Ear infection or swimmer’s ear — what’s the difference?

Swimmer’s ear may seem like a made-up name for an ear infection, but it’s not. Not only is swimmer’s ear distinct from an ear infection, but the two conditions also have disparate causes and symptoms, and require different treatments.

Being old enough to read, you might think your days of ear infections and swimmer’s ear are behind you. You’d be wrong, however — both can affect you throughout your lifetime. Here’s how to tell them apart, and what to do if you’re experiencing symptoms of either condition.

What causes an ear infection?

Each one of your ears has a direct pathway to your nasal cavity. These tubes are called your eustachian tubes, and they’re responsible for pressurizing your ears — they’re what “pops” when you’re on an airplane. Your eustachian tubes also drain the small amount of fluid that your middle ear cavity produces.

Usually, these pathways function normally. If you contract a cold, the flu, or experience allergies, however, this can trigger inflammation and swelling, causing a feeling of blocked eustachian tubes. This inflammation or swelling can stop your ears from draining properly, leading to congestion.

Since your eustachian tubes are also a direct path to the back of your throat, germs from there can proliferate in the built-up ear fluid, resulting in an ear infection, or acute otitis media. This is often why you experience ear infections following a cold or other illness.

Young children, especially those under five, have much shorter, narrower, and less steep eustachian tubes than adults. This makes it easier for mucus and germs to get stuck in them and is one reason why they’re so much more susceptible to ear infections.

What are the symptoms of an ear infection?

Although adults can also experience fever as a symptom, it’s more likely to be seen in children. In adults, ear infection symptoms more typically include:

• Ear pain
• Muffled hearing or hearing loss
• Full or plugged-up ear sensation
• Fluid or pus draining from the ear

In younger kids who can’t voice their pain, ear infection symptoms may include:

• Irritability or fussiness
• Difficulties sleeping
• Difficulties hearing quiet noises
• Unexplained fever
• Tugging on the ears

Diagnosing and treating an ear infection

To diagnose an ear infection, your healthcare provider will take your medical history and ask about your symptoms. They may also look in your ear with a pneumatic otoscope, a tool that causes mild air pressure changes in your ear canal. In a healthy eardrum, these pressure changes spur slight movements. If you have an ear infection, however, the fluid behind your eardrum will prevent it from responding typically.

Because a certain proportion of ear infections are caused by viruses, not bacteria, antibiotics may not be the first thing your healthcare provider recommends. Instead, your provider may advise you to wait a few days to see if the infection clears on its own. In this case, you can take an over-the-counter (OTC) pain reliever and avoid sleeping on the affected ear to minimize your symptoms.

Whether it’s bacterial or viral, a mild ear infection may resolve on its own after a few days. If your symptoms are still present after a week, however, your provider will likely prescribe an antibiotic to treat your ear infection.

As with all antibiotics, you should take them as directed until you finish your course of treatment. If you stop taking them sooner — even if you feel better — you run the risk of having the infection return, or of producing antibiotic-resistant bacteria.

What are the complications of an ear infection?

Your inner ear contains your vestibular system, which is responsible for your balance. Sometimes, untreated ear infections can damage this system, leaving you with more long-term symptoms like dizziness, vertigo, or both. These symptoms can usually be addressed, however, with medication and physical therapy.

Another complication of untreated ear infections can be a large buildup of fluid behind your eardrum. Without a release, this fluid has nowhere to go except to push on your eardrum. Sometimes all of that pressure can result in a perforated eardrum.

A perforated eardrum can feel like a sudden sharp pain, but it can also cause a sudden decrease in pain as all of that pressure releases. Either way, the condition can affect your hearing. Luckily, the tear usually heals within a few weeks. Occasionally, however, the rupture can become infected again which can lead to permanent hearing issues.

What causes swimmer’s ear and is it different from an ear infection?

Swimmer’s ear, also known as otitis externa, is different from a middle ear infection, or what you might call a “typical” ear infection. Swimmer’s ear is an infection in the skin of your external auditory canal — the part you clean with a cotton swab. It can affect any part of your ear between your tympanic membrane, or eardrum, and your pinna, which is the external part of your ear that you can see.

While the condition gets its name because it often occurs after water gets trapped in the ears, it’s not confined solely to swimmers. In fact, swimmer’s ear isn’t even the result of water getting into your ear canal — it’s actually caused by bacteria. The reason swimmers are vulnerable to it is that water containing bacteria enters their ears.

