Swimmer’s Ear (Otitis Externa) Versus Acute Ear Infection (Otitis Media) – What the Heck is the Difference?

It's summer, which usually means more time at the pool, lake, or ocean! While the increase in water activities helps to stave off the heat exhaustion that long summer days bring, it also leads to increased ear issues, especially in the pediatric population. As a parent, have you ever struggled to differentiate between swimmer’s ear and an acute ear infection? And then the age-old question – Is there any way to prevent this? This article will break down the difference between the causes and symptoms of swimmer’s ear versus acute otitis media. It will review when determining when further medical management and care is needed. It will also include tips to assist in preventing swimmer’s ear this summer.

What is Otitis Externa?

Otitis externa (OE), also known as swimmer’s ear, is inflammation of the external auditory canal. It occurs most often during the summer months and in tropical climates due to retaining water in the ears. In fact, swimming can increase the risk of contracting otitis externa by five times compared to non-swimmers. Otitis externa can be both acute (<6 weeks) or chronic (>3 months). The most common cause of acute otitis externa is a bacterial infection caused by Pseudomonas aeruginosa and/or Staphylococcus aureus. It is typically seen in children over the age of 2 years, and the peak incidence is 7-14 years of age with boys and girls being equally susceptible.

What is Acute Otitis Media?

Acute Otitis Media (AOM) is an infection caused by bacterial, viral, or a combination of the middle ear space – this is what most people refer to as a common ear infection. From a bacterial perspective, it is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and/or Moraxella catarrhalis. The most common viral infections to cause acute otitis media are respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and picornaviruses. The most affected ages for infection are 6 to 24 months although otitis media can occur throughout the lifespan even in adulthood.

Common Signs & Symptoms of OE vs AOM

Otitis Externa	Acute Otitis Media
Redness of the outer ear Itching in the ear Ear pain, specifically when touching or wiggling the ear lobe Drainage from the ear Swollen lymph node glands in the upper neck or around the ear Muffled hearing or hearing loss	Ear pain especially when lying down Pulling or Tugging at the Ears Increased Irritability Disrupted or Restless Sleep Decreased Feeding or Appetite Vomiting and/or Diarrhea Fever (100 F or 38 C), usually remains low-grade Muffled hearing or hearing loss Drainage from the ear

Treatment of OE vs AOM

Both otitis externa and otitis media are considered clinical diagnoses. This means a medical provider will review your child’s recent history of events and symptoms leading up to the appointment. The provider will also examine the external ear, surrounding lymph nodes, and use an otoscope to look at your child’s tympanic membrane (aka eardrum) to determine the amount of inflammation present and if there is fluid or pus behind the tympanic membrane, also known as an effusion. Otitis Externa (Swimmer’s ear) is typically treated with antibiotic ear drops multiple times per day for an average of 7-10 days for clinical resolution. While otitis media is most frequently treated with oral antibiotics with high-dose amoxicillin being the most common first-line agent. If the tympanic membrane is perforated, then antibiotic ear drops are used instead of oral as this delivers much higher concentrations of antibiotics to the affected area without the side effects of oral antibiotics. Tylenol or NSAIDs, like Motrin or ibuprofen, can be administered based on age-appropriate instructions for persistent discomfort or fever.

Tips to Prevent Otitis Externa (Swimmer's Ear)

Dry Ears After Being Submerged in Water – use a soft towel and tip your head side to side to drain water from the ear canal and safely dry off the outer ear.
Avoid Putting Foreign Objects in Your Ear – Use of items like cotton swabs, fingernails, or other objects can push ear wax further into the ear canal and cause blockage or cause breakdown of the skin making it more prone to bacterial infections.
Over-Counter Swimmer’s Ear Drops – As long as you do not have a punctured eardrum, you can safely use over-the-counter eardrop solutions made to assist in drying your ears out more quickly after swimming with hopes of preventing infection.
Protect your Ears While Swimming – If you or your child is prone to ear infections in the past, use ear plugs or a swimming cap to keep ears dry while swimming.