Swimmer’s Ear or Ear Infection … is There a Difference?

Dear Mamas,

My four year old daughter has been taking swim lessons at our local Y all summer. She loves the water, and between lessons we spend a few afternoons a week hanging out at our community pool. Two or three times this summer she’s complained that one or the other of her ears hurts when she touches it. I’ve looked, but can’t see anything wrong, and it always seems to go away after a couple of days.

Yesterday, she woke up complaining more than usual. She was pretty cranky all day, and didn’t even want to go to the pool — unusual for her. I have an appointment with her pediatrician, but they couldn’t get us in until tomorrow and she’s pretty miserable. What’s going on? Is this an ear infection, or something I’ve heard about called swimmer’s ear? What can I do to prevent it?

She’s hurting, and so am I!

Dear Hurting,

This is a great question that comes up all the time in the summer months. The answer makes perfect sense if you picture the anatomy of the ear.

The outer part that you see is called the pinna, and its function is to funnel sound from the environment towards the ear canal. The canal is like a short tube that carries the sound towards the middle ear and dead-ends at the eardrum, a translucent membrane (pretty similar to the head of a drum) that separates the middle ear from the outer ear.

On the other side of the eardrum, the middle ear sits in a semi-sealed space that doesn’t connect with the outside under normal circumstances, but is connected to the throat by the eustachian tubes. More about that, later …

So now back to swimmer’s ear: when kids or adults spend time in the water, some of it naturally flows into the ear canal. It is stopped by the ear drum and can’t go any farther, but because the canal is angled in and down, the water tends to sit there.

Like any wet, warm place, this becomes the perfect spot for bacteria to set up shop. A day or two later you end up with an inflamed and infected (AND painful) outer ear. Hurts when you touch it or pull on the lobe. Ouch!

Mild cases may go away without treatment — the body’s pretty good at taking care of this stuff — but if the bugs throw a really big party, antibiotic drops, and sometimes oral antibiotics, are called for. Sometimes the drops include a topical steroid, too, to help reduce inflammation. Sounds like that’s where you are with your little one right now. So call that doctor’s office back and let them know you need to get in right away.

Mama’s hint: ask the pediatrician for an additional prescription for anesthetic ear drops along with the antibiotic. They will instantly make her feel better while the antibiotic is taking hold and killing those bacteria.

So, technically, swimmer’s ear is an infection of the outer ear, and some kids seem especially prone to it. Here’s a home remedy to help prevent the problem– it can also treat mild cases: take a cotton ball and a bit of hydrogen peroxide (that clear liquid in the brown bottle). Wet the cotton and sqeeze a few drops into each ear canal after swimming (don’t put the cotton ball in the ear). It will fizz and tickle and sound really weird, but it helps sterilize and dry up that water.

The ear infection we moms are more familiar with is an infection of the middle ear. That’s the kind that often follows a cold, or just appears on its own in small kids.

The cause is similar, only the location is different. When kids have a cold they make tons of mucous. Some of this ends up in the middle ear, where it sits around just like the water we just talked about. Because little guys have little, short eustachian tubes that don’t drain well, bacteria and viruses can move in and do their thing … multiply. Because this neighborhood is sealed off from outside, oral antibiotics are sometimes needed to get there through the bloodstream.

BUT many middle ear infections are caused by viruses and won’t respond to antibiotics at all. Those will go away on their own. Anesthetic ear drops can be a real life saver in these cases while you and your kiddo are waiting for nature to do its thing.

So that’s the whole story … hope she feels better soon!

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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