Otitis externa — commonly known as swimmer's ear — is an infection of the ear canal, the passage that carries sounds from the outside of the body to the eardrum. It can be caused by many different types of bacteria or fungi.
The infection commonly occurs in kids who spend a lot of time in the water. Too much moisture in the ear can irritate and break down the skin in the canal, allowing bacteria or fungi to penetrate. For this reason, otitis externa occurs more often in summertime, when swimming is common.
But you don't have to swim to get swimmer's ear. Anything that causes a break in the skin of the ear canal can lead to an infection. Dry skin or eczema, scratching the ear canal, vigorous ear cleaning with cotton-tipped applicators, or inserting foreign objects like bobby pins or paper clips into the ear can all increase the risk of developing otitis externa.
And if someone has a middle ear infection, pus collected in the middle ear can drain into the ear canal through a hole in the eardrum and cause otitis externa.
Signs and Symptoms
The primary symptom of otitis externa is ear pain, which can be severe and gets worse when the outer part of the ear is pulled or pressed on. It also may be painful for someone with otitis externa to chew. Sometimes the ear canal itches before the pain begins.
Swelling of the ear canal might make a child complain of a full or uncomfortable feeling in the ear. The outer ear may become reddened or swollen, and lymph nodes around the ear can become enlarged and tender. Some discharge from the ear canal is possible; it might be clear at first and then turn cloudy, yellowish, and pus-like.
Hearing might be temporarily affected if pus and debris or swelling of the canal blocks the passage of sound into the ear. Fever isn't typical in most cases, and otitis externa is not contagious.
Using over-the-counter drops of a dilute solution of acetic acid or alcohol in the ears after swimming can help prevent otitis externa, especially if a child is prone to the infection. These drops are available at pharmacies and should only be used in kids who do not have ear tubes or a hole in the eardrum.
After time in the water, kids should gently dry their ears with a towel and help water run out of their ears by turning their heads to the side.
To avoid trauma to the ear, kids should not clean their ears themselves. Also, never put objects into kids' ears, including cotton-tipped applicators.
Treatment of otitis externa depends on the severity of the infection and how much pain the child feels. For most cases, your doctor may prescribe ear drops that contain antibiotics to fight the infection, mixed with a steroid to reduce swelling of the ear canal. Ear drops are usually given several times a day for 7 to 10 days.
If swelling of the ear canal makes it difficult to give the drops, the doctor may insert a wick into the canal to help carry the medicine inside the ear. In some cases, the doctor may need to remove pus and debris from the ear with gentle cleaning or suction. This will allow the ear drops to work more effectively. For more severe infections, oral antibiotics also may be given, and the doctor may order a culture of some of the discharge from the ear to help identify which bacteria or fungi are causing the infection.
Over-the-counter pain relievers can often be used to manage pain, but if pain is severe, prescription pain medication may be needed. Once treatment has begun, your child will start to feel better in a day or two. Otitis externa is usually cured within 7 to 10 days of starting treatment.
Otitis externa should be treated by a doctor. If left untreated, the ear pain will get worse and the infection may spread. To help relieve the pain until your child sees the doctor, you can place a warm washcloth or heating pad against the affected ear. Acetaminophen or ibuprofen may also ease discomfort.
At home, follow the doctor's instructions for administering ear drops and oral antibiotics, if they are prescribed. It's important to keep water out of your child's ear during the entire course of treatment. A shower cap offers protection while showering or bathing, and your doctor may also recommend earplugs.
When to Call the Doctor
Call your doctor immediately if your child has any of the following: pain in the ear with or without fever, decreased hearing in one or both ears, or abnormal discharge from the ear.