Swimmer's Ear

Dear Lisa,

My daughter has right ear pain. She has been swimming a lot. How can I tell if the ear pain is from swimmer’s ear or from an ear infection? If she’s having a lot of pain does that mean it must be an inner ear infection?

“Ear Pain”

Dear “Ear Pain”,

“Swimmer’s Ear” or acute otitis externa is an infection of the external auditory canal. Swimmer’s ear affects one in every 100 to 250 Americans each year. It frequently occurs in children who have been swimming since the water trapped in the ear canal can lead to inflammation and infection. Trauma to the ear canal, such as a scratch from a cotton swab, fingernail or foreign body may also lead to otitis externa or swimmer’s ear. The symptoms of swimmer’s ear includes pain with chewing , pain with touching or manipulation of the tragus (the triangle shaped piece of cartilage that is located in front of the ear canal opening, at the level where the cheek bone and jaw bone meet), white cheesy discharge from the ear, and ear pain.

An “ear infection” or acute otitis media is an infection behind the eardrum in the space of the middle ear. It is a common complication of an upper respiratory infection. The symptoms include deep ear pain, ear pain which increases at night or when lying down, pulling or holding the ears, pain with sucking, cough, runny nose, fever, irritability, and difficulty hearing. If a child has otitis media, the ear drum may spontaneously rupture due to the pressure of the accumulated exudate behind the eardrum. If this occurs there will be an immediate relief of pain and a discharge will come out of the ear canal. This discharge typically has a bad odor and usually is very sticky. This discharge should be gently cleaned from the exterior of the ear (not with a cotton swab) because it may cause an infection of the ear canal (swimmer’s ear) or the skin around the ear (cellulitis).

The level of pain that a child has cannot differentiate one type of infection from another. Even though most people feel that an inner ear infection is the most painful, “Swimmer’s ear” is also many times very severe and can interfere with a child’s normal activity level. (1) In addition, a child can have both swimmer's ear and a middle ear infection at the same time. The only way to be sure which type of infection your child has is to have an examination by a Doctor or Nurse Practitioner.

Children with swimmer’s ear should not participate in swimming until the infection clears. Most cases resolve in 7 to 14 days with proper treatment. The treatment for swimmer's ear includes pain medication as well as ear drops with an antibiotic/antiseptic and cortisone as ingredients. The ear drops typically provide prompt relief if administered correctly. (1) Proper adminstration involves cleaning the debris out of the canal before the drops are instilled. If the ear canal is very swollen your Doctor or Nurse Practitioner may put an ear wick in the canal to ensure the drops get into the ear. Once the drops are administered, the child should lie flat on her side for 20 to 30 minutes. Within twenty-four hours of starting the ear drops there should be a marked improvement in your child's condition. Therefore, if a child diagnosed with swimmer’s ear does not have any improvement in pain, she should be re-evaluated in order to rule out other health problems such as an inner ear infection or cellulitis of the surrounding area.

(1) Rosenfeld RM, Brown L, Cannon CR. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2006;134:S4-S23.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Sick Kids