Riding along with water isn’t the only way bacteria can enter your ears though. Hearing aids, ear plugs, or earbuds can also convey bacteria — especially if you’re not cleaning them regularly. And, other factors can contribute as well.

Swimmer’s ear is more likely to happen to those in humid climates, or to those with a skin condition like psoriasis or eczema. In some cases, allergic reactions to cosmetics or jewelry can also trigger it.

In mild cases, swimmer’s ear will go away by itself. But because of the pain it causes, most people will seek treatment. Complications can occur, however, if you have a more serious case of swimmer’s ear, so it’s best to check in with a healthcare provider either way.

What are the symptoms of swimmer’s ear?

You’d be forgiven for thinking that the discomfort of trapped water in your ear is the same as swimmer’s ear. But the condition is more severe than that — swimmer’s ear is an infection, and it can often be painful. If you have it, you’ll likely experience some of the following symptoms:

• Itching inside your ear canal
• Earache or ear pain — this can often feel much worse than a “normal” ear infection
• Pain inside the ear while chewing
• Redness and swelling of the ear canal
• Green or yellow pus-like discharge from the ear
• Increasing pain when pulling on or moving the ear
• Hearing loss — this is typically temporary and usually returns to normal after treatment
• Swollen glands in the neck

Diagnosis and treatment for swimmer’s ear

Your healthcare provider can diagnose swimmer’s ear based on symptoms, medical history, and recent activities alone, although they may choose to use an otoscope as well.

While it can sometimes resolve without treatment, swimmer’s ear is often quite painful and many choose to treat it. Ibuprofen or acetaminophen can address your immediate discomfort or pain, and OTC counter ear drops are also available. But while these drops can help dry out your ear, they don’t do anything to address the underlying condition.

To actually treat the bacterial infection, your healthcare provider can prescribe antibiotic ear drops. If your ears are too swollen for the drops to penetrate, a wick, which is essentially a piece of compressed cotton, can be put in your ear. Adding the ear drops to the wick causes it to expand. It then pulls the drops down your ear canal to target the infection.

What are the complications of swimmer’s ear?

In extremely rare cases, the infection from swimmer’s ear can spread into the tissue surrounding your ear. This condition, known as malignant otitis externa, is typically seen only in individuals who are elderly, immunocompromised, or who have diabetes.

Malignant otitis externa is responsive to treatment with oral or drip antibiotics, but the earlier it’s caught, the better. Left unchecked, it can spread into not only facial tissue, but also the bones of the skull and your cranial nerves. Once it’s progressed to this point it can be fatal.

How can you prevent an ear infection and swimmer’s ear?

Keeping your ears dry and free of foreign objects is the best way to prevent swimmer’s ear. Items that do have to go in your ear — like hearing aids — should be cleaned and maintained properly.

For everything else, keep it out of your ears. Even using q-tips in your ears is bad — the box they come in actually says not to use them inside your ears. And most doctors will tell you to never put anything smaller than your elbow in your ear.

When it comes to ear infections, prevention isn’t as direct. Ear infections aren’t contagious, but colds and respiratory viruses that cause them are, so you should steer clear of anyone around you who’s sick. You should also avoid being around cigarette smoke and address your allergies.

Anything that can make you congested could potentially lead to an ear infection. So keep yourself in tip-top shape by staying healthy, getting enough sleep, eating a balanced diet, and getting your flu shot.

When to see a doctor

While ear infections often go away on their own, sometimes they require professional care. If you’re wondering how long an ear infection lasts that’s considered normal, the answer is pretty clear. If it sticks around for longer than three days with no signs of improvement, you should see a doctor. Likewise, if your pain increases in intensity, you have trouble moving part of your face, or if you develop a high fever, medical attention is warranted.

If your child is under six months old or if they have an earache and you can’t comfort them, they should see a doctor. And, if you or your child experiences sudden hearing loss or severe pain, seek medical help.

Not all middle-of-the-night ear issues warrant a wait in the emergency room. If you’re looking for treatment for your ear infection or swimmer’s ear, Maple can help. Maple can connect you with a Canadian-licensed doctor 24 hours a day, from your phone, tablet, or computer.

Ear infections and swimmer’s ear can be painful, but treating them doesn’t have to be. Speak with a doctor online today and take the first step towards clearing your ears.