Otitis externa in infants

Overview

Otitis externa, also called swimmer's ear, is an infection or inflammation of the outer ear canal — the tube that leads from the outside of the ear to the eardrum. In infants, this condition can cause discomfort because the ear canal is narrow and easily irritated.

Otitis externa is less common in infants than in older children, but it can occur, especially if the ear canal stays wet or if your baby has eczema or a weakened immune system.

It can affect any infant, but it is more likely in babies who swim frequently, live in humid climates, or have conditions like eczema or allergies.

Symptoms

Common symptoms

• Ear pain – your baby may cry or seem more fussy than usual
• Pulling or tugging at the affected ear
• Itchiness inside the ear
• Redness or swelling of the outer ear
• Clear, yellow, or bloody fluid draining from the ear (not the same as earwax)
• Mild fever

Symptoms in children

• Swimmer's ear is more common in older children; symptoms are similar to adults but they may complain of earache, feel fullness in the ear, or have trouble hearing temporarily.

Symptoms in older adults

• Older adults with otitis externa may have a drier ear canal, more itching, and a higher risk of complications if they have diabetes or a weakened immune system.

Causes

Main causes

• Bacteria (most common) or fungi that infect the skin of the ear canal
• Moisture trapped in the ear after bathing, swimming, or excessive humidity
• Damage to the delicate skin of the ear canal – for example, from using cotton swabs or scratching

Risk factors

• Swimming or frequent water exposure (even bath time if water gets in the ears)
• Hot, humid climates
• Eczema or other skin conditions near the ear
• Allergies that cause itchy ears
• Narrow ear canals (common in some infants)
• Weak immune system (from illness or medications)

When to see a doctor

See a doctor urgently if:

• Your baby has severe pain, high fever, or swelling around the ear
• You notice discharge from the ear that is bloody or thick
• Your baby is very fussy and not feeding well

Book a routine appointment if:

• Mild ear discomfort that lasts more than a day
• Your baby occasionally pulls at the ear but otherwise seems well
• You want advice on how to keep the ear dry during baths

Diagnosis

A healthcare provider will gently look inside your baby's ear with a lighted instrument called an otoscope. They check for redness, swelling, discharge, and any object stuck in the ear canal. They may also gently press on the outer ear (tragus) to see if it causes pain, which is common in otitis externa.

Tests that may be done

• Otoscope examination of the ear canal
• If there is discharge, a small sample (swab) may be taken to identify the specific bacteria or fungus
• In rare cases, if the infection does not improve, a hearing test or imaging (such as a CT scan) may be considered

What to expect at your appointment

The doctor will ask about your baby's symptoms and how long they have lasted. The examination is quick – your baby may be held on your lap or lie down. The doctor might need to clean a small amount of discharge or earwax to see the ear canal clearly. This can be a little uncomfortable but is not painful.

Treatment

Treatment focuses on cleaning the ear canal and using medication to fight the infection and relieve pain. Most infants get better with ear drops and simple home care. A doctor will decide the best treatment based on your baby's age and how severe the infection is.

Self-care at home

• Keep your baby's ear dry – use a soft cloth or cotton ball (not a swab) to gently dry the outer ear after baths
• Avoid swimming or getting water in the ear until the infection heals
• If your baby is old enough to sit up, you can use a dry washcloth or a hair dryer on the lowest cool setting (held at arm's length) to gently dry the ear
• Do not put anything inside the ear – no cotton swabs, fingers, or ear drops unless prescribed by a doctor

Medical treatments

Doctors may prescribe ear drops that contain a combination of an antibiotic (to fight bacteria) and sometimes a steroid (to reduce swelling and itching). The drops are placed in the affected ear several times a day for about a week. For pain, paracetamol or ibuprofen (in infant doses) may be recommended – always follow the dosing instructions from your doctor or pharmacist. In rare cases where drops cannot be used (for example, if there is a hole in the eardrum), oral antibiotics may be given. Fungal infections may need antifungal ear drops.

When is surgery considered?

Surgery is very rarely needed for otitis externa in infants. It may be considered if the infection does not clear with medicine, or if it spreads to the bone (malignant otitis externa) – a very rare complication that requires hospital care and intravenous antibiotics.

Living with this condition

While your baby has otitis externa, try to make them comfortable. Keep the ear dry and avoid any pressure on it. Hold your baby more upright during feeds to reduce ear pressure. If your baby is in pain, follow your doctor's advice on pain relief. The infection usually improves within 48–72 hours of starting treatment.

Lifestyle tips

• Avoid swimming or getting water in the ear until the infection is completely gone
• When bathing your baby, use a cotton ball lightly coated with petroleum jelly (like Vaseline) to plug the outer ear – but only if your doctor advises it
• Keep your baby's nails short to prevent scratching the ear
• After bath time, dry your baby's ears with a soft cloth – do not use cotton swabs inside the canal

Diet and exercise

Your baby does not need any special diet. Continue breastfeeding or formula as usual. If your baby is eating solids, offer soft foods if they seem uncomfortable. Gentle play is fine – avoid activities that put pressure on the ears.

Mental health and emotional wellbeing

Caring for a fussy, uncomfortable baby can be stressful for parents. It is okay to ask for help from family or friends. If you feel overwhelmed, talk to your doctor or a mental health professional. Remember that this infection is temporary and your baby will feel better soon.

Prevention

Yes, to some extent. The most important steps are to keep your baby's ears dry and avoid putting anything inside them. After each bath, tilt your baby's head to one side to let water drain out, then gently dry the outer ear with a soft cloth. If your baby swims, consider using a swim cap or specially designed ear plugs (after checking with your doctor).

Vaccines

There is no vaccine specifically for otitis externa. However, keeping your baby's routine vaccinations up to date may help prevent other infections that could weaken the immune system.

Screening programmes

There is no routine screening for otitis externa. If your baby has frequent ear infections or a known risk factor (like a narrow ear canal), your doctor may check the ears during regular well-baby visits.

Complications

If left untreated

• The infection may become chronic (long-lasting) and harder to treat
• The infection could spread to the surrounding skin and deeper tissues (cellulitis)
• In very rare cases, severe infection can reach the bones at the base of the skull (malignant otitis externa), which requires intensive hospital treatment

Long-term outlook

The outlook is excellent. With proper treatment, most infants are back to their happy selves within a few days to a week. The infection usually clears completely without any lasting effects. If your baby seems to get ear infections often, talk to your doctor – they can help you find ways to reduce the risk.

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