

Use ear-drying drops after swimming
These ear-drying drops should only be used if your child does not have punctured ear drums, ear drainage, swimmer’s ear or ear tubes.

Do not put objects in the ear canal
Children like to put things in their ear for fun or as a way of soothing discomfort if they have swimmer’s ear. Make sure they do not do that as it can be dangerous! Keep things like keys, paperclips, cotton-tip swabs and pencils out of children’s sight if they have swimmer’s ear or keep a close eye on them.

Do not try to remove ear wax
Don’t try to always remove earwax from your child’s ear; ear wax helps prevent infection in the ear canal. If you want to remove earwax from your child’s ear, go to a doctor to get it removed.

Will swimmer’s ear last for long?

The good news is that infections for swimmer’s ear often heal on their own or are eliminated by following the measures above. Very rarely do children develop complications like temporary hearing loss or ringing in the ears.

The key is to always ensure that your child uses earplugs or a swimming cap while swimming, and always keep in mind that his ears are dried thoroughly after swimming or showering.

References

  1. https://pubmed.ncbi.nlm.nih.gov/26074134/
    Hajioff, D., & MacKeith, S. (2015). Otitis externa. BMJ clinical evidence, 2015, 0510.
  2. https://pubmed.ncbi.nlm.nih.gov/15318488/
    Hajjartabar M. (2004). Poor-quality water in swimming pools associated with a substantial risk of otitis externa due to Pseudomonas aeruginosa. Water science and technology : a journal of the International Association on Water Pollution Research, 50(1), 63–67.
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