Otitis externa - commonly known as swimmer's ear - is an infection of the ear canal, the tubular opening that carries sounds from the outside of the body to the eardrum. It can be caused by many different types of bacteria or fungi.
The infection commonly occurs in children who spend a lot of time in the water. Too much moisture in the ear can irritate and break down the skin in the canal, allowing bacteria or fungi to penetrate. In temperate climates, otitis externa occurs more frequently during the summer months, when swimming is more common.
But you don't have to swim to get swimmer's ear. Anything that causes a break in the skin of the ear canal can lead to an infection. Dry skin or eczema, scratching the ear canal, vigorous ear cleaning with cotton-tipped applicators, or inserting foreign objects like bobby pins or paper clips into the ear can all increase the risk of developing otitis externa. Sometimes, in a child with a middle ear infection, pus collected in the middle ear can drain into the ear canal through a hole in the eardrum and cause otitis externa to develop.
Signs and Symptoms
The primary symptom of otitis externa is ear pain, which can be severe and gets worse when the earlobe or other exterior part of the ear is pulled or pressed on. It may also be painful for a person with otitis externa to chew. Sometimes the ear canal itches before the pain begins.
Swelling of the ear canal may make your child complain of a full or uncomfortable feeling in the ear. The outer ear may become reddened or swollen, and lymph nodes around the ear may become enlarged and tender. There may be some discharge from the ear canal as well; it may be clear at first but then turn cloudy, yellowish, and pus-like. Hearing may temporarily be affected if pus and debris or swelling of the canal blocks the passage of sound into the ear. Fever is not common in typical cases of otitis externa.
Contagiousness
Otitis externa is not contagious.
Prevention
Using over-the-counter drops of a dilute solution of acetic acid or alcohol in the ears after getting them wet can help prevent otitis externa, especially if your child is prone to the infection. These drops are available at pharmacies and should only be used in children who do not have ear tubes or a hole in the eardrum. After spending time in the water, it is also a good idea for children to gently dry their ears with a towel and help water run out of their ears by turning their heads to the side. Speak with your child's doctor before using earplugs.
To avoid trauma to the ear, children should not clean their ears themselves and should never put objects into their ears, including cotton-tipped applicators.
Incubation
There is no set incubation period for otitis externa, but the ear pain often follows an episode of swimming or immersion in water.
Duration
Otitis externa is usually cured within 7 to 10 days of starting treatment.
Professional Treatment
Treatment of otitis externa depends on the severity of the infection and how much pain the child feels. For milder cases, your child's doctor may prescribe eardrops that contain antibiotics to fight the infection and a steroid to reduce swelling of the ear canal. Eardrops are usually given several times a day for 7 to 10 days.
If swelling of the ear canal makes it difficult to give the drops, your child's doctor may insert a cotton wick into the canal to help carry the medicine inside the ear. In some cases, the doctor may need to remove pus and debris from the ear with gentle cleaning or suction. This will allow the eardrops to work more effectively. For more severe infections, oral antibiotics may be given as well, and the doctor may order a culture of some of the discharge from the ear to help identify which bacteria or fungi are causing the infection.
Over-the-counter pain relievers can be used to manage any pain your child may feel. Once treatment has begun, your child will start to feel better in a day or 2.
Home Treatment
Otitis externa should be treated by a doctor. If left untreated, the ear pain will get worse and the infection may spread. To help relieve the pain until your child sees the doctor, you can place a warm washcloth or heating pad against your child's ear. Acetaminophen or ibuprofen may also ease discomfort.
At home, follow the doctor's instructions for administering your child's eardrops and oral antibiotics, if they are prescribed. It's important to keep water out of your child's ear during the entire course of treatment. A shower cap offers protection while showering or bathing, and your child's doctor may also recommend earplugs.
When to Call Your Child's Doctor
Call your child's doctor immediately if your child has any of the following: pain in the ear with or without fever, decreased hearing in one or both ears, or abnormal discharge from the ear.
Updated and reviewed by: Steven Dowshen, MD
Date reviewed: March 2006
