Dr. Greene's Answer
Your questions are timely ones for our readers in the Northern Hemisphere — it’s time for fun in the sun and the water! My apologies to those of you from Brazil, Australia, South Africa, and other countries that are heading into the winter months. But wherever you are, if you are a summer lover, take comfort in knowing that this information about swimmer’s ear and sunburn will be useful to you – in a few months.
Swimmer’s ear is an infection of the skin lining the ear canal. Bacteria normally live on the surface of this skin with no ill effect. If there is a break in the skin’s normal barrier, however, the bacteria can get inside and cause an infection called external otitis or swimmer’s ear (this is different from otitis media). If the ear is wet for a long period of time, the skin can become prune-like in the same way one’s fingers and toes become soft and wrinkled when they are in water for a long period of time. Bacteria can easily move into the soft skin. Tiny scratches in the ear canal (usually from sticking a finger or some other object into the ear) also leave the skin vulnerable to infection. The skin can even be breached as a result of the ear’s becoming extraordinarily dry, causing the skin to crack. Ironically, swimmer’s ear can be the result of spending time in desert conditions.
Swimmer’s ear is more common in people who spend time in swimming pools than in people who swim in lakes. This is thought to be the case because the chlorine in swimming pools kills the good bacteria in the ear fairly effectively, but is not as effective against the harmful bacteria hiding in the ear canal. This does not mean the water in the swimming pool is infected — the wetness is the problem. For unclear reasons, swimmer’s ear is not common in infants, but it is particularly prevalent in pre-school and school-age children.
There are a couple of ways to prevent swimmer’s ear. One is to make sure the ears get dry after being in the water. This can be facilitated by turning the head and gently pulling the ear in different directions to help drain the water out of the ear. It is also very helpful to dry the opening of the ear very carefully as far as you can reach with a towel. Avoid using cotton-tip applicators in the ear. If swimmer’s ear becomes a recurrent problem, you can put a few drops of rubbing alcohol in each time it becomes wet, to facilitate drying. Another good alternative is instilling a few drops of white vinegar. The acetic acid inhibits the growth of bacteria in the skin.
The symptoms of swimmer’s ear are itchy and/or painful ear. This is often accompanied by a small amount of clear discharge. The ear is particularly sensitive to the ear lobe’s being moved up and down. If a child does develop swimmer’s ear, it can often be treated with a few drops of white vinegar placed in both ears. Put the vinegar in one ear and leave it for about five minutes before turning that ear down in order to drain the vinegar solution. Repeat this twice a day for three days. If the symptoms worsen or persist for over three days, prescription antibiotic drops may be necessary.
Swimming is generally not associated with the other type of ear infections — otitis media. This is true even if a child has ear tubes.
Another summer consideration is protection from the sun’s rays and sunburn. Sunglasses with UV-protection help protect children’s eyes from the UV rays and decrease the risk of cataracts in adulthood. Sunscreen, loose clothing, and hats help protect children’s sensitive skin from sunburn. This is very important because, even though skin cancer occurs in adults, the serious skin cancers are caused by the sun exposure (particularly the sun burns) that occur during childhood.
Try to avoid the sun’s most intense rays by staying out of the sun during the middle of the day — and don’t be lulled into complacency by overcast days, since most of the sun’s harmful rays will get through the clouds. Be especially careful if you are around water, sand, snow, or any surface that will reflect and therefore intensify the sun’s rays. Remember, the sun’s rays are more intense the higher you get in elevation.
When purchasing sunscreen, select a PABA-free brand with an SPF of at least 15 and both UVA and UVB protection. While we used to believe that UVB was the main danger in sunlight, recently, dermatologists and researchers have come to realize that UVA light rays may also contribute to sunburn, skin damage and skin cancer.
In general, infants’ skin is much thinner and more sensitive to the sun than adults’ skin, even in individuals with darker complexions. I recommend sunscreen with a SPF of 30 or greater for all children. Sunscreen is most effective if first applied 20-30 minutes before sun exposure. Use sunscreen whenever you expect to be in the sun for thirty minutes or more, and re-apply after swimming. Even water-proof sunscreens should be re-applied every 80 minutes or so, after being in the water.
Also keep in mind that many of us grossly underestimate the amount of sunscreen we need to apply – many dermatologists recommend using at least one ounce (the amount that fills a shot-glass) to cover the body.
This is a wonderful time of the year. Most children love to be outdoors. By all means, take your children outdoors and enjoy the summer fun. While you are giving your children a good time, you can also give them the gift of future good health by being careful. Protecting your children’s eyes from the dangerous rays of the sun and protecting their skin from sunburn is a gift that will last their whole lives.