Swimmer's ear (otitis externa): key symptoms to spot

diagram of the ear showing swimmer's ear infection

It's called swimmer's ear because repeated exposure to water can make your ear more vulnerable to this kind of inflammation and infection.

It's different to an middle ear infection (otitis media), which occurs behind the eardrum, further inside the ear, and is usually caused by a viral infection.

What are the symptoms of swimmer's ear? Are they different to symptoms of a middle ear infection?

If your child has swimmer's ear, they may:

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Complain of pain near the opening of their ear or pain the increases when you pull on their earlobe
Pull or tug on their ears
Complain of itching or a sensation of fullness in the ear
Have an outer ear that looks red or be painful to touch
Have a discharge of pus or liquid from the ear
Have some hearing loss

A middle ear infection can have similar symptoms but usually the pain feels as if it's deeper in the ear and it increases when your child is lying down. Middle ear infection is also more likely to be accompanied by fever, lack of appetite, vomiting and diarrhoea.

Can children get swimmer's ear if they don't swim?

Yes – although it is more likely if they have been swimming a lot because their ears are constantly getting water in them.

The skin of ear canals that constantly get water in them quickly become soft and moist, leaving them more vulnerable to infection from bacteria and fungi – especially if you've been swimming in open watering in lakes, ponds or rivers.

On top of that, water in your ears can make you put your finger in them to get the water out. When you do this, you can accidentally scratch the skin inside your ear, making it more vulnerable to infection, especially if your fingernails are a bit grubby.

Saying all that, your child can get swimmer's ear from hair-washing, showering or cleaning inside their ear with cotton buds – don’t do this, please!

If your child has an itchy skin condition, such as eczema, they may be more vulnerable to swimmer's ear as their skin doesn't work as well as a barrier to prevent infection, and the itchiness is more likely to make them scratch.

Can babies and toddlers get swimmer's ear?

They can do, but it is more common in children over the age of 2.

What’s the treatment for swimmer's ear?

Your child will need ear drops or a spray for the ears. These typically include steroids to bring down any inflammation, as well as antibiotic or antifungal medication.

You will be given directions as to how to use the drops or spray. If you are using drops, you may be advised to lie your child down on the sofa for a few minutes afterward, with the affected ear up. When it's time for your child to stand up, you may need to wipe up any dripping with a tissue.

Do not attempt to clean the ear yourself at home, and avoid inserting cotton wool buds into the ear. After using the drops or spray, do not insert cotton wool or anything else into the ear.

Do I need to call a doctor?

Yes, you will need to see your doctor as the medications for swimmer's ear are not available over the counter. It is also important to rule out other conditions and to get your child checked out by a healthcare professional if they are otherwise unwell or you are concerned.

Will swimmer's ear go away by itself?

It is possible that your child's symptoms may improve on their own, or when they are not swimming so much, but if they don't or you are concerned, please seek medical advice.

Can my child swim with swimmer's ear?

Swimming while having swimmer's ear may slow down recovery, so it is sensible to avoid swimming until the symptoms have gone. However, swimming with swimmer's ear is unlikely to cause significant harm.

Is swimmer's ear infectious?

No, swimmer's ear isn't infectious to other people.

How can you prevent swimmer's ear?

Ideally, try to keep the external ear canals dry. So, after swimming or hair-washing, turning your child's head from side to side to help any water run out.

Avoid using cotton ear buds to clean the ears or attempt to remove water, as they are likely to simply cause ear wax to impact, meaning that the water can then get trapped behind it.

If, in addition to painful ears, your child is unwell, with a fever or other signs, then please seek medical advice as soon as possible.

Pics: Getty Images

Dr Philippa KayeGP

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice.

What is swimmer's ear?