But one of the unwanted consequences of spending lots of time in the water is ear infections, commonly known as swimmer’s ear. The Cedars-Sinai Newsroom spoke to Abhita Reddy, MD, a pediatric otolaryngologist and head and neck surgeon at Cedars-Sinai Guerin Children’s, about what causes swimmer’s ear, how parents can protect their children, and how physicians diagnose and treat the condition.

What is swimmer’s ear?

Swimmer’s ear, properly known as otitis externa, is an infection of the ear canal where you often have drainage. You can have fluid sitting in the ear canal. Sometimes it looks like fluffy tissue that drains. It can cause discomfort and can also cause hearing impairment if left untreated.

What causes swimmer’s ear?

Swimmer’s ear occurs most commonly in the summertime when people are swimming in contaminated water like lakes or rivers, even sometimes in the ocean. We also see it a lot when people go surfing or do water sports, or when kids are going under water frequently or diving deep. Swimming in chlorinated or saltwater pools is less likely to cause swimmer’s ear.

How do you know if your child has swimmer’s ear?

Parents usually know when their child is getting an external infection like swimmer’s ear when they see drainage coming out of the ear, not something brown that looks like wax, but oftentimes it’s white or yellow, and it can smell bad. Swimmer’s ear is often associated with children having pain in their ear, and sometimes it can be associated with small children not letting you touch their ear, so if you tug at their ear or pull their ear it hurts a lot.

How does swimmer’s ear differ from other ear infections?

The biggest difference between a middle ear infection, known as otitis media, versus an outer ear infection, known as otitis externa, or swimmer’s ear, is that middle ear infections, which are behind the eardrum, do not have drainage coming out unless your child has ear tubes. Usually when children have middle ear infections they tug or pull at their ears, which makes it feel better. They also may develop a fever. The opposite is true with swimmer’s ear, or otitis externa, which hurts when you tug on the ear.

How are these infections treated?

Swimmer’s ear is often treated with ear drops because it’s very easy for the drops to get to the area where the infection is. With middle ear infections we often must treat it with antibiotics because unless you have ear tubes, it’s very hard for the drops to reach the infected area.

How can you prevent swimmer’s ear?

When parents ask me how to prevent their kids from getting swimmer’s ear, it often has nothing to do with swimming at all. I just tell them not to use cotton swabs such as Q-tips in their kids’ ears. When you use Q-tips in your children’s ear, it can offset the pH balance inside the ear canal, or cause small breaks in the canal skin, which can then increase the risk of getting ear infections. It is also helpful to consider using earplugs or swim caps for children. Parents can also try to dry the ear if the ear is very wet after a swim. Parents can use a hair dryer around a shoulder length away from their child’s ear on the lowest setting for about 10 seconds at a time, and that can dry out the ear canal and help prevent swimmer’s ear.

Read more from Cedars-Sinai Stories and Insights: How to Treat Sleep Apnea in Children

An accomplished neurotologist and skull base surgeon, Miller joined Cedars-Sinai in 2021 and serves as director of Neurotology for the Cedars-Sinai Acoustic Neuroma and Lateral Skull Base Surgery Center. Her expertise includes otology, neurotology, cochlear implantation, vestibular schwannoma and acoustic neuroma care, lateral skull base surgery, Ménière’s disease, and hearing restoration.

“My vision is to continue to develop each of our subspecialties to the highest standard of rigorous academics and education paired with clinical excellence,” said Miller, also the inaugural LuEllen Margaret Edwards Chair in Otology and Neurotology. "Every patient who comes to us deserves care from a team that is both deeply trained and fully committed to outstanding outcomes, and every trainee deserves an environment where they can grow into an exceptional clinician."

As an initial priority, Miller has hired Cedars-Sinai’s first otolaryngology PhD researcher to help lead the development of a hearing regeneration lab.

