External Ear Infection: Swimmer’s Ear
Two days after your family gets home from the annual vacation to the lake, your six-year-old begins to complain of ear pain. It becomes quite severe over the next few hours, and is extremely painful to touch or lay upon. -or-
The day after your child attended a swim party she complains about severe ear pain, especially when she yawns or swallows. -or-
Your two-year-old loves to put his head under water during bath time. Several hours after a bath he complains about ear pain, which becomes worse over the course of the evening.
What is causing this ear pain? Is it an ear infection? Should you go to the ER, or page your doctor? Here is the Dr. Sears guide to diagnosing, treating, and preventing swimmer’s ear.
WHAT IS SWIMMER’S EAR?
This is an infection in the skin of the ear canal, similar to an infection anywhere else on the skin such as from a scrape or a bite. It is different from an ear infection, which occurs in the middle ear space behind the eardrum. Swimmer’s ear infection occurs externally to the ear drum in the ear canal.
HOW DOES SWIMMER’S EAR OCCUR?
When water gets stuck in the ear canal after swimming or bathing, the water can irritate the skin of the ear canal. This irritated skin then gets invaded by bacteria. This infection will fester until it builds up enough to cause pain. This can occur over a few hours, or can take several days.
Lake water is the most likely to cause an infection, followed by ocean water, bath water, then pool water.
HOW DO I TELL IF MY CHILD HAS SWIMMER’S EAR OR AN INTERNAL EAR INFECTION?
Clues that your child has swimmer’s ear include:
- Known exposure to water in the ear such as swimming or bathing.
- Ear pain with yawning or swallowing.
- Pus draining from the ear canal.
- There is usually no fever associated with swimmer’s ear.
- Try the ear movement test:
- Push on the anterior ear flap – the small flap of ear that covers the ear canal.
- Pull back and up on the entire ear.
- Push on the face just in front of the ear.
- If any of these movements cause severe pain, then that is a big sign of swimmer’s ear. Try the test on the other ear. Swimmer’s ear is even more likely if the unaffected ear does not hurt with this test.
- Absence of any cold symptoms – if there is an actual internal ear infection, there will most often be runny nose and congestion prior to the ear infection. If your child has no cold symptoms, then a swimmer’s ear is much more likely with the above symptoms.
- Visit our ear infections page for a discussion on how to tell if an internal infection may be present.
HOW DO I TREAT A SWIMMER’S EAR?
The treatment is a prescription antibiotic ear drop. Place 5 – 10 drops into the ear 2 to 4 times a day (depending on the brand used) for 5 to 7 days. The number of ear drops is not so important. The main idea is to almost fill the ear canal with drops, but no more than 10 drops are usually needed. Allow the drops to stay in the ear canal for approximately 10 minutes, then you may allow the fluid to flow out onto a napkin or cloth. There is really no effective over-the-counter treatment.
Tylenol or ibuprofen (Motrin or Advil) can be used to treat the pain until the ear drops take effect. Use both together for severe pain. Click here for dosing.
Very important – you must follow dry ear precautions for at least several days after the treatment is finished. This means do not let any water get into the ear canal. Ear plugs usually are not effective enough. Allowing water into the ear canal may prolong the healing process. If your child must participate in a water activity that is very important to her, then you can get the ear wet, but this will prolong the course of healing. Use white vinegar in the ear as described below if your child does get water in the ear canal during a swimmer’s ear infection.
HOW DO I PREVENT SWIMMER’S EAR?
If your child seems prone to swimmer’s ear infections, then follow these precautions in the future:
- White vinegar drops.
- Rubbing alcohol drops.
- Both vinegar and alcohol mixed together (equal amounts).
- You can also buy swimmer’s ear drops in the drug store. THESE DO NOT TREAT SWIMMER’S EAR, THEY JUST PREVENT IT. These drops do not really have any advantage over plain white vinegar and alcohol.
- Place 5 to 10 drops into each ear immediately after water exposure. Allow the drops to stay in the ear for a few minutes, then drain them out onto a napkin or cloth. This will help evaporate water out of the ear.
- Important – do not place alcohol into an already sore or infected ear. This will be very painful for an already hurting child. If your child has a swimmer’s ear, and gets water in it, then use just white vinegar.
WHEN DO I NEED TO SEE THE DOCTOR?
If you are fairly certain your child has a swimmer’s ear and not an internal ear infection, your doctor may call in an antibiotic ear drop without an appointment. Swimmer’s ear can wait until morning to page your doctor. If the diagnosis is unclear, you should have your child examined. The doctor can usually tell whether or not it is a swimmer’s ear or an internal infection. If you start treatment for a swimmer’s ear, but no improvement is evident within two days, then your child should be examined by the doctor. If the area behind the ear is swollen, red, and tender to touch, this may be a sign that an infection has spread into the bone behind the ear. You should see your doctor right away, or page the doctor if it is after hours.