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Swimmer's Ear - Otitis Externa

Pediatric Basics

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Updated May 19, 2011

Children with swimmer's ear (otitis externa) have inflammation in their external ear canal. It is usually caused by water irritating the skin inside the ear, which then becomes infected with a bacteria, or more rarely, a fungus.

Symptoms of Swimmer's Ear

Ear pain is the most common symptom of swimmer's ear. Unlike the pain of a middle ear infection (otitis media), which might follow a cold, the ear pain from swimmer's ear is made worse by tugging on your child's outer ear. Looking inside your child's ear, your Pediatrician will likely see a red, swollen ear canal, with some discharge.

Diagnosis of Swimmer's Ear

The diagnosis of swimmer's ear is usually made when a child has the classic symptom of outer ear pain that is made worse by tugging on the child's ear.

Swimmer's ear can be confused with a middle ear infection, especially when your pediatrician is not able to see your child's ear drum.

Treatments for Swimmer's Ear

Once your child has swimmer's ear, it is not the time to put alcohol based ear drops, which are often used to prevent swimmer's ear. They will likely burn and make your child's ear feel even worse. Instead, swimmer's ear is usually treated with antibiotic ear drops, either with or without added steroids (which some experts think can reduce inflammation and make symptoms go away faster).

Common otic (ear) drops that are used to treat swimmer's ear include:

  • Ciprodex*
  • Cipro HC*
  • Cortane-B*
  • Cortisporin*
  • Domeboro Otic
  • Floxin
  • Vosol
  • Vosol HC*
*antibiotic ear drops that include a steroid.

Although expensive, Floxin, Ciprodex, and Cipro HC, are most commonly prescribed, as they have less side effects, can be used just twice a day, and may provide better coverage against the bacteria that cause swimmer's ear.

For mild cases of swimmer's ear, you might ask your pediatrician if you can first try a solution of half strength white vinegar ear drops (half water/half white vinegar) twice a day -- a common home remedy that some parents try.

Pain relievers, including acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can also be used to to reduce your child's pain until his ear drops start working.

If there is enough swelling, so that ear drops can't get into your child's ear, your pediatrician may place an ear wick inside his ear canal.

Prevention of Swimmer's Ear

In general, you can prevent swimmer's ear by keeping water out of your kids' ears. Fortunately, that doesn't mean that your kids can't swim and enjoy the water. Instead, use an over-the-counter ear drying agent that contains isopropyl alcohol (rubbing alcohol), such as Auro-Dri or Swim Ear, or one with acetic acid and aluminum acetate (Star-Otic).

If you like, you might also create your own homemade swimmer's ear prevention solution by mixing equal parts of rubbing alcohol and white vinegar, and putting it in your child's ears after he swims.

Although some experts think that earplugs are irritating and can lead to swimmer's ear, you can also keep water out of your kids' ears by using a barrier, like earplugs, including Mack's AquaBlock Earplugs or their Pillow Soft silicone Earplugs. If your kids have a hard time keeping their earplugs in, consider also using the Aqua-Earband or Ear Band-It neoprene swimmer's headband.

What You Need To Know

  • Swimmer's ear is usually caused by an infection with the Pseudomonas aeruginosa or Staphylococcus aureus bacteria.

  • You can often prevent swimmer's ear by keeping water out of your child's ears.

  • Pools that are poorly maintained are more likely to spread swimmer's ear.

  • Swimmer's ear can be treated with prescription antibiotic drops, either with or without steroids.

  • Once your child is better, you should continue to use his ear drops for an additional two or three days, during which time he stays out of the water.

  • Ear wax may be protective against swimmer's ear, so don't aggressively remove wax from your child's ear. Cleaning your child's ears with a cotton-tip applicator may also put them more at risk for swimmer's ear.

  • In addition to swimming, kids can be at risk for getting swimmer's ear if they get water in their ears when bathing or showering.

  • Oral antibiotics are rarely needed to treat uncomplicated cases of swimmer's ear.

  • Malignant otitis externa is a rare complication of swimmer's ear.

  • Fungal infections and noninfectious disorders, including eczema, psoriasis, seborrheic dermatitis, and allergic contact dermatitis, can also cause otitis externa, and should be suspected in chronic cases of swimmer's ear.

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