Swimmer’s ear is a form of otitis externa (external ear infection). It is a painful bacterial infection of the skin inside the ear canal. Swimming is by far the most common cause in children. Otitis externa is not at all related to common middle ear infections (otitis media), which are infections behind the ear drum. Water trapped in the ear damages the skin, which leads to infection by bacteria that live in the ear canal. Otitis externa can also be caused by other damage to or irritation of the skin like scratches or insect bites or cleaning the ear too much.
What are the symptoms?
- Ear pain is the main symptom. The ear usually hurts to touch or to tug on it or to clean it.
- Swelling, redness, and/or slight discharge of the ear canal can sometimes be seen.
- There is usually a history of swimming or getting water in the ear.
- There is usually not fever or nasal congestion like there is with otitis media.
- Because the ear canal is a tube, swelling of the skin can cause the tube to get narrower or to close all the way.
What causes swimmer’s ear?
Swimmer’s ear is an infection of the skin in the ear canal by germs that normally live there. Ear wax helps protect the skin and prevent infection. Infection occurs when the skin is damaged by scratching or irritation, often from trying too hard to clean the ear canal and remove wax. Removing too much wax also removes the protection from the skin. Water left in the ear seems to change the pH of the ear canal and also irritate the skin, leading to infection. Too much wax in the canal can sometimes trap water in the ear canal and help lead to an infection.
How is it treated?
- Treatment is with antibiotic ear drops, since it is a bacterial infection. The drops may also contain a steroid which can help decrease the swelling and pain. For mild cases, acetic acid drops (vinegar) can be used, with our without an added steroid.
- The child should be lying down or have the head tilted to the side. Pull the outer ear up a little and fill the canal with the medication, usually 2-4 drops. Gently wiggle the outer ear and push on the front part a few times. The child should keep the head down and the drops in the ear for 3-5 minutes. To keep it in even longer, a cotton ball can be used for 20-30 minutes while child is up and moving around.
- Usually there is improvement in 2-3 days and symptoms are resolved in 6-7 days.
- The ear should be kept as dry as possible until all symptoms have resolved, and definitely for the first 2-3 days. A cotton ball coated with petroleum jelly (Vaseline) can be used while taking a shower. If swimming, try to keep the ear dry. Avoid diving and going under water for a week, or wear ear plugs. The ear can be gently dried afterwards with a hair dryer.
- Acetaminophen or ibuprofen can be used for pain. Ear drops for pain (often used for ear infections (otitis media) should not be used. They are not approved for this condition, have not been shown to help, and may interfere with the antibiotic drops or mask other symptoms.
- If the ear canal is very swollen, sometimes an ear wick is used, which is a piece of material used to soak up the antibiotic drops and keep them in contact with the infected skin. The wick will fall out when the swelling goes down.
- Very mild cases can be treated at home if caught early in the infection. Mix white vinegar with an equal amount of water or rubbing alcohol and put 4-5 drops in the affected ear 2-4 times a day for several days. If symptoms persist or worsen, then antibiotic drops are necessary.
How to prevent swimmer’s ear
- Rid the ear of water after swimming or bathing. Turn the head to the side and pull the earlobe in several directions to get the water to drain, then dry the ear thoroughly. Do not put anything into the canal to clean or dry it. Dry it externally with a towel; a hair dryer on low setting can also be used gently.
- If the ear canal has a lot of wax in it, this can trap water behind it. The wax should be removed at home with ear wax kits (after the infection has healed) or by your doctor to prevent further cases of swimmer’s ear.
- Children prone to swimmer’s ear can use swimmer’s ear drops from the drug store. These are alcohol drops which force water to evaporate. They can be used after swimming. You can make your own prevention drops at home by using rubbing alcohol, or by mixing rubbing alcohol with an equal amount of white vinegar.
- Children prone to swimmer’s ear can also use ear plugs when swimming, but be sure the plugs are not pushing wax into the ear. The ear still needs to be dried afterwards.
When should I seek further care?
Call us for an appointment today or tomorrow if:
- The ear pain gets worse.
- There is not significant improvement in 2-3 days.
- Your child complains of tasting the ear drops.
- A rash develops from the ear drops.
