As children seek refuge from the summer heat in pools and lakes, parents should be alert for the symptoms of painful swimmer's ear. To avoid unnecessary discomfort, pediatricians recommend the ailment be treated as soon as symptoms appear and that swimmers stay out of the water until it is healed. "Swimmer's ear is characterized by an inflammation and irritation of the external auditory canal," explains Dr. Jan Drutz, chief of the residents' primary care group clinic at Texas Children's Hospital and professor of pediatrics at Baylor College of Medicine. "Itching can occur; however, pain is the most common symptom. Gentle movement of the outer cartilaginous portion of the ear, particularly the skin-covered cartilage just in front of the opening to the ear canal, can cause extreme discomfort. "The external auditory canal becomes red and swollen and, in severe cases, the canal can swell shut," Dr. Drutz adds. "The patient does not run a high fever or risk hearing loss; however, the pain usually is intense." During swimming, water entering the external auditory canal can cause a change in the normal acidity of the canal. The membranous canal normally is protected by a coating of ear wax. When the hydrogen ion concentration (pH, or normal acidity) of the canal is changed, it becomes susceptible to infection. Once swimmer's ear is diagnosed, oral medications containing acetaminophen, ibuprofen or stronger pain relievers may be prescribed. Your pediatrician also may prescribe liquid drops containing a pain reliever to be applied into the external canal. "It's important to address the infection," Dr. Drutz stresses. "If the infection is bacterial, ear drop antibiotics — some of which also may contain steroids — are prescribed to treat the infection and reduce inflammation of the canal. If the condition does not improve, it may be caused by a fungal infection that may require anti-fungal agents." Most importantly, people being treated should stay out of the water for at least five to seven days, or until the infection is under control. "Even if your child is the star of the swim team and can't miss the 'big meet’, there's no reason to further irritate the external auditory canal," Dr. Drutz urges. "With treatment, the condition usually clears in three to four days. Severe cases may take up to a week." There are preventive measures parents can take to lower the risk of swimmer's ear. "When a child gets out of the water, dry the ears with a clean towel. It's a good idea to use one of the over-the-counter preparations, a few drops of hydrogen peroxide, or a home remedy of rubbing alcohol and white vinegar to maintain the ear canal's normal acidity. " Dr. Drutz advises swimming only in pools that are chemically treated to maintain a normal pH balance. There may be a greater chance of acquiring swimmer's ear by swimming in a lake or river.