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Q: My young son has had a lot of middle ear infections over the past three years. Now that he will be starting to swim inside at the local pool, I'm concerned that he will have more problems. What advice can you give?

-- L.M., Cumberland, Md.

A: I'm glad that your son is fortunate enough to be able to swim on a regular basis, and hopefully he will develop good fitness habits for the rest of his life. Let me explain why you should not be overly concerned about his ears.

There are three types of ear infections: that of the inner ear, the middle ear (otitis media) and the external ear (otitis externa). Swimmer's ear is a common name for an outer ear infection because it's more likely to occur when the ear canal is warm and moist for long periods of time, or when it's exposed to more bacteria from contaminated water.

Swimmers and people who submerge their heads under water in a hot tub are especially at risk of getting this infection. Although swimmer's ear is most common during the summer, especially among children, it occurs year-round, thanks to the increased use of indoor pools and hot tubs in the winter.

Also, some people are more at risk of getting otitis externa because of the shape of their ear canal and because of having larger amounts of ear wax that trap water behind it.

Mechanical trauma is another major cause of, or aggravating factor for, otitis externa. When people use paper clips, dry cotton swabs, or other objects. to clean their ears, they run the risk of irritating or puncturing the eardrums and scratching the tender lining.

Because public swimming pools have such high amounts of chlorine or bromine disinfectants, they are less of a problem than home hot tubs, in which people often do not like to keep the concentration of these chemicals high.

Symptoms of otitis externa usually include itching, pain (especially upon touch) and a smelly discharge. One can see, especially through an otoscope, that the lining of the ear canal is red and swollen, and pus may be observed.

If the ear canal becomes too swollen and fills with pus and debris, hearing can be impaired. In more severe cases, infection may spread beyond the outer ear canal.

The approach to treatment for any superficial infection, including of the ear canal, is to physically remove the infected tissue and debris, and apply antibiotics directly if necessary to stop the infection.

Your son's more frequent middle ear infections should not increase the chances that he will have problems with outer ear infections. And since the risk of an outer ear infection is quite low, I suggest that you do not frighten your son with a lot of worry. Simply make him aware of the possibility, and both of you monitor him for the symptoms.

By the way, a recent study done by the Agency for Healthcare Quality Research found that nine in 10 children with middle ear infections resolved the problem without using antibiotics. The study also found that perforation of the ear drum and repeated ear infections were not affected by taking antibiotics.

I caution, as the researchers did, that these statistics apply to the average case and that it's important to work with your pediatrician to make an individual determination of the best treatment.

Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at This column is not intended to take the place of consultation with a health-care provider.

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