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URMC / Patients & Families / Health Matters / September 2018 / What’s Behind That Ear Ache?

What’s Behind That Ear Ache?

When a great day at the pool is followed by a troubling night of ear pain, swimmer’s ear may be the culprit. UR Medicine Pediatric ENT specialist Dr. Margo McKenna Benoit explains the difference between it and the common middle-ear infection known as otitis media, and how to spot and treat them.Young child with a doctor, being examined for ear pain

The main difference lies in where the infection is located.

Swimmer’s ear, or otitis externa, is an infection in the ear canal, outside of the ear drum. Typically, bacteria collect when water from the outside world pools in the ear canal, external to the drum.

Otitis media results from bacteria that come from the back of the nose and mouth and collect in the middle ear, underneath the ear drum.

Distinguishing the two is especially important because the treatments differ, and it’s important to use the right kind of antibiotics.

Swimmer’s Ear (Otitis Externa)

Signs may include:

  • Pain, sometimes intense, that lasts 24 hours or longer
  • Drainage from the ear
  • Swelling of the ear canal
  • Visible redness around the outer part of the ear

You’re more susceptible to swimmer’s ear if you swim a lot and tend to put your head under water. If you are prone to it, using ear plugs may help. Consider asking your doctor for other preventive ideas.

With treatment—usually prescription topical antibiotics in the form of ear drops—it should clear up in seven to 10 days. In rare cases, if the infection spreads to skin around the ear, your doctor may order oral antibiotics.

Otitis Media (OM)

Signs may include:

  • Pain
  • Fever
  • Poor sleep and appetite
  • Difficulty lying flat
  • Bloody drainage from the ear, if the ear drum ruptures

Young children (ages 6 months to 3 years) are most prone to this middle-ear infection, which tends to taper off as their ears grow and immune systems get stronger. Prevention includes protecting yourself and your child from illness through handwashing and limiting exposure to bacteria and viruses when possible. We do know the risk is higher for kids exposed to secondhand smoke and for those attending day care. Breastfeeding appears to provide some protection against OM. Unlike swimmer’s ear, getting water in your ear does not trigger OM.

Treatment usually includes a course of oral antibiotics for seven to 10 days. Although OM sometimes clears without treatment, it’s still important to call your doctor. In extreme cases, untreated OM can lead to complications.

In cases of recurrent middle-ear infections (for example, four infections within six months) or with persistent fluid in between infections, your doctor may recommend inserting tiny ear tubes that help drain the fluid.

When in doubt, it’s always best to check with your doctor who can help assess the problem and may stave off problems that could lead to complications.


Pediatric otolaryngologist Margo McKenna Benoit


Margo McKenna Benoit, M.D., is an associate professor of both Otolaryngology and Pediatrics and program director for UR Medicine Pediatric Otolaryngology, the area’s only dedicated pediatric-centered ENT program, located at 125 Lattimore Rd., Rochester.


Lori Barrette | 9/5/2018

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