Swimmer's Ear in Children: Outer Ear Infection Signs and Care

What makes swimmer's ear different from a regular ear infection

A middle ear infection (the most common type in toddlers) sits behind the eardrum and is usually triggered by a cold or respiratory virus. Swimmer's ear — medically called acute otitis externa — is an infection of the skin lining the outer ear canal 1Ref 1Rosenfeld RM, Schwartz SR, Cannon CR, et al. (2014).Clinical Practice Guideline: Acute Otitis Externa (Update).Diagnosis of acute otitis externa including tragus tenderness as hallmark sign; topical antibiotic drop treatment for 7-10 days; recommendation against oral antibiotics for uncomplicated cases.

The clearest way to tell the difference at home: swimmer's ear typically causes pain when the outer part of the ear is tugged or when the cartilage in front of the ear canal (the tragus) is pressed — because that movement stretches the infected canal 1Ref 1Rosenfeld RM, Schwartz SR, Cannon CR, et al. (2014).Clinical Practice Guideline: Acute Otitis Externa (Update).Diagnosis of acute otitis externa including tragus tenderness as hallmark sign; topical antibiotic drop treatment for 7-10 days; recommendation against oral antibiotics for uncomplicated cases2Ref 2Jackson EA, Geer K (2023).Acute Otitis Externa: Rapid Evidence Review.Pseudomonas and Staphylococcus as primary pathogens; maceration from water exposure as mechanism; topical treatment 7-10 days; oral antibiotics only for cellulitis outside the canal. Middle ear infections usually do not cause that specific pain on touching the outer ear.

How swimmer's ear develops

Water that stays in the ear canal after swimming, bathing, or even sweating can soften the skin and wash away the thin protective layer of earwax, raising the canal's pH and creating conditions where bacteria can take hold in the warm, moist environment 1Ref 1Rosenfeld RM, Schwartz SR, Cannon CR, et al. (2014).Clinical Practice Guideline: Acute Otitis Externa (Update).Diagnosis of acute otitis externa including tragus tenderness as hallmark sign; topical antibiotic drop treatment for 7-10 days; recommendation against oral antibiotics for uncomplicated cases2Ref 2Jackson EA, Geer K (2023).Acute Otitis Externa: Rapid Evidence Review.Pseudomonas and Staphylococcus as primary pathogens; maceration from water exposure as mechanism; topical treatment 7-10 days; oral antibiotics only for cellulitis outside the canal. The most common bacterial culprits are Pseudomonas aeruginosa and Staphylococcus aureus.

Summer is peak season for swimmer's ear, particularly in children who spend time in pools or lakes. Scratching the ear canal with a finger, cotton swab, or other object can break the skin barrier and start an infection. Children with eczema or psoriasis affecting the ear canal may be more prone 2Ref 2Jackson EA, Geer K (2023).Acute Otitis Externa: Rapid Evidence Review.Pseudomonas and Staphylococcus as primary pathogens; maceration from water exposure as mechanism; topical treatment 7-10 days; oral antibiotics only for cellulitis outside the canal.

What it looks and feels like

Swimmer's ear usually starts with itching or a sensation of fullness in the ear. Pain follows — sometimes significant — and tends to worsen with jaw movement like chewing 1Ref 1Rosenfeld RM, Schwartz SR, Cannon CR, et al. (2014).Clinical Practice Guideline: Acute Otitis Externa (Update).Diagnosis of acute otitis externa including tragus tenderness as hallmark sign; topical antibiotic drop treatment for 7-10 days; recommendation against oral antibiotics for uncomplicated cases. The outer ear may look red or slightly swollen. There can be drainage from the canal that is clear, white, or yellowish.

Hearing may be temporarily muffled if swelling inside the canal is significant. Fever is less common with swimmer's ear than with middle ear infections, though it can occur if the infection is severe or spreading.

How it is treated

A doctor will examine the ear canal, often gently clearing any debris. Treatment for uncomplicated swimmer's ear is typically antibiotic ear drops — sometimes combined with a mild steroid to reduce swelling — applied directly to the canal for 7 to 10 days 1Ref 1Rosenfeld RM, Schwartz SR, Cannon CR, et al. (2014).Clinical Practice Guideline: Acute Otitis Externa (Update).Diagnosis of acute otitis externa including tragus tenderness as hallmark sign; topical antibiotic drop treatment for 7-10 days; recommendation against oral antibiotics for uncomplicated cases2Ref 2Jackson EA, Geer K (2023).Acute Otitis Externa: Rapid Evidence Review.Pseudomonas and Staphylococcus as primary pathogens; maceration from water exposure as mechanism; topical treatment 7-10 days; oral antibiotics only for cellulitis outside the canal. This targeted approach delivers medication where it is needed and avoids systemic side effects.

For children with ear tubes or a non-intact eardrum, the choice of drops matters: fluoroquinolone drops (ciprofloxacin or ofloxacin) are generally preferred in that setting because some other drop formulations are not safe if the eardrum has an opening 3Ref 3American Academy of Pediatrics (2025).Swimmer's Ear in Children.Fluoroquinolone drops preferred when tympanic membrane is non-intact; limiting swim duration to under one hour as prevention; ear drop treatment 5-7 days per AAP. Oral antibiotics are reserved for cases where infection has spread beyond the canal to surrounding tissue.

Keeping the ear dry during treatment — avoiding swimming and minimizing water exposure — helps the canal heal.

Preventing swimmer's ear

Helping the ear canal dry after swimming or bathing reduces the chance of infection. Tilting the head to each side after getting out of the water can help water drain. Avoiding putting objects into the ear canal — including cotton swabs — protects the skin barrier 2Ref 2Jackson EA, Geer K (2023).Acute Otitis Externa: Rapid Evidence Review.Pseudomonas and Staphylococcus as primary pathogens; maceration from water exposure as mechanism; topical treatment 7-10 days; oral antibiotics only for cellulitis outside the canal.

Custom or fitted earplugs can help children who swim frequently and are prone to repeat infections. The AAP also notes that limiting continuous water immersion to under one hour may reduce risk 3Ref 3American Academy of Pediatrics (2025).Swimmer's Ear in Children.Fluoroquinolone drops preferred when tympanic membrane is non-intact; limiting swim duration to under one hour as prevention; ear drop treatment 5-7 days per AAP.