Swimming Issue Calls

We are receiving a high number of phone calls related to swimming issues.  These issues involve:

• Swimmer’s Ear
• Chemical Conjunctivitis related to swimming
• Bathing Suit Irritation leading to urination symptoms

Dr. Miller Comment: 

Swimmer’s Ear: Due to the elevated outdoor temperatures and prolonged swimming we are seeing high numbers of children with these issues.   Please consider using preventive ear drops (1 to 2 parts of rubbing alcohol with 1 part white vinegar).  Apply 2-3 drops in each ear (let sit for 5 seconds and drain); after swimming every day. 

Pool (Chemical) Conjunctivitis: Chemical conjunctivitis occurs because a chemical from the pool is irritating the eye.  Due to the high temperatures and prolonged swimming time, we suggest wearing goggles to prevent this.  If it occurs, it will cause a red eye and or discharge from the eye, especially upon awakening in the morning.  If this occurs, please soothe the eye with cotton balls soakedwith lukewarm water.  Give diphenhydramine for itching and swelling.  Avoid contact with water until this improves.  If you must go swimming, wear goggles in the water.

Bathing Suit Irritation:  Prolonged contact with a wet bathing suit (and or sand in the suit) may irritate the genital area.   Wet swimming suits (many of which are synthetic and do not breath well) may cause irritation, frequent urination, and painful urination.  We suggest getting out of the suit during breaks in swimming.  If irritation occurs, give a sitz bath.  This consists of soaking in a tub of lukewarm water with 2 tablespoons of baking soda.  Sit for 20″ twice during the first day and once the day after.  Give real cranberry juice.  This makes the urine less irritating.  If there is itching or the rash persists for more than 24 – 48 hours, apply clotrimazole (brand name lotrimin) cream to the area twice a day for 10-14 days.  This will treat any yeast component that keeps the irritation going.  If your child has a fever, this may mean a urinary tract infection.  Please call so that we can evaluate that possibility.

SWIMMER’S EAR

This summer has introduced us to high humidity and higher temperatures.   This usually leads to swimmer’s ear, typically in August.  This year there has been a significant increase in swimmer’s ear as kids seek relief from the heat and the stay at home recommendations.   What is there to know and what can you do about it?

OVERVIEW

Swimmer’s ear is a condition that occurs when the ear canal becomes irritated. The ear canal is the part of the ear that leads from the outer ear to the ear drum (figure 1).  “Swimmer’s ear” is the name for external otitis that occurs in a person who swims frequently.

RISK FACTORS

Several factors can increase your risk of swimmers ear.

Cleaning the ear canal removes ear wax. Ear wax serves to protect the ears from water, bacteria, and injury. Excessive cleaning or scratching can injure the skin, potentially leading to infection.

• Swimming on a regular basis removes some of the ear wax, allowing water to soften the skin. Bacteria, which normally live in the ear canal, can then enter the skin more easily.
• Wearing devices that block the ear canals, such as hearing aids, headphones, or ear plugs, can increase the risk of external otitis (if worn frequently) by injuring the skin.

SYMPTOMS

The most common symptoms are:

• Pain in the outer ear, especially when the ear is pulled or moved
• Itchiness of the ear
• Fluid or pus leaking from the ear
• Difficulty hearing clearly

DIAGNOSIS

If you think that your child could have swimmer’s ear, you should call us to make an appointment.  We will examine the outside and inside of your ear to confirm the diagnosis. This is more likely the diagnosis if you wiggle the ear lobe and it causes pain (some have this), or you push on the extra skin that protrudes out in front of the ear canal (called the tragus)

TREATMENT

Treatment aims to reduce pain and eliminate the infection.  In some cases, we will flush out your ear with water and hydrogen peroxide before you begin treatment; this speeds healing by removing dead skin cells and excess ear wax.

