Otitis externa (swimming ear)

Advice for professionals

INFORMATION FOR PROFESSIONALS: After you have read this page please can you provide feedback to one very quick question at the bottom of this page which will help us make sure the information you have read has helped your decision making.


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:

  • Is going blue around the lips
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern
  • Too breathless to talk/eat or drink
  • Becomes pale, mottled and feels abnormally cold to touch
  • Becomes extremely agitated, confused or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (the 'Glass Test')
  • Has a fit/seizure
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber 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:

  • Develops swelling behind the ear or increasing pain/redness behind the ear
  • Develops dizziness or is losing their balance
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up)
  • Is complaining of a severe headache and neck stiffness/pain or discomfort with bright lifts (photophobia)
  • Is having breathing problems, such as rapid breathing, shortness of breath or laboured breathing (drawing in of muscles below the lower ribs when they breath in)
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Has extreme shivering or complains of muscle pain
  • Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Signs of otitis externa and fever of 38.0°C or above
  • Is getting worse or if your are worried

You need to contact a doctor or nurse today

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

If none of the above features are present

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

This guidance has been reviewed and adapted by healthcare professionals across North East and North Cumbria with consent from the Hampshire development groups.

Choose appropriate sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath).



  1. Shake the inhaler well and remove cap.

  2. Fit the inhaler into the opening at the end of the spacer.

  3. Place mask over the child’s face or mouthpiece in their mouth ensuring a good seal

  4. Press the inhaler once and allow the child to take 5 slow breaths between each dose or count to 10

  5. Remove the inhaler and shake between every puff. Wait 1 minute between puffs.

    Repeat steps 1 – 5 for subsequent doses
    Plastic spacers should be washed before 1st use and every month as per manufacturer’s guidelines

Videos on inhaler technique.

Asthma Attack - 1.jpg

Asthma Attack 2.jpg

  • Keep your child well hydrated by offering them lots to drink
  • Most children with coughs and colds do not require treatment with antibiotics. 
  • If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.
  • Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help.
  • Try using saline nose drops or spray if your baby has a blocked nose.
  • For children over 2 years, vapour rubs (containing camphor, menthol and/or eucalyptus) may help children sleep better.


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


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)
Feedback Question: Has the advice on this page helped you with a healthcare decision?

Accessibility tools