Last winter my 15-year-old daughter came down with a severely painful ear infection that the doctor called swimmer's ear. She was given antibiotic eardrops and had her ear vacuumed out by an ear specialist. This summer she went swimming, and her ear has been plugged since. I have been putting hydrogen peroxide drops in the ear. Although it has not turned into a painful infection, her ear is uncomfortable. Will this be a ongoing problem? How can we unplug the ear? She uses earplugs in the shower, but they don't keep all the water out. Is there any treatment to cure or prevent this?

L.

Swimmer's ear is also known as acute otitis externa. "Acute" refers to its rapid onset. "Otitis" is a generic term for ear inflammation, and "externa" indicates that it is an infection of the outer part of the ear -- the auditory canal, to be exact. The common name, "swimmer's ear," refers to the fact that otitis externa often occurs after water gets into the ear canal. Otitis externa may occur without water exposure, however. For more background information on this condition, please see my earlier column on otitis externa.

Otitis externa is almost always caused by overgrowth of bacteria called Pseudomonas. Pseudomonas are water-loving bacteria, hence the association with swimming. At present, the only treatment you are giving your daughter is hydrogen peroxide, which you can think of as "water with an attitude." Hydrogen peroxide liberates oxygen (that's the fizz), and consequently has a mild antibacterial effect. But after it has finished fizzing, all that's left behind is water -- just what Pseudomonas loves! Needless to say, you should stop putting hydrogen peroxide in her ear.

If your daughter's ear is uncomfortable, then you really ought to take her to back to her ENT (ear, nose and throat) specialist. Suctioning of the ear canal will often result in immediate relief of the pain and hearing loss associated with otitis externa. You cannot unplug her ear yourself. Over-the-counter ear-wax irrigation kits all involve flushing the canal with a water-based liquid (often a peroxide), and this may make matters worse, not better.

Until your daughter's infection resolves, it is a good idea to keep water out of the infected ear canal. For the time being, swimming is out of the question. Will this be an ongoing problem? Maybe. Some people simply cannot get water in their ears, because they get otitis externa whenever their canals get wet. This can be tough on kids, who may regard methods of keeping their ears dry as punishment. Nevertheless, with appropriate ear protection, most aquatic activities are permissible for patients who need to observe strict "dry-ear precautions." Your daughter's ENT can help you find an appropriate combination of protective devices (ear bands and plugs) that will enable your daughter to get back in the water.