With summer just around the corner, physicians warn parents to be wary of the cleanliness of the water their kids swim in, and the effects of swimmer’s ear.

Swimmer’s ear is an infection in the outer ear canal, which runs from your eardrum to the outside of your head. It’s often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth.

Swimmer’s ear is most commonly caused by bacteria invading the skin inside your ear canal. Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer’s ear by damaging the thin layer of skin lining your ear canal.

“Swimmer’s ear is very common in Southern California,” says Ayal Willner, M.D., pediatric ear, nose & throat specialist, MemorialCare Miller Children’s & Women’s Hospital Long Beach. “Not every kid gets it; it depends where they are swimming, with cleaner water making infections less likely.

“With hot temperatures and all the recreational opportunities that bring us to this area, it is not uncommon for junior lifeguards, swimmers and beachgoers to get swimmer’s ear.”

Even children who frolic in chlorinated swimming pools can get swimmer’s ear, Willner notes, because while chlorine helps purify the water it also irritates sensitive skin in the ear canal.

“Most kids complain of pain, which alerts parents to the issue,” Willner explains. “Swimmer’s ear is more likely to elicit pain than even an ear infection behind the eardrum. With swimmer’s ear if you gently pull or push the ear, it will hurt. The skin in the ear canal is made to be more sensitive than things on the inside.”

Treatment for swimmer’s ear is the same in children and adults. The first line of defense is ear drops that contain antibiotics.

“Sometimes the drops are coupled with oral antibiotics and sometimes the drops don’t work because the ear canal gets swollen and inflamed,” Willner says. “The ear can produce debris, which contains sloughed-off skin cells and other materials, and the drops sit on top of ear and don’t go in.

“Adults tend to have bigger ear canals and it’s easier for drops to go in,” he adds.

In the case of plugged ears, physicians prescribe oral antibiotics and use an ear wick – a small, medicated sponge that gently opens the passage. “As the sponge expands it gives very gentle pressure to ease out the fluid that causes inflammation, and then the wick comes out, providing more space to let the drops in,” Willner says. The procedure is conducted in the physician’s office.

If swimmer’s ear is ignored, children can develop severe infections that go on to infect the bones of the skull itself. Extreme cases of swimmer’s ear, particularly in immune-compromised people or diabetics, can lead to bone infections, Willner says.

“If a child has been swimming in dirty water or has done a lot of swimming and they have ear pain, one of the classic hallmarks is tenderness when you pull the ear gently up and back,” he says, “or if you gently press on the triangle-shaped area in front of the ear.

“It will elicit an immediate response.” Parents should immediately take children suffering with ear pain to the doctor, who will likely diagnose swimmer’s ear.

He recommends that children who swim frequently use inexpensive, moldable silicone ear plugs, with our without swim caps, to lessen the chance of swimmer’s ear.