Ear drops — Ear drops are usually prescribed to reduce pain and swelling caused by external otitis. It is important to apply the ear drops correctly so that they reach the ear canal:

• Lie on your side or tilt your head towards the opposite shoulder.
• Fill the ear canal with drops.
• Lie on your side for 10-20 minutes or place a cotton ball in the ear canal for 20 minutes.
• Finish the entire course of treatment, even if you begin to feel better within a few days.

You should begin to feel better within 36 to 48 hours of starting treatment. If your pain worsens or does not improve within this time period, call us.

Pain medication — If you have bothersome ear pain, you can take a non-prescription pain medication.

Avoid getting ears wet — During treatment, you should avoid getting the inside of your ears wet. While showering, you can place a cotton ball coated with petroleum jelly in the ear. However, you should not swim for 7 to 10 days after starting treatment (or until your child has NO pain with wiggling the ear and pressing on the part of the skin that protrudes from the ear).  Avoid wearing hearing aids and in-ear headphones until pain improves.

PREVENTION

The old saying, “Don’t put anything smaller than your elbow in your ear” to clean the ear is true. The ear is self-cleaning; fingers, towels, cotton-tipped applicators, and other devices should not be used to clean the inside of the ears.

If you swim frequently, we recommend the following tips to reduce the chance of developing swimmer’s ear:

• Shake your ears dry after swimming
• After a day of swimming apply 2-3 drops of a preventive solution.  This can be purchased, or you can make it up yourself by adding 1 part of rubbing alcohol to 1 part of white vinegar.  Mix this into a eye dropper bottle and keep it in your swim bag.

COVID-19 Update

I am sure that you are aware of the rising cases of COVID-19 throughout the country. As we open up more and there is more travel, there is sure to be a rise in cases in New York State. We can take great reassurance as we negotiate the upcoming 6 months

• Studies continue to provide information about the lower risk in children. This includes lower risk of spread, lower risk of getting infection, lower risk of poor outcomes.
• We have an excellent tracking mechanism in New York State. It allows tracking by region and by county, so we know what our rates are.
• We live in a less population dense area.
• New York State has been very reactive to the situation as it changes. While we are sure to see more cases, we have every strategies that can adjust to the disease.
• We are learning what medications reduce the effects of the infection when present.
• There is intensive work throughout the world on vaccine development. This is important, as we will need a vaccine to get back to a return of our lives as we know it.
• As we have moved back to a containment strategy, we have tested over 25 children, teenagers and young adults with active fevers and symptoms that might represent the SARS-CoV-2 infection. We have had no positive tests to date.

We will continue to work hard to keep you safe. We know that there was a significant number of families in our practice and throughout the country that did not come in for their well visit, for fear of the infection. We are now trying to fit in all the well visits that did not occur. We will continue a careful, well thought out strategy to keep you safe and well cared for. We do want you to be aware of our current procedures for sick visits.

• Patients with fevers and symptoms that might represent the SARS-CoV-2 virus are carefully evaluated. At the present time, we are minimizing exposure to you and to our staff. No child with suspected infection will be brought into the building. We are currently doing Tele-Health Visits to go over the history, determine if a physical appointment is needed and discuss the possibility of testing before coming to the office. At the present time, that means a visit in your car in the back of our building. This limits exposure in the building to reduce risk to you and to our staff. Only one staff member sees the patient (our MD or PA), so that nurses are protected as well. New York State and the CDC allow for self administered tests to reduce our exposure (we evaluate each patient for this possibility). Additionally, we are making arrangements for an exam room to be temporarily set up outside our building. In the coming month, you may be directed to this Exterior Exam Area.

For all in office visits, please remember the special precautions we continue to make:

• We have asked that you cancel your well visit if you have symptoms that are most consistent with the virus, including cough, shortness of breath, fever, cold symptoms, sore throat, diarrhea or vomiting.
• Waiting room time has reduced. Patients are placed in a room after check in is complete. Sneeze guards are in place at check in.