If your child is prone to ear infection or swimmer’s ear, it can be difficult to recognize the difference. Here’s how to handle them.

Published: June 7, 2017 | Updated: March 21, 2022

Understanding swimmer’s ear vs. ear infection differences and how to recognize them can be difficult. Ear pain and infections are common and a host of reasons can be the cause. Here’s how to handle them.

There are two main types of ear infections: acute otitis media (a middle ear infection) and otitis externa (swimmer’s ear). A middle ear infection occurs behind the eardrum, whereas swimmer’s ear occurs in the ear canal. Different organisms cause these infections.

“Middle ear infections are more common in younger children and most often are caused by viruses (such as colds), as well as Streptococcus pneumoniae, Haemophilus Influenzae or Moraxella catarrhalis,” said April Mattingly, M.D., pediatrician with Norton Children’s Medical Group – Crestwood.

Middle ear infection symptoms

Symptoms usually start as a common cold, cough, runny nose and congestion, then may progress to:

• Fever
• Ear pulling
• Fussiness
• Decreased appetite
• Vomiting
• Diarrhea

Fever or severe pain in children younger than 2 years old may require a visit to the pediatrician by the next day. Older children or those with mild symptoms may be observed for 24 to 48 hours before an office visit is necessary.

Swimmer’s ear is most often caused by germs known as pseudomonas, which are found in pools and hot tubs,” according to Dr. Mattingly. These are the same bacteria often associated with a skin rash known as “hot tub folliculitis,” which can appear after being in a hot tub. Swimmer’s ear also may be caused by some strains of Staphylococcus that typically live on the skin.

Swimmer’s ear symptoms

• Pain made worse by pulling on the outer ear
• Itching and redness in ear canal
• Clear drainage
• Swelling of the ear canal

“Keeping the ears dry can help prevent swimmer’s ear,” Dr. Mattingly said. “Use earplugs while swimming or over-the-counter drops after swimming.”

If treatment is not immediately available for swimmer’s ear, there is little need to worry. Parents may safely treat the pain and symptoms until they are able to seek medical treatment. However, in extreme cases, it can lead to secondary infections, such as cellulitis, and bone or cartilage damage.

With both infections perforation of the eardrum is a risk, so you should seek treatment. In addition, persistent presence of fluid in the ear has the potential to affect hearing and speech in children.