"We are delighted for Dr. Miller to step into the role of division director," said Cristina R. Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. "Her expertise as a surgeon, dedication to education and clear vision make her an ideal leader for this team. We look forward to the many ways she will strengthen patient care and mentor the physicians of tomorrow."

Miller earned her bachelor’s degree from Harvard University and her medical degree from Harvard Medical School. She completed her surgical internship and residency in head and neck surgery at UCLA, followed by fellowship training in neurotology and skull base surgery at the University of California, San Diego (UCSD). Prior to joining Cedars-Sinai, Miller served as director of the Center for Balance and Falls at the University of California, San Francisco (UCSF), where she led clinical and research initiatives. She also spent seven years as an associate at the House Ear Clinic.

Miller succeeds Gene Liu, MD, in the role of division director.

“Over the course of his years at Cedars-Sinai, Dr. Liu made outstanding contributions to the Department of Surgery, and we are grateful for his leadership,” Ferrone said. “Through his recruitment of 19 surgeons across the network and the establishment of the ENT residency, he provided a strong foundation of excellence in the academic and clinical footprint of the division for Dr. Miller to build on.”

Read more from the Cedars-Sinai Newsroom—TODAY: Treating Hearing Loss Can Protect Your Brain From Cognitive Decline

“We use our voice to express ourselves, whether it’s enthusiasm at our team scoring a buzzer-beater, or extreme disappointment when they miss the shot,” said Anca Barbu, MD, laryngeal surgeon and associate professor in the Jim and Eleanor Randall Department of Surgery, Division of Otolaryngology-Head and Neck Surgery at Cedars-Sinai. “And those expressions are fine, but the volume at which we’re doing so can put the vocal cords at risk of trauma.”

Barbu, who specializes in professional voice and voice disorders, recently spoke with the Cedars-Sinai Newsroom about tips for enjoying the upcoming NCAA Tournament, and other major sporting events, while maintaining vocal health.

What are the risks of screaming too much during sporting events? What short- and long-term damage can you do?

Vocal cord trauma, also known as phonotrauma, can occur when we overuse our voice, potentially causing damage to the cords. In the short term, this can present as a change or loss of voice. Typically, this type of injury should resolve itself in 24 to 48 hours.

In the long term, vocal cord damage can become chronic laryngitis if the voice doesn’t get a chance to rest and heal.

If you lose your voice all of a sudden, such as in the middle of talking or yelling, we worry about more of an acute event such as a vocal fold hemorrhage. If that happens, seek medical care.

What tips do you recommend for preventing vocal strain while cheering on your favorite team?

In already loud environments, such as a packed arena or even an in-home watch party with friends, people tend to get louder to project over the ambient noise, creating a greater risk of vocal cord strain. I always tell patients that during these times, you can still be animated by cheering with your hands and facial expressions or clapping and using other external noisemakers rather than projecting your voice. Signs and banners are a great option, too. Just think outside of the voice box, if you will.

Are there certain foods and drinks you should avoid to protect your voice?

When you think about the types of foods consumed at these kinds of sporting events or watch parties, they tend to be very reflux-inducing foods. Foods that are greasy, fatty or spicy, alongside alcohol and carbonated beverages, will tend to create more acid in your stomach, leading to heartburn and silent reflux, also known as laryngopharyngeal reflux [LPR]. This creates an environment in your throat where tissues may be swollen, which makes them more prone to trauma and can present as a sore throat the next day. If you’re planning to enjoy these foods that may trigger silent reflux, do so in moderation or consider taking an antacid to help avoid the issue.

Additionally, it is important to avoid other carcinogenic products like tobacco or vaping, as those can irritate your vocal cords and throat as well.

If you do overdo it, how can you recover?

If you lose your voice instantaneously or experience hoarseness following overuse, the best thing to do is to simply be quiet. Vocal rest, avoiding all talking, is recommended for at least 24 and up to 72 hours, depending on the severity of the laryngitis. Do not try to push through with your voice or even whisper, because that is when greater injuries may occur.

At what point should you consult a doctor for vocal issues?

If vocal rest has not resolved the issue in 72 hours, you should contact your primary care doctor.

However, if it's been three or more weeks of laryngitis from yelling and your voice has not returned to baseline, it’s important at that point to see an ENT [ear, nose and throat specialist] for an exam of your vocal cords. If you are someone, such as a singer or actor, who relies on their voice professionally, it would be recommended to specifically see a laryngologist—an ENT with specialized training for voice-related issues, including vocal cord swelling and trauma.

Read more from Cedars-Sinai Stories and Insights: The Science of Hangovers

Safaa, weighing just 1.1 pounds, was in the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s.

“Shortly after Safaa was born, pandemic lockdowns were implemented and only one visitor was allowed in the hospital at a time, so we had to take turns visiting her in the NICU,” Cardello said. “We were not only scared of getting germs at the hospital, but we were scared of bringing germs into the hospital and harming Safaa.”

Safaa experienced a number of health challenges in those early days, including bronchopulmonary dysplasia, or premature lung disease, because her lungs were not fully developed. Additionally, her physicians discovered Safaa had an extremely narrow upper airway, making it difficult for her to breathe without medical intervention.

“I would honestly say Safaa had the smallest windpipe I’ve ever seen,” said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children’s and one of Safaa’s consistent care providers.

To bypass her narrow airway, Safaa’s doctors performed a tracheostomy, a procedure to create an opening in the neck that extends to the trachea, allowing easier breathing and enabling oxygen to reach the lungs.

Safaa graduated from the Cedars-Sinai Guerin Children’s NICU four months later, in July 2020, but her airway issues were not solved, so she went home with the tracheostomy tube in her neck.

Fixing Safaa’s Airway

“When I first met Safaa, her airway opening was only a couple of millimeters wide,” said Gene Liu, MD, director of Academic Otolaryngology for Cedars-Sinai Medical Center and a pediatric ear, nose and throat specialist for Cedars-Sinai Guerin Children’s. “And even though she was growing, her windpipe needed help to expand.”

Hoping to avoid a major surgical procedure on her neck that would come with additional risks, Safaa’s family and their care team opted for a less invasive approach using a balloon dilation to gradually widen her airway over time.

“Every few months, we would look at Safaa’s airway with a fiberoptic camera, and the balloon dilation procedure would gently push open the airway little by little until it became a very nice, normal-looking airway,” Liu said.

In March 2024, shortly after Safaa’s 4^th birthday, her tracheostomy tube was removed.

Becoming Like Family

Through four years of appointments and procedures, the Cardello family and Safaa’s Cedars-Sinai care team became quite close.

“Safaa got to know us really well and I think that helped when she would come in for her balloon dilation,” Dralyuk said. “I would always meet her and her family in pre-op and either Dr. Liu or I would carry her back to the procedure area. She’s a tough cookie. She and her parents have done an amazing job.”

Dralyuk said she especially loves to hear Safaa say her name. “Early on, we didn’t know what Safaa’s voice might sound like due to her narrow airway and whether there may be any residual damage to her vocal cords. Now when I see her, and I hear, ‘Hi Dr. Dralyuk,’ it is really special.”

Ahmadi Cardello said she and her family are thankful for the care and attention they received.

“The advice Drs. Liu, Dralyuk and all of Safaa’s other doctors gave us always felt like it was something they would recommend for their own child,” Ahmadi Cardello said. “We didn’t feel alone.”

What’s Next for Safaa

Now that her tracheostomy tube has been removed, Safaa and her parents are waiting patiently for the stoma, or the hole where the tube was previously located, to close. That typically happens on its own in a few months.

Prior to the removal, many things that would be normal for a toddler were risky for Safaa as they could cause infection of the stoma.

“I can’t wait to teach her how to swim,” Cardello said, “It’ll be fun to finally take her to the park and let her play in the sand. We haven’t been able to do that until now.”

Ahmadi Cardello is relieved. “Now that Safaa’s tracheostomy has been removed, I feel like we can all breathe a little easier,” she said.

