Not all ear infections are created equally. Swimmer's ear differs from a middle ear infection. It is an inflammation of the skin lining the ear canal and is most common in older children and teens. Middle ear infections (otitis media) are caused by pus behind the eardrum and are most common in infants and younger children.
What is swimmer's ear?
Swimmer's ear (AKA otitis externa) gets its name because it is commonly caused by water in the ear canal making a good environment for bacteria to grow, causing an infection of the skin.
Water can come from many sources, including lakes, pools, bath tubs, and even sweat, so not only swimmers get swimmer's ear.
Increasing the risk of swimmer's ear:
Anything that damages the skin lining the ear canal can predispose to a secondary infection, much like having a scraped knee can lead to an infection of the skin on your knee. Avoid putting anything in your ears, since it can scratch the skin of the ear canal. This includes anything solid to clean wax out of the ear.
Excess earwax can trap water, so cleaning with a safe method can help prevent infection. A little wax is good though -- it actually helps prevent bacterial growth. For more on earwax, please see Ear Wax: Good and Bad.
Yes, it sometimes hurts!
Swimmer's ear can cause intense pain. Sometimes it starts as a mild irritation or itch, but pain worsens if untreated. It typically hurts more if the ear is pulled back or if the little bump at the front of the ear canal is pushed down toward the canal.
Ear buds (for a music player) or hearing aides can be very uncomfortable (and increase the risk of getting swimmer's ear due to canal irritation).
Other symptoms:
Sometimes there is drainage of clear fluid or pus from the canal.
If the canal swells significantly or if pus fills the canal, hearing will be affected.
More severe cases can cause redness extending to the outer ear, fever, and swollen lymph nodes (glands) in the neck.
Swimmer's ear can lead to dizziness or ringing in the ear.
Prevention of swimmer's ear:
Controlling wax
If your child has excessive wax buildup, talk with his doctor about how often to clean the wax. Wax does help keep your ears clean, so you don't want to clear it too much!
Keep out!
Never put anything solid into the ear canal.
Drying ears
Dry the ear canals when water gets in.
Tilt the head so the ear is down and hold a towel at the edge of the canal.
Use a hair dryer on a cool setting several inches away from the ear to dry it.
If kids get frequent ear infections or are in untreated water (such as a lake), use over the counter ear drops made to help clean the canal. You can buy them at a pharmacy or make them yourself with white vinegar and rubbing alcohol in a 1 to 1 ratio. Put 3-4 drops in each ear after swimming. The acid of the vinegar and the antibacterial properties of the alcohol help to clear bacteria, and the alcohol evaporates to help dry the canal.
DO NOT use these drops if there are tubes or a hole in the eardrum, if pus is draining, or if the ear itches or hurts.
Avoiding swimming when needed
If your child has a scratch in the ear or a current swimmer's ear infection, avoid swimming for 3-5 days to allow the skin to heal.
Avoid bubble baths and other irritating liquids that might get into ear canals.
If there's tubes...
If your child has tubes placed for recurrent middle ear infections, talk with your ENT about ear protection during swimming.
The use of ear plugs for swimming with tubes has been controversial, but are generally not needed. Dr. Burton discusses this in 5 Fantastical Ear Tube Myths .
Treating swimmer's ear:
Pain control
If you think your child has swimmer's ear, start with pain control at home with acetaminophen or ibuprofen per package directions.
Heating pads to the outer ear often help, but do not put any heated liquids into the ear.
Visit your doctor
Most often swimmer's ear is not an emergency, but symptoms can worsen if not treated with prescription ear drops within a few days.
Bring your child to the office for an exam, diagnosis, and treatment as indicated. Most can go to their usual physician during during normal business hours if you can get adequate pain control at home.
When to be seen immediately
If the pain is severe, redness extends onto the face or behind the ear, the ear protrudes from the head, or there are other concerning symptoms, your child should be seen immediately at their primary care office or another urgent/emergent care setting.
Ear wicks
Occasionally we will remove debris from the canal or insert a wick to help the drops get past the inflamed/swollen canal.
Never attempt this at home unless you've been instructed on how to do it safely!
Prescription ear drops and oral medicine
The prescription ear drops may include an antibiotic (to kill the bacteria), a steroid (to decrease inflammation and pain), an acid (to kill bacteria), an antiseptic (to kill the bacteria), or a combination of these. They are generally used 2-3 times/day.
Have your child lie on his or her side to put the drops in the ear. He or she should remain on that side for several minutes before getting up or changing sides to allow the medicine to stay in the ear. They can use a cotton ball or tissue to collect and dripping when they get up.
Symptoms generally improve after 24 hours and the infection clears within a week.
Oral antibiotics are usually not required unless the infection extends beyond the ear canal.
If an infection causes more itch than pain or does not clear with initial treatment, we might consider a fungal infection. This requires an anti-fungal medication.
No swimming until the infection clears.
Swimming just adds insult to injury. Let the skin heal before getting it soaked in the pool again!
Special circumstances
Kids (and adults) with diabetes or other immune deficiencies are more likely to get severely sick with any infection.
Visit your doctor early if you suspect a problem.