Swimmer’s Ear (Otitis externa)

As soon as the weather turns warmer and children look for ways to cool off, our office begins to see children with “Swimmer’s Ear”. I do not like to use the term “swimmer’s ear” because it only describes one way of getting this type of infection. There are many other causes of Otitis externa.

Before learning about the causes and treatment of Otitis externa, it is important to learn a little about the anatomy of the ear. The easiest way to think about infections in the ear is to use the eardrum as a dividing line between infections in the middle ear, that typically need oral antibiotics, and infections of the ear canal (swimmer’s ear/Otitis externa), which typically need antibiotic drops. When you swim and water gets into your ear, it may stay in the ear canal. It is common for people to think that this fluid can get into the middle ear through the eardrum, but this is not the case. If there is an infection of the ear canal, the diagnosis is Otitis externa. If there is an infection on the other side of the eardrum, in the middle ear, the diagnosis is Otitis media. The two infections are not always related.

Persistent fluid in the ear canal washes away the protective wax from the canal that may result in irritation and inflammation. This can subsequently cause a bacterial infection. Whenever there is irritation of the external ear canal, whether from water, over-zealous “Q-tips”, or dirty fingers, your child can get Otitis externa (Swimmer’s Ear). The ear canal becomes red, swollen, and painful. Bacteria may further complicate the picture by causing pus to form, which further inflames the ear canal.

Many times a parent can make the diagnosis of Otitis externa. A parent may notice discharge coming out of the ear and your child may be resistant to you touching their ear. The inflammation of the ear canal makes any movement of the ear painful. When on the phone we typically ask parents to “wiggle their child’s ear”, and if the child complains of pain, we are fairly certain of Otitis externa.

After making the diagnosis of Otitis externa, we will elect to use either antibiotic eardrops or anti-inflammation eardrops (or a combination of both). This treatment will decrease the bacteria in the ear canal and will improve inflammation. Either should make your child feel better within 24-48 hours.

Otitis externa is not contagious, but it is a good idea to stay out of the water for the next two days to allow the infection to improve and not worsen. If your child is prone to Otitis externa, you may want to use eardrops as prevention. We recommend instilling 5 to 10 drops of a solution of equal parts water and rubbing alcohol into the ear after swimming. Alternatively, you may purchase commercial brands like “Auro-Dri” or “Swim Ear”. Ear plugs or an ear band may also help prevent water from entering the ear.

Overall, Swimmer’s ear (Otitis externa) is not a serious problem and is easily treated.

Reasons to call the doctor during regular hours:

• If there is no improvement after 48 hours of treatment

• If there is significant discharge coming out of the ear

• If there is redness and swelling of the ear or the skin surrounding the ear

• If your child has fever

• If there are any symptoms you are concerned about