Otitis externa in children

Overview

Otitis externa, also called swimmer’s ear, is an infection of the outer ear canal — the tube that leads from the eardrum to the outside of the head. It causes redness, swelling, and discomfort in the ear.

Yes, it is a common condition in children, especially in warm weather or after swimming.

It most often affects children who swim a lot, but any child can develop it if the ear canal gets irritated or infected.

Symptoms

Common symptoms

• Ear pain that gets worse when you pull on the earlobe or press on the little bump in front of the ear
• Itchiness inside the ear canal
• A feeling of fullness or blockage in the ear
• Redness or swelling of the outer ear
• Clear or yellow fluid draining from the ear

Symptoms in children

• Children may tug at their ear or cry more than usual
• They might have trouble sleeping because of the pain
• Fussiness or irritability
• Difficulty hearing clearly

Symptoms in older adults

• In older adults, the same symptoms occur, but they may also have more trouble hearing because of swelling or discharge

Causes

Main causes

• Water trapped in the ear canal after swimming, bathing, or showering
• Skin irritation from putting objects like cotton buds or fingers in the ear
• An infection caused by bacteria (most common) or fungi (less common)
• A cut or scratch inside the ear canal

Risk factors

• Swimming or spending a lot of time in water
• Living in a warm, humid climate
• Using hearing aids or earplugs that block the ear canal
• Having a skin condition like eczema or psoriasis near the ear
• Excessive cleaning of the ear with cotton buds

When to see a doctor

See a doctor urgently if:

• The child has severe ear pain or a high fever
• There is swelling that makes it hard to open the mouth or move the neck
• The pain does not improve after a day of home care

Book a routine appointment if:

• Mild ear pain that does not go away after a day or two
• Itchiness or discharge that lasts more than a few days
• Any hearing loss that does not improve after the ear feels better

Diagnosis

A doctor or nurse will look into the child’s ear with a special tool called an otoscope to see the ear canal and eardrum. They will check for redness, swelling, and discharge.

Tests that may be done

• In most cases, no tests are needed — the diagnosis is made by the ear exam.
• Sometimes, if the infection does not get better, the doctor may take a small sample of discharge to test for bacteria or fungi.

What to expect at your appointment

The exam is quick and usually not painful. The doctor may gently clean the ear canal if there is too much discharge. Your child might feel a little discomfort, but it should not hurt.

Treatment

Treatment focuses on clearing the infection, reducing pain and swelling, and keeping the ear dry. Most children recover fully with simple care.

Self-care at home

• Keep the ear dry — avoid swimming and use a shower cap or cotton ball coated in petroleum jelly to keep water out while bathing
• Give over-the-counter pain relief such as paracetamol or ibuprofen if the child is in pain (always follow dosage instructions for the child’s age)
• Avoid putting anything in the ear, including cotton buds
• If there is discharge, gently clean the outer ear with a soft cloth, but do not push anything into the ear canal

Medical treatments

The main medical treatment is medicated eardrops that help kill infection and reduce inflammation. These are usually given by a doctor and used for 7 to 10 days. Sometimes the doctor will also prescribe oral pain relief or antibiotics if the infection is more severe.

When is surgery considered?

Surgery is rarely needed for otitis externa. It may be considered only if there is a severe infection that does not respond to treatment, or if there is a complication like an abscess that needs draining.

Living with this condition

During treatment, avoid getting water in the ear. After the infection is gone, you can gradually return to normal activities. Keep ear canals dry after baths or swimming by gently tilting the head and letting water run out.

Lifestyle tips

• Use earplugs when swimming to prevent water from getting in
• Dry ears thoroughly after water exposure by using a towel on the outer ear only
• Avoid using cotton buds, bobby pins, or fingers to clean inside the ear

Diet and exercise

No special diet is needed. Exercise is fine as long as the child feels well and the ear is kept dry during the infection.

Mental health and emotional wellbeing

Ear pain can be distressing for children, especially for sleep and play. Reassure your child that the infection will heal and talk to your doctor if pain or discomfort continues for a long time.

Prevention

Yes, in many cases. Keeping the ear dry and avoiding irritation are the best ways to prevent otitis externa.

Vaccines

There is no specific vaccine for otitis externa.

Screening programmes

No routine screening is needed. Check your child’s ears if they complain of pain or if you notice discharge or redness.

Complications

If left untreated

• The infection can spread to the surrounding skin or deeper into the ear canal, causing more swelling and pain
• It can become a chronic condition that keeps coming back
• Very rarely, it can spread to the skull bones (malignant otitis externa) — this is more common in children with weakened immune systems

Long-term outlook

With proper treatment, otitis externa almost always clears up within a week or two. There are usually no lasting problems. Following prevention tips can help stop it from returning.

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