Read more from the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

Huntington Health has added numerous highly respected and deeply rooted local physicians through the affiliation, enhancing and expanding local access to expert care and services in Pasadena and the San Gabriel Valley. Among these: cancer; cardiac, vascular and thoracic surgery; obstetrical and gynecological care; pediatric subspecialty services; and otolaryngology (ear, nose and throat).

“We chose to affiliate with Cedars-Sinai for many reasons, including their commitment to grow care at a local level to build healthy, strong communities,” said Lori J. Morgan, MD, MBA, president and CEO of Huntington Health. “Under this guiding principle, we’ve come a long way in two short years.”

Thomas M. Priselac, president and CEO of Cedars-Sinai Health System, credits the commitment of teams at both organizations for the affiliation’s early achievements.

“When we welcomed Huntington Health into the Cedars-Sinai family in August 2021, we were excited about the many opportunities to collaborate, as well as the opportunity to share resources and expertise,” Priselac said. “It is very gratifying that we already have up-and-running collaborations and new information-technology platforms in place that are benefiting patients.”

The accomplishments of the affiliation include:

• Patient care/patient experience—Huntington Health launched CS-Link, a secure, electronic medical records system that enables patients to communicate with their doctors, schedule appointments and access their personal health information. A newly created software system—designed to enhance and simplify the billing/payment experience for patients—also has been implemented.
   
• Cancer care—Huntington Cancer Center, an affiliate of Cedars-Sinai Cancer, has seen tremendous growth in dedicated personnel and services. Additional physicians have joined Huntington Health to expand the already expert roster of skilled clinicians who provide comprehensive cancer care—from diagnosis through surgery and recovery. There are expanded capabilities for infusion for chemotherapy and direct access to Cedars-Sinai Cancer clinical trials.
   
• Cardiac, vascular and thoracic surgery—Expert surgeons have joined the Cardiac, Vascular and Thoracic Surgery Program at Huntington Health to offer a wide range of lifesaving and life-enhancing surgeries to local patients. New, innovative treatment options include robotic valve repair, coronary artery bypass grafting, aortic root and arch surgery, surgical treatment of arrhythmias and minimally invasive thoracic surgery, making this a state-of-the-art program in the San Gabriel Valley. Cedars-Sinai is pleased that cardiac surgeon Robbin Cohen, MD, has joined the faculty and serves as director of the Cardiac Surgery Program at Huntington Health and professor of Cardiac Surgery in the Department of Cardiac Surgery at Cedars-Sinai.  
  
  These surgeons enable San Gabriel Valley residents to access the full spectrum of coordinated care offered by the Smidt Heart Institute at Cedars-Sinai. Cedars-Sinai is best in California and #2 in the U.S. for Cardiology, Heart & Vascular Surgery, according to U.S. News & World Report's "Best Hospitals 2023-24" rankings.
   
• Otolaryngology—Cedars-Sinai’s nationally recognized Otolaryngology Program is now available to adult and pediatric patients throughout the San Gabriel Valley who have conditions affecting the ear, nose and throat.
   
• OB-GYN—Fair Oaks Women’s Health, one of the most respected and longstanding obstetrical and gynecological practices in the San Gabriel Valley, joined Cedars-Sinai in May. With six specialists, it will provide patients access to an even greater network of specialized care.
   
• Pediatric care—Huntington Health’s Neonatal Intensive Care Unit and pediatric physicians now have access to Cedars-Sinai pediatric subspecialists via teleconsultations. The affiliation also enables direct transfers to Cedars-Sinai Guerin Children’s for the most complicated conditions. Outpatient pediatric care in endocrinology and cardiology is also now available at Huntington Health.

“We are so pleased with the progress this partnership has made over the past two years, and I’m confident that these strides point to continued success in the years ahead,” Priselac said.

Read more on the Cedars-Sinai Blog: Heart Disease | When to Get a Second Opinion