What to do if your child gets swimmer’s ear

Chances are if you’re a parent you’ve experienced the common childhood middle ear infection. This type of ear infection is caused by inflammation of the eardrum and is often associated with an upper respiratory infection.

Less typical is swimmer’s ear (or otitis externa) which affects the skin lining of the outer ear canal, just outside the eardrum. What might surprise you though is that, despite fewer reported cases of swimmer’s ear, it still accounts for over 2.4 million healthcare visits in the U.S. annually.

In fact, ear infections like swimmer’s ear are one of the main conditions we see at urgent care.

Does my child have swimmer’s ear?

If your child has otitis externa, you’ll probably know pretty quickly. Unlike a middle ear infection, one of the key indicators of a swimmer’s ear is a pain when chewing, pulling on the earlobe, or pressing on the “tag” on the front of the ear. It’s most common in children and adolescents ages 5-18. A high percentage of instances occur during the summer months when kids spend a lot of time in the pool – hence the name swimmer’s ear!

Moisture from a waterlogged ear can be a culprit. However, it’s not the only reason for otitis externa. According to Dr. Christian Molstrom, Regional Lead Physician at Legacy-Urgent Care, “Anything that disrupts the ear canal’s wax-skin barrier can promote an infection.”

Under normal conditions, ear wax (or cerumen) provides a barrier to the ear canal’s skin lining because it seals out moisture and traps debris with its stickiness. But excessive water exposure can cause the skin to soften and become macerated, creating a favorable environment for the growth of bacteria or fungus.

Abrasions to the outer ear can also lead to bacterial or fungal infections. If your child uses cotton-tip swabs, ear plugs or headphones – or accidentally scratches his or her ear – it can result in a break in the skin lining.

Certain hair care products and jewelry can also be irritants. Plus, those that suffer from skin conditions like eczema and seborrhea are at higher risk for infection.

Besides an outer earache, other symptoms to be aware of with swimmer’s ear are redness and swelling of the ear canal as well as tender or enlarged lymph nodes in this area.

Sometimes a cloudy, yellowish discharge can fill up the outer ear. Should swelling or pus block the auditory canal, your child might also temporarily lose hearing.

What home remedies provide pain relief from swimmer’s ear?

Most of the time swimmer’s ear is not an emergency situation. But that doesn’t mean it’s not painful. Even mild otitis externa can cause discomfort.

So what helps with a swimmer’s ear? As long as your child doesn’t have a perforated eardrum or ear tube, you can use non-prescription ear drops to make them feel better.

Non-prescription ear drops can be purchased at the drugstore, or you can create your own ear drops at home. These are made with a half-and-half mixture of alcohol and vinegar and are intended to restore the normal acid balance to the ear while evaporating excess water.

Other swimmer’s ear remedies can also be used to alleviate pain. Like ear drops, a heating pad can be applied to your child’s infected ear to dry it out. To avoid accidental burning, it’s best to keep the heating pad on its lowest setting and only use it in short durations.

If these remedies don’t provide the desired relief, you can also try an over-the-counter medication such as acetaminophen or ibuprofen.

No matter how itchy or irritating the infection becomes, encourage your child to keep their fingers away from the ear. Removing any visible discharge or debris can lead to further trauma.

Plus, while your child might want to get right back into the water, they should avoid swimming until symptoms subside since continued swimming can slow recovery.

When should we visit urgent care?

A more severe swimmer’s ear infection that doesn’t improve with at-home treatment may require a visit to the doctor.

“It’s easy for a Urgent Care provider to diagnose otitis externa by taking a brief history and performing a limited physical exam that involves looking inside your child’s ear to determine if the infection is internal or external to the eardrum,” Dr. Molstrom explains.

Depending on what is found, the doctor may recommend a prescription for an antibiotic ear drop. The insertion of an ear wick may be needed for more severe cases of otitis externa where the canal demonstrates significant swelling, to allow adequate penetration of antibiotic drops.  If your child suffers from reoccurring infections, their doctor might also refer you to an otolaryngologist (ear, nose and throat specialist) for further examination.

How do I prevent swimmer’s ear?

Knowing how painful a swimmer’s ear can be, parents often ask how they can prevent an earache caused by water in the first place.

Precautions you can take to ensure they’re safe this summer:

• Keep your child’s ears as water-free as possible when swimming. Custom-fitted swim caps and ear plugs can help to protect the ear canal. However, excessive use should be avoided as this can actually lead to a swimmer’s ear.
• Check pool pH levels and make sure water is properly disinfected.
• Avoid swimming in lakes or rivers that have high levels of bacteria.
• Dry your child’s ears completely after swimming.

Here are some safe methods for how to remove water from the ear:

• Let gravity do the work. Outside of using a towel to dry your child’s ears, the most practical way to remove water is by tilting the head to hold each ear facing down. Pulling the earlobe in different directions while the ear is face down can help drain water.
• Create suction with your hands. Have your child cup their palm tightly over the ear and tilt their head to the side, mimicking a vacuum. This can help to loosen up the water so it can be pulled out.
• Apply a warm compress. Try using a warm washcloth as a compress over your child’s ear to extract water and help soothe discomfort.
• Use a hair dryer. To help evaporate any trapped water, place a hair dryer on its lowest setting and hold it about a foot from your child’s ear. Move it back and forth slowly to distribute the force of air. You can also simultaneously tug on the earlobe to help release water.
• Make an ear drop mixture. Similar to vinegar and rubbing alcohol ear drops, a mixture of half water and half hydrogen peroxide can also be used to help soften ear wax and drain any trapped water.

In addition, your child should avoid using cotton-tip swabs to remove water or earwax from their ear. Swabs and other items like bobby pins or fingernails cause a break in the skin lining. They can also push wax further back into the ear canal where it doesn’t belong, and this might require your child needing medical help to get it out.

Accidentally pushing swabs too far can also damage the eardrum or the tiny hearing bones (hammer, anvil and stirrup) underneath.

Complications with chronic swimmer’s ear

With proper treatment, instances of acute (not chronic) otitis externa usually clear up in 7-10 days. However, if the outer ear infection isn’t easily resolved or reoccurs in multiple sequential episodes, it can lead to chronic otitis externa.

An acute case of swimmer’s ear can become chronic if the bacteria or fungus that’s causing the infection is a rare strain, the infection is both bacterial and fungal, or your child has an allergic reaction to an antibiotic prescribed. 

Symptoms of chronic swimmer’s ear include a fever and pain that radiates to the face, neck and head. If untreated, it can lead to conditions such as hearing loss or cellulitis.

Treatment for chronic otitis externa with antibiotic ear drops or oral antibiotics is usually successful. But depending on the severity of the infection, it may take some time and require repeat treatment. 

Other ear conditions that may cause ear pain

Eustachian tube dysfunction

Eustachian tube dysfunction usually occurs during or after a deep-water dive. It is a result of the barometric change, so divers are particularly affected. It can also occur from a reaction to the chlorine in a swimming pool, which may cause the lining of the nose to become irritated, thinning the tubes over time. The pressure pushing bacteria and mucous into the ear has also been known to cause this dysfunction.

Nose and ear plugs may help to prevent this from happening though. During a dive, you can also slowly breathe out the air from your mouth until you reach the surface.

Medical treatments for Eustachian tube dysfunction include nasal decongestants and anti-bacterial ear drops, which can be prescribed to you if diagnosed.

Malignant external otitis

While rare to occur, malignant external otitis develops when bacteria infect the bones inside the ear canal and spread to the base of the skull. Symptoms include ear pain with sudden facial paralysis, hoarseness, hearing loss, and throat pain.

Older adults with diabetes, anyone with HIV, and children who have impaired immune systems are at the highest risk for malignant external otitis.

Antibiotics are used to treat this infection.

To summarize

As your family turns to the pool to find relief from hot summer days, it’s important to take extra precautions to avoid the discomfort of the swimmer’s ear. Individuals are more susceptible to otitis externa when they spend large amounts of time swimming, especially in water with high levels of bacteria.

Children in particular are more vulnerable to infection since they have narrower ear canals. You can help prevent swimmer’s ear by ensuring your child’s ears stay dry. It will be a long summer if they have to sit poolside while all their friends are enjoying the water.

Please feel free to visit any of our Urgent Care Centers for any ear pain or concerns that do not resolve after 2-3 days of conservative management. One of our skilled providers would be happy to assess your concerns and get you back on the path to feeling better.