Swimmer’s Ear vs. Middle Ear Infections: 3 Ways to Tell the Difference

July 27, 2020

Summer can be a prime time for ear troubles to pop up in both children and adults – and no, it’s not just because of swimming.

Infection of the outer ear (otitis externa), commonly called “swimmer’s ear,” can be caused by a number of things on top of water contamination. It also has symptoms incredibly similar to middle ear infections (otitis media), which can make it difficult to determine which is which.

Mild cases of both conditions can clear up on their own, but it’s important to know how to react to them, so as to not exacerbate symptoms. If symptoms persist longer than 2-3 days, you should reach out to your doctor as soon as possible. When more severe cases are left untreated, serious repercussions may arise, such as hearing loss and further spread of infection.

So, how can you tell the difference between swimmer’s ear and an ear infection?

1. Location, location, location:

First and foremost, try to determine where the pain is coming from, says Jefferson Health ENT Dennis C. Fitzgerald, MD. “Swimmer’s ear occurs in the external ear canal, making it easier to see the infection, which can present with redness and swelling,” explained Dr. Fitzgerald.

Most often caused by bacterial infection of the skin, swimmer’s ear can result from repeated exposure to water, as well as trauma from scratching/picking or using Q-tips.

Middle ear infections, on the other hand, occur behind the ear drum. They result from congestion and swelling of our eustachian tubes – a pair of narrow tubes that run from the middle ear to the back of the throat to help regulate and replenish air in the middle ear. When allergies, common colds, or other viruses cause blockages in the eustachian tubes, it often leads to infection, says Dr. Fitzgerald.

Studies show that children under the age of two are at particular high risk for ear infections, as their eustachian tubes are narrower and more horizontal.

2. Symptoms:

Severe pain (often disrupting sleep), drainage/discharge, and difficulty hearing are all common symptoms for both infections.

Swimmer’s ear tends to be less medically serious, but often more painful. Prominent symptoms include:

  • Itching
  • Swelling
  • Discomfort

Another way to diagnose swimmer’s ear is to tug on the outer ear. If there is pain, it is swimmer’s ear, says Dr. Fitzgerald.

Middle ear infections can cause a wider range of symptoms, especially in children. They may include:

  • Trouble sleeping
  • Excess crying and fussiness
  • