What are the symptoms of swimmer’s ear?

Symptoms of swimmer’s ear include itchiness, redness, swelling or pain of the outer ear, muffled hearing and fluid draining from the ear. Children may also be sensitive to having the ear touched.

What are the signs of a middle ear infection in children?

Middle ear infections are usually caused by a virus or bacteria, often following a cold, flu or other illness. Common signs include ear pain, fussiness, fever, trouble feeding, trouble sleeping, excessive crying and pulling at the ear. Parents should seek medical care if pain lasts longer than 72 hours, is severe, affects both ears, is accompanied by ear discharge or high fever, or if a child younger than 6 months appears to have a middle ear infection.

How can you tell the difference between swimmer’s ear and a middle ear infection?

Swimmer’s ear often causes a red, swollen and itchy outer ear that may be painful to touch and may drain fluid. Middle ear infections are typically associated with fussiness, fever, trouble feeding or sleeping and significant ear pain. Babies with a middle ear infection may cry frequently and pull at their ears.

Can swimmer’s ear or middle ear infections be prevented?

While ear infections cannot always be prevented, steps can reduce the risk. Children who swim frequently can use earplugs or a swim cap and tilt their heads after swimming to help water drain from the ears. Parents should avoid putting soap, cotton swabs or other objects into the ear canal. To help prevent middle ear infections, children should follow recommended vaccination schedules, maintain healthy eating and sleep habits, practice good hand hygiene, avoid sharing cups and utensils, and limit exposure to air pollution and secondhand smoke.

When should parents contact a doctor about an ear infection?

Parents should contact a healthcare provider if they suspect swimmer’s ear, if ear pain lasts longer than three days, if the pain is severe, if a child has a high fever or ear discharge, or if the child is not acting like themselves. Children younger than 6 months who may have a middle ear infection should be evaluated by a doctor right away.

Can repeated ear infections cause complications?

Untreated or recurring ear infections can sometimes lead to hearing loss or speech delays. Some children with frequent infections may need ear tubes placed to help fluid drain from the middle ear.

Swimmer’s ear vs. middle ear infection: How to spot the difference

Q: What causes swimmer’s ear?

Swimmer’s ear (otitis externa) is an infection of the ear canal most often caused by water that remains in the ear after swimming, bathing or other water activities. The trapped moisture creates an environment where bacteria can grow. Symptoms can include itchiness, redness, outer ear swelling or pain, muffled hearing and fluid draining from the ear. Swimmer’s ear most commonly affects school-age children, typically age 5 and older, but can also occur in adults. Treatment usually requires prescription antibiotic ear drops.

child smiling and swimming touching side of their head

The return of hot summer days brings splashing at the pool and on sandy beaches.

But as families flock to the water, they might worry: What if my child ends up with an earache?

Ear pain can go from annoying to uncomfortable in a flash. Parents might be unsure if their child is experiencing swimmer’s ear or a middle ear infection (also known as acute otitis media).

Both conditions are types of infections. They’re caused by different things, and they typically occur at different ages. Here’s my advice on how to spot each issue — and what to do next.

What causes swimmer’s ear?

An infection of the ear canal, swimmer’s ear (otitis externa) is most often caused by water that stays in the ear after swimming, bathing or other water activities. This trapped moisture creates an ideal environment for bacteria to grow.

Symptoms of swimmer’s ear include:

Itchiness
Redness
Outer ear swelling/pain
Muffled hearing
Fluid draining from ear

Swimmer’s ear often affects school-age children, typically those 5 years old and up, but it can occasionally occur in adults.

It’s important to know that swimmer’s ear will likely not get better on its own. Acetaminophen or NSAIDs (such as ibuprofen) can help with pain relief, but treatment requires a prescription of antibiotic ear drops. Always finish the full course of medication, even if symptoms improve.

Don’t put fingers, cotton swabs or other objects into the ear; this can upset the ear’s natural balance and lead to worsening infection or inflammation. Home remedies like oils are not recommended.

If you suspect your child has swimmer’s ear, contact your healthcare provider.

Signs of middle ear infection in children

Middle ear infections are usually caused by a virus or bacteria, often from a cold, flu or other illness. These infections usually attack the middle ear, which is hidden behind the eardrum.

They are almost invisible to the naked eye, and they tend to affect babies and toddlers.

These ear infections often clear up on their own, roughly within three days. Use acetaminophen or NSAIDS if your child is in pain.

Antibiotics may be needed to fight the infection. Seek medical care if you spot any of these middle ear infection symptoms:

Pain lasting longer than 72 hours or is unbearable
Child can’t be calmed down or won’t feed
Both ears are affected
Discharge from ear and/or high fever

If a child is 6 months or younger and appears to have a middle ear infection, call their doctor right away.

Ear infections can run in the family. If parents or siblings had frequent ear infections, your children may be more likely to get them.

What type of earache does your child have?

If you peek at your child’s ear and see it looking red and swollen — and they mention it feels itchy or they are resistant to the ear being touched — it is likely swimmer’s ear. You might even spot some fluid trickling out.

With a middle ear infection, the clues are usually fussiness, fever, trouble feeding or sleeping, and ear pain that can seem overwhelming. For babies, it might just be lots of crying and pulling at their ear.

Can you stop swimmer’s ear or middle ear infections from happening?

While you can’t always avoid ear problems, preventive steps can be taken.

If your child swims a lot, grab some earplugs or a snug swim cap, and teach them to tip their head back after swimming to let water drain out.

Some parents even use a hair dryer on the lowest setting, keeping it several inches away, to dry out their child’s ears. Skip the soap in the ear canal; it messes up the body’s natural defenses.

A strong immune system — boosted by healthy eating, good sleep and an active lifestyle — can give children extra protection against middle ear infection.

Parents should follow the recommended vaccination schedule for their child, breastfeed (if possible), limit kids’ exposure to air pollution and secondhand smoke, and teach them to wash their hands and not share cups and utensils.

When repeat ear infections happen

Earaches aren’t just uncomfortable. Untreated infections, especially repeat ones, can sometimes lead to lasting hearing loss or speech delays. Some kids need tiny tubes placed in their ears to help fluid drain.

Remember, if the pain lasts longer than three days, is severe or your child just isn’t themselves, get in touch with your pediatrician.

Nishaat Farooqui, MD

Nishaat Farooqui, MD, is a board-certified pediatrician with expertise in diagnosing and treating illnesses and injuries and provides comprehensive care for infants, children and adolescents.

Learn more about Dr. Farooqui

Where Should I Go for Care Today?

You never know when a sudden injury or illness may happen. That's why it's so important to be prepared and know what steps you can take as soon as symptoms appear. Click below to learn more about the best times to visit primary care, urgent care or the emergency department.