Swimmer's ear (otitis externa) is an infection in the soft tissue of the outer ear, which is the part of the ear you can see outside of the eardrum. It's caused when bacteria or fungi break into the soft tissue and begin to grow and spread.
"Swimmer's ear can cause very severe pain due to significant swelling in an area with many nerves," says Felicity Lenes-Voit, M.D., an ear, nose and throat specialist at Children's Health℠. "If the pain worsens when you pull on the ear, it may be a sign of an external ear infection."
In addition to ear pain, children with swimmer's ear may experience muffled hearing or fluid that drains out of the ear.
What causes swimmer's ear?
Though it's called swimmer's ear, children can get this infection whether or not they've been swimming. Anything that causes the protective barriers of ear wax to break down can lead to an infection. Even taking a Q-tip to clean out wax can scratch the ear canal and cause an infection.
Ear wax protects the ear from infection in different ways. First, it acts as a physical barrier, actually keeping bacteria away from ear surfaces. But it is also acidic, creating an unfriendly environment for bacteria that like a more alkaline environment. Ear wax also contains enzymes that break down bacteria.
The water and chlorine in swimming pools can dry out the skin of the ear canal, so children who spend a lot of time in the water may be at risk for infection. However, most kids who go swimming never develop the infection at all.
"Kids are more likely to get outer ear infections if they are immunocompromised or have diabetes," says Dr. Lenes-Voit. "They may also be at higher risk if they have a condition that affects their skin barrier, such as eczema."
How do I treat swimmer's ear?
Swimmer's ear may resolve on its own, but is typically treated with antibiotic drops. If it is very painful, the American Academy of Otolaryngology–Head and Neck Surgery guidelines recommend alternating between age-appropriate doses of Tylenol and Motrin every few hours. Most children won't need any stronger pain medications. If the pain does not improve after starting antibiotic ear drops, evaluation by your pediatrician or ENT is very important.
"Topical antibiotics are a lot more effective and have fewer risks than antibiotics taken via mouth," says Dr. Lenes-Voit.
Many antibiotics are safe to place in the ear, even if there is a perforation or a child has ear tubes. However, some can cause hearing loss if the ear drum is not intact. Your doctor will be able to examine your child and prescribe a safe therapy.
In some cases, your child's ear canal may be so swollen that the drops cannot get to the site of the infection. Your child may need to see an ear, nose and throat physician who can clean out any debris or place a wick. A wick is a small piece of sterile cotton that is placed into the ear. Drops can then be passed through the wick all the way to the ear drum. Unfortunately, wick placement and ear cleaning can be painful for children, but are crucial in these cases for improvement.
Are there home remedies for swimmer's ear?
There are also some home remedies that may help with swimmer's ear. However, these are only safe to use if you know for certain your child's eardrum is intact, and these remedies won't work as quickly as antibiotics.
One swimmer's ear remedy is to dilute vinegar with hydrogen peroxide, so the solution is about half and half. The acidic vinegar may help rid the ear of bacteria.
Some home remedies sold in stores use rubbing alcohol, which should probably be avoided as it may dry out the ear canal too much, making it more susceptible to infection, and could be toxic to hearing if there is a perforation in the ear drum.
No matter if you choose antibiotics or a home remedy, you should keep your child's ear dry while they are fighting swimmer's ear.
"We recommend against baths and swimming with an outer ear infection," she says. "When your child does need to bathe, we recommend to shower and to take a big cotton ball, cover it in Vaseline and then put it on the opening of the ear to keep water from getting in."
Dr. Lenes-Voit says parents should also seek out medical advice if the infection is not improving or getting worse. You should also see a doctor quickly if your child has facial asymmetry, a change in their voice or hearing, or other symptoms that affect the nerves of the face.
How can I prevent swimmer's ear?
The best way to prevent swimmer's ear in both adults and children is to never put anything in your ear, even Q-tips.
"We say never put anything smaller than your elbow in your ear," says Dr. Lenes-Voit. "We don't want to eradicate ear wax and a lot of time using a Q-tip or bobby pins just pushes it further into the ear canal and makes it harder for your ear to clean itself out."
Dr. Lenes-Voit says earplugs won't necessarily help either. Children with tubes in their ears may use earplugs when swimming in a lake or pond, but don't need them in a pool. Children without ear tubes don't need earplugs at all.
Even the protective drops sold in stores may not help. Research doesn't back up their use, and they can dry ears out.
If your child is experiencing repeated swimmer's ear infections, talk to your doctor about ways to protect their ears safely before you try any preventative measures.
Children's Health offers the largest group of ENT pediatric doctors in North Texas, which gives parents and patients access to expertise, support and services not available anywhere else. Learn more about Pediatric Ear, Nose and Throat program.
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