Swimmer's Ear (Otitis Externa) in Children

What swimmer's ear actually is

Swimmer's ear, known medically as otitis externa, is an infection of the skin lining the outer ear canal — the tube that runs from the opening of the ear to the eardrum. This is a different place from a middle-ear infection (acute otitis media), which happens behind the eardrum and is usually tied to colds and congestion. The distinction matters because the two conditions can feel different, are treated differently, and call for different prevention. For more on middle-ear infections and other ear, nose, and throat topics, see our ENT guides.

The ear canal has natural defenses. Earwax (cerumen) is slightly acidic and water-repellent, which helps keep bacteria and fungi in check. When that protective layer is disrupted — most often by trapped water or by scratches from cleaning — germs that normally live harmlessly on the skin can multiply and cause infection.

What causes it

The name is a clue: water is a common culprit. When moisture lingers in the canal after swimming, bathing, or even a humid day, it can soften the skin and wash away protective earwax, creating a warm, damp environment where bacteria are more likely to thrive. Lakes, rivers, and poorly maintained pools may raise the risk, but any water source can contribute.

Water is not the only trigger. Anything that scratches or irritates the delicate canal skin can open the door to infection, including:

• Cotton swabs, bobby pins, fingernails, or other objects pushed into the ear
• Earbuds, earplugs, or hearing aids worn for long stretches
• Skin conditions such as eczema or psoriasis that affect the ear canal
• Aggressive earwax removal that strips away the ear's natural protection

This is why the old advice — never put anything smaller than your elbow in your ear — holds up. Cleaning inside the canal often does more harm than good.

How to recognize it

Swimmer's ear often begins with itching and a feeling of fullness, then can progress to pain that may become intense over a day or two. A common sign is that the pain tends to worsen when you gently tug on the outer ear or press on the small flap of cartilage in front of the canal (the tragus). Chewing may hurt, too.

Other common signs include:

• Redness and swelling of the ear canal or outer ear
• Drainage that may be clear at first, then thick, cloudy, or pus-like
• Muffled or reduced hearing on the affected side as swelling narrows the canal
• Tenderness around the ear and sometimes swollen glands nearby

Because the infection is in the canal rather than behind the eardrum, high fever and cold symptoms are less typical than with a middle-ear infection, though a mild fever can sometimes occur. If you are unsure which type of ear problem your child has, that is a good reason to check in with your clinician — the treatments are not the same.

How swimmer's ear is treated

Most cases are treated with prescription ear drops that a clinician selects after looking in the ear. These drops often combine an antibiotic to fight infection with a mild steroid to reduce swelling and pain; some are antifungal when a fungus is involved. Oral antibiotics are usually not needed and are generally not the first choice for a straightforward canal infection. Because the right medicine depends on the exam — including whether the eardrum is intact or your child has ear tubes — this is not a situation to treat with leftover drops from a previous illness.

A few practical steps can help the drops work and keep your child comfortable:

• Keep the ear dry during treatment; your clinician will advise how long to stay out of the water.
• If the canal is very swollen, a clinician may place a soft wick so the medicine can reach the infection.
• For pain and fever, an over-the-counter pain reliever such as acetaminophen or ibuprofen can help. Your clinician or pharmacist can confirm the right choice and dose for your child's age and weight — our OTC medicine and dosage tools can help you double-check.
• For most children, pain begins to ease within a day or two of starting the drops, and symptoms typically clear over about a week, though recovery times can vary.

Never use leftover ear drops from a past illness or from another person. Some ear drops are unsafe if the eardrum has a hole or your child has ear tubes, so the medicine must be matched to your child's exam. If pain is not improving after a couple of days of treatment, call your clinician rather than continuing on your own.

Preventing swimmer's ear

Prevention comes down to keeping the ear canal dry and leaving it alone. After swimming or bathing:

• Tilt the head to each side to let water drain, and gently dry the outer ear with a towel.
• Use a hair dryer on the lowest, coolest setting held a short distance away to help evaporate moisture.
• Consider well-fitting swim earplugs or a swim cap for children who get repeated infections.
• Skip cotton swabs and other objects, and let earwax do its protective job.

For children who get repeated infections, some families use a clinician-recommended drying agent after swimming — such as an over-the-counter drying drop or a diluted acetic-acid (vinegar) and alcohol solution — to help dry the canal and support its natural acidity. These can help some children, but they should never be used if your child has ear tubes, a known or suspected hole in the eardrum, ear pain, or active drainage, so check with your clinician first about whether and how to use them. Choosing well-maintained, properly treated pools also lowers the risk.

When to call the doctor

Reach out to your child's clinician whenever you suspect swimmer's ear, since early treatment can shorten the discomfort. Call promptly if:

• Pain is severe or your child cannot sleep despite pain relief
• There is fever, or redness and swelling spread to the outer ear, face, or neck
• Drainage is heavy, bloody, or foul-smelling, or symptoms are not improving after a couple of days of treatment
• Your child has ear tubes, a possible perforated eardrum, diabetes, or a weakened immune system

Seek same-day or emergency care if your child has redness and swelling spreading over the outer ear or into the face or neck, a high fever with a very painful ear, facial weakness or drooping, dizziness, or swelling, redness, or pain behind the ear that pushes it outward. That last sign in particular can mean infection is spreading beyond the ear canal (for example, to the bone behind the ear) rather than a typical case of swimmer's ear, and it needs urgent evaluation. Children with diabetes or weakened immune systems should be seen quickly for any ear-canal infection. This article is for general education and does not replace advice from your child's clinician.