Swimmer's ear (otitis externa)

Otitis externa, or swimmer’s ear, is an inflammation of the outer ear canal. It mainly affects children over two years of age.

Swimmer’s ear often occurs in the summer months because more children are swimming during this time. It happens when prolonged wetness of the ear causes the skin to slough off (shed itself), allowing organisms to enter the skin. These organisms can cause infections and inflammation.

Otitis externa
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Swimmer's ear (otitis externa) is an inflammation of the outer ear canal that occurs when organisms enter the skin. Symptoms can include a feeling of blockage in the ear, loss of hearing or drainage from the ear canal.

Signs and symptoms of swimmer's ear

Your child may have:

  • pain, tenderness and itching, usually in one ear but sometimes in both ears
  • muffled hearing or loss of hearing
  • a feeling of blockage in the ear
  • pain in the ear canal when chewing
  • discharge or drainage from the ear canal.

Complications of swimmer's ear

If left untreated, swimmer’s ear can lead to serious complications, including:

  • a severe deep skin infection called cellulitis
  • long-term infections such as chronic otitis externa
  • bone, nerve and cartilage damage, called malignant otitis externa.

Taking care of your child at home

Treat the pain

Swimmer’s ear can be painful. At first, you can use over-the-counter pain medicines such as acetaminophen​ or ibuprofen to help with your child's pain.

Avoid swimming or putting the head in water

Your child should avoid swimming or putting their head under water until the infection is gone. If your child is showering, have them avoid letting the stream of water enter their ear directly.

When to see a doctor

Always go to a doctor if your child has:

  • ​tenderness, swelling or redness around or behind the ear
  • a fever
  • pain that is not well controlled.

What your doctor can do for swimmer's ear

Swimmer’s ear is often treated with eardrops containing antibiotics and, sometimes, steroids. These eardrops must be prescribed by your doctor. For more severe cases, the doctor may also prescribe an antibiotic to be taken by mouth.

Your doctor may also try to use a wick to decrease the swelling in the ear canal and make it easier to give eardrops. A wick is a small piece of gauze that is soaked in antibiotic drops and inserted in the ear canal. It allows the antibiotic to stay in contact with the affected skin and is changed regularly until the infection clears.

How to give eardrops at home

Follow these tips to give eardrops easily.

  1. ​Lay your child on their side or have them sit upright with their head tilted to one side.
  2. If there is a lot of discharge (fluid) from the ear, clear this out gently a few times with a twisted tissue, which will soak up the fluid.
  3. Apply the recommended number of drops as instructed by the doctor.
  4. Wiggle your child's ear to make sure the drops go all the way down the ear canal.
  5. Keep your child's head in the same position for three to five minutes after putting in the drops.

​​​Never use a cotton bud or Q-tip to clean the ear canal. It may pack wax and fluid down or rupture the eardrum if it is inserted too far.​​

The infection should start to improve in two or three days and usually be resolved after about one week.

Call your child's regular doctor again if your child:

  • develops a high fever
  • develops or continues to have tenderness, redness or swelling around or behind the ear.

Preventing swimmer's ear

Keep water out of the ears

Swimming with earplugs may help prevent swimmer’s ear from coming back. Use soft earplugs that are designed for swimming. Avoid hard earplugs, as they can hurt or cause damage to the ear when they are inserted.

Remove water from the ears

If water does get into the ears, you can try removing it by positioning the head to one side or removing the water with a towel. Avoid cotton swabs, as they can cause damage to the ear drum or pack ear wax within the canal.

Key points

  • Swimmer’s ear is an infection of the ear canal, usually caused by swimming.
  • Swimmer's ear is usually treated with prescription eardrops. You can treat any pain with over-the-counter medications, but discuss this with your child's doctor.
  • See your doctor if your child has a high fever or if the skin around or behind the ear is red or swollen.
  • Never put cotton buds or Q-tips in the ear.
  • Consider using soft earplugs when swimming to prevent water from getting in the ear.
Janine A. Flanagan, HBArtsSc, MD, FRCPC