In the summertime, when the weather is hot … .jpg

In the summertime, when the weather is hot …

IT’S SWIMMING pool time! For everyone, grown-ups and children. Sometimes we have doubts about who has more common sense and who behaves more rationally. Trust me, I have been a doctor in the Algarve for 25 years and I have seen a lot of irrational holiday behaviour. I usually say that when people go on holiday, they think they enter a state of grace and, therefore, can do everything they would not usually do, as nothing wrong can possibly happen. It is a holiday after all! Completely wrong! Due to the fact that people do things they don’t usually do, anything might go extremely wrong.

Children, more than anybody else, can run into big problems, from heat rashes to life-threatening situations. No parents have any doubt that kids love splashing around in the pool, but swimming pools, as lovely as they are for many fantastic reasons, meaning lots of fun, are a different environment that parents and children need to learn how to deal with. It is amazing how many disagreeable things could be avoided if only people would be more aware of the risks.

Are we fish? Are our ears made for living in the water like fishes’ ears? Not really; that is why, in the summertime, there are so many ear problems related to “living in the water”, generally known as ‘swimmer’s ear’.

Swimmer’s ear: why and how do people get it?

Water normally flows in and out of our ears without causing any problems. We can nearly always shower, bathe, swim and walk in the rain without incident, which is remarkable considering how large and deep an opening the ear provides. We’re protected by the ear’s shape, which tips fluid out, and by its lining which has acidic properties that protect against bacteria and fungi.

However, when your ear is exposed to excess moisture, water can remain trapped in your ear canal. The skin inside becomes soggy, diluting the acidity that normally prevents infection. When this happens, bacteria and fungi have the ideal environment to grow, as it is warm and humid, causing a condition known as swimmer’s ear (acute otitis externa, or external otitis).

Swimmer’s ear is an infection of the outer ear and ear canal. It can be associated with a middle ear infection (otitis media) and the eardrum can possibly rupture.

Swimmer’s ear is common in children and young adults. There is an increased risk of infection if a skin condition such as eczema causes itchiness and makes you scratch your ears excessively. Earwax build-up or blockage may also increase the risk, by trapping water in the ear and increasing the likelihood that you will cut the skin while cleaning the ear.

Other ear problems may also increase the risk of swimmer’s ear, including small ear canals that do not drain well and chronic middle-ear infections that moisten and perforate the eardrum.

If you’re an older adult, or have an underlying medical condition such as diabetes, your immune system may be impaired, increasing the risk of swimmer’s ear. If you have poorly managed diabetes, you are at increased risk of developing severe, painful swimmer’s ear that may be difficult to treat.

Tips to avoid swimmer’s ear

• Dry the ears thoroughly after exposure to moisture from swimming or bathing. Dry only the outer ear slowly and gently with a soft towel or cloth. Never insert your finger or any other object into the ear.

• Avoid swimming in polluted water.

• Use earplugs designed specifically to keep water out of the ears when swimming.

• Mix one part white vinegar with one part alcohol to make an effective eardrop to use before and after swimming. Pour one teaspoon of the solution into each ear and let it drain back out. This mixture may help prevent the growth of bacteria and fungi that can cause swimmer’s ear.

• Use oil or lanolin eardrops in the ears before swimming to prevent the effects of water.

• Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. Using these items can pack material deeper into the ear canal and irritate the thin skin inside your ear.

• Avoid substances that may irritate the ear, such as hair sprays and hair dyes. Put cotton balls in the ears when applying these products.

• If you already have an ear infection or have recently had ear surgery, talk to your doctor before you swim.

• Nothing should be used without doctor’s advice when children have ear tubes or if children already have swimmer’s ear (acute otitis externa).

• If trouble starts, never mind all your efforts, do not wait to consult a doctor, as progressing infection may cause severe disease and life-long hearing problems.  

• Don’t swim, fly or scuba dive during treatment for swimmer’s ear.

• Until an ear infection heals, it is important to keep water from getting in the ears, even while showering or bathing.

Plaster casts …

and grommets!

Good old plaster of Paris casts are not water safe; they melt with water. Trying to water-protect such plaster casts with plastic bags does not work and it generally turns to disaster. However, fibreglass casts are water-safe and the inside lining used with these is water-repellent.

Grommets (ear tubes) are controversial. Basically, there are two perspectives: on one side, some physicians argue that the tubes are placed in the ear to prevent ear infections by draining fluid. So, if water should get into the middle ear, it will probably drain out of the tubes. On the other side are physicians who don’t want children with ear tubes to swim at all. They say that if you mix water and wax in the ear canal, you could get certain bacterial infections. These infections could jeopardise the tubes and even make it necessary to remove them.

A reasonable compromise is this: if children with ear tubes just want to splash around in the water without submerging their heads, it’s OK. If children do want to put their heads under water, then it’s best to first fit them with individually moulded earplugs. In any case, children with ear tubes should not dive.

Swimming do’s and don’ts for children

When your children are pleading to go swimming, there is a lot more to think about besides wondering if the pool is clean.

• A parent or other responsible person should always stay in the water with a child aged five or younger. Beginners should stay in the shallow end of the pool and be closely supervised.

• It is OK for kids to swim after lunch, unless lunch was a large feast and the child feels lethargic. After a snack, children don’t have to sit beside the pool for an hour. Let them go in the water and enjoy it.

• Consider having your child wear goggles for protection from chlorinated water.

• Children are bound to take a few gulps of pool water at one time or another, especially when first learning to swim. A little swallowed pool water is no cause for worry.

• Children should never swim alone. Even the best swimmers should have partners. This is especially true for children with physical impairments, seizure disorders or heart rhythm disorders.

Children should stay out of hot tubs and spas until they are tall enough to keep their heads completely out of the water with their feet firmly touching the bottom. Youngsters can quickly get overheated in hot tubs.

Last but by no means least important … .S Never, ever, let any non-supervised child go near a pool, and by ‘near’ I mean even inside the house with the door open to the pool area!

Best health wishes,

Dr. Maria Alice

Consultant in General and

Family Medicine

Director – Luzdoc International Medical Service Tel. 917 811 988