After a day at the pool or a long bath, some children start tugging at an ear, say it hurts, or complain that it feels blocked. That can be swimmer’s ear (otitis externa), an infection of the outer ear canal. This article explains how it differs from a middle ear infection and what parents can do.

Why It Happens

The CDC describes swimmer’s ear as an infection of the outer ear canal and notes that it differs from a middle ear infection. A 2011 CDC MMWR report defines acute otitis externa as inflammation of the external ear canal, most often caused by bacteria, and points to limiting water exposure of the ear as a preventive step.

The skin of the ear canal is normally protected by a thin coating of earwax, but long exposure to water, or scratching with cotton swabs, creates a damp, irritated environment where bacteria can grow. Symptoms usually appear within a few days of water exposure. Typical signs include itching in the ear, redness and swelling, pain when the outer ear is tugged or the area in front of the ear is pressed, and pus-like drainage.

How It Differs by Age

Babies and toddlers cannot say that an ear hurts. They may pull at it, fuss, or feed poorly, which looks much like a middle ear infection. Fever or a recent cold alongside ear pulling makes an exam more useful. Preschool and school-age children can usually say “it hurts when I touch it” or “it feels plugged,” which makes the link to swimming easier to spot. Children who swim often, or who have narrow ear canals, tend to get repeat episodes.

Care at Home

Prevention matters most. The CDC says drying the ears well after swimming helps prevent swimmer’s ear. Parents can:

  • Tilt the head so each ear faces down and let water drain, one side at a time.
  • Gently dry the outer ear with a towel.
  • If water still feels trapped, some sources suggest a hair dryer on the lowest heat and fan setting, held several inches away for a short time.
  • Consider a bathing cap, ear plugs, or custom-fitted swim molds.

CDC guidance suggests checking with a healthcare provider before using ear-drying drops. Putting drops in an ear that already hurts or is draining is not something to do on your own, particularly if the eardrum might have a hole or the child has ear tubes, because some medicines are not safe in that situation.

The 2014 AAO-HNSF guideline recommends topical drops as the first treatment for diffuse, uncomplicated acute otitis externa, and says oral antibiotics should not be the initial therapy unless the infection spreads outside the ear canal or certain host factors such as diabetes are present. It also advises assessing pain and choosing pain relief according to severity, and when swelling or debris blocks the canal, a clinician may clean it or place a wick so drops can reach the skin. If the eardrum may be perforated, a non-ototoxic drop is advised, and if there is no improvement within 48-72 hours, the child should be reassessed.

Common Misunderstandings

First, that all ear pain is a middle ear infection. Pain when tugging the outer ear after water exposure points toward swimmer’s ear first. Second, that cotton swabs prevent problems. Swabs can scratch the canal skin. Third, that itching is only trapped water and needs no care. Pain or drainage is a reason for an exam. Fourth, that once cured it will not come back. Repeated swimming can bring it back, so prevention habits matter.

Signs That Need Emergency Care Right Away

Go to the emergency room right away if swelling and redness spread to the face or neck with fever and a limp, drowsy child, if the area behind the ear swells and pushes the ear forward, or if there is severe dizziness or facial weakness. Children with diabetes or other chronic conditions should be seen promptly. If it is not an emergency but pain is strong, there is drainage, or there is no improvement after about two days, contact your pediatrician or an ear specialist. Consider talking with a pediatrician if you are unsure. This information reflects general guidance from the United States; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.