DEAR MAYO CLINIC: My daughter is 7 and has been taking swim lessons this summer. She has been complaining about her ears hurting, and our pediatrician diagnosed her with otitis externa and prescribed eardrops. What is otitis externa, and how do I prevent it in the future?

ANSWER: Otitis externa is an infection in the outer ear canal, which runs from the eardrum to the outside of the head. The condition is also known as swimmer's ear because often it is brought on by water that remains in the ear after swimming, creating a moist environment that aids bacterial growth. The most common cause of this infection is bacteria invading the skin inside the ear canal.

Swimmer's ear can affect people of any age, and it can affect those who do not spend time in the water since it occurs because of bacteria invading the skin inside the ear canal. Excess moisture in the ear from heavy perspiration or prolonged humid weather also can be a culprit.

Scratches or abrasions in the ear canal increase the risk of developing otitis externa. Putting fingers, cotton swabs or other objects in the ears, such as earbuds or hearing aids, also can lead to this infection by damaging the thin layer of skin lining the ear canal. Any small breaks in the skin can allow bacteria to grow.

Occasionally people can have a reaction to hair products or jewelry, which can cause an allergic reaction and skin issues that promote infection.

Swimmer's ear symptoms are usually mild at first, but they can worsen if the infection isn't treated or spreads.

Common signs and symptoms to watch out for include:

• Itching in the ear canal.
• Slight redness inside the ear.
• Mild discomfort that's worsened by pulling on the outer ear (pinna or auricle) or pushing on the little "bump" in front of the ear (tragus).
• Some drainage of clear, odorless fluid.

Swimmer's ear usually isn't serious if treated promptly, but complications can occur. Usually swimmer's ear is treated with eardrops.

Be aware if your daughter complains of a feeling of fullness, increased pain or more intense itching, or experiences hearing complications. The infection may be progressing. However, temporary hearing loss could occur until the infection clears.

Follow these tips to avoid swimmer's ear:

• Keep ears dry.
  After swimming or bathing, dry her ears by wiping the outer portion gently with a soft towel or cloth. Have her tip her head to the side to help water drain from the ear canal. You also can use a hair dryer on the lowest setting, holding it at least a foot away from the ear.
• Use a preventive treatment.
  As long as she doesn’t have punctured eardrums, you can use homemade preventive eardrops before and after swimming to help reduce the risk for swimmer's ear. A mixture of one part white vinegar to one part rubbing alcohol can promote drying, and prevent the growth of bacteria and fungi that can cause swimmer's ear. Pour 1 teaspoon of the solution into each ear and let it drain back out. Similar over-the-counter solutions might be available at your drugstore.
• Avoid putting foreign objects in her ear.
  Cotton swabs can pack material deeper into the ear canal, irritate the thin skin inside the ear or break the skin. If you are trying to clean the ear and remove wax, do so without using cotton swabs or other instruments. And encourage your daughter to keep her fingers and objects out of her ears.
• Protect her ears from irritants.
  While this may not pertain to your daughter at her age, putting cotton balls in the ears while applying products such as hair sprays and hair dyes can reduce risk of bacteria getting into the ear canal.

Since your daughter already has been diagnosed, it might be ideal to encourage her to wear earplugs while swimming. Also, talk with her health care provider to see how long she should wait before returning to swimming. Recurrent infections may require additional treatment. — Compiled by Mayo Clinic staff

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