Otitis externa (swimming ear)

Otitis externa is an infection of the skin of the ear canal and is common in children and adults. It occurs more commonly when water enter the ear canal, such as after swimming. When the ear canal is wet for long periods of time, the skin becomes soft and 'soggy' which makes it an ideal environment for infection. Otitis externa is usually one-sided.

Symptoms of otitis externa:
  • Pain and tenderness in the ear canal
  • Itchiness
  • Foul smelling yellow or green pus in the ear canal
  • Reduced hearing/'blocked ear'
  • Noises inside the ear, such as buzzing, humming or ringing (tinnitus).
When should you worry?

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink
  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
  • Breathing that stops or pauses
  • Is pale, blue, mottled or feels unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched cry or can’t be settled
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the ‘Glass Test’)
  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)






You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

 

If your child has any of the following:

  • Has pus coming out of their ear
  • Has pain, redness or swelling behind the ear
  • Severe headache persisting despite regular painkillers
  • Dizziness or is losing their balance
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips or tongue
  • Not had a wee or wet nappy in last 8 hours
  • Poor feeding in babies (less than half of their usual amount)
  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
  • Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
  • Temperature less than 36°C in those over 3 months
  • Getting worse and I am still worried






You need to contact a doctor or nurse today.

Please ring your GP surgery or contact NHS Wales 111 

 

If none of the above are present

  • Watch them closely for any change and look out for any red or amber symptoms
  • Additional advice is also available to young families for coping with crying of well babies – click here.
  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.






Self care

Continue providing your child’s care at home. If you are still concerned about your child, ring your GP surgery or contact NHS Wales 111 

Treatment

Most children with otitis externa do not need antibiotics. That's because research has shown antibiotics make very little difference to how quickly your child gets better. If you think that your child has otitis externa, you should consider using 2% acetic acid ear drops (e.g. Earcalm), which is an effective treatment for otitis externa. These are available without a prescription from your pharmacist. If your child is still no better after a week of using acetic acid drops, they should see a GP who may consider starting them on antibiotic ear drops.

If your child has redness extending to the skin around the ear (cellulitis), go and see your GP as they may need treatment with oral antibiotics. In addition, if your child has any features of severe infection (amber or red features above), they will need to be urgently seen by a healthcare professional who may decide that your child may benefit from antibiotic treatment.

You can help relieve symptoms by:

  • Giving your child paracetamol or ibuprofen to help relieve pain
  • Encourage your child to drink plenty of fluids

Prevention

It is not possible to prevent ear infections; however, you can do things that may reduce your child's chances of developing the condition.

  • Avoid cleaning your child's ears with cotton buds - this may damage and irritate the ear canal and also push wax further into the ear. Wax is designed to come out by itself.
  • Try not to let soap or shampoo get into your child's ear canal.
  • Try to keep your child's ears dry; if water gets in, tip it out. This can be extremely challenging in young children!
  • Ensure your child is up-to-date with their immunisations
  • Avoid exposing your child to smoky environments (passive smoking)

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

Improving the physical and emotional health and wellbeing of expectant mothers, infants, children and young people throughout Aneurin Bevan University Health Board Area.

(N.B: The Family and Therapies team at ABUHB is NOT responsible for the content on the webpage links that we refer to in our resource sections and linked information to external sites. All information was accurate and appropriate at the time the webpage was created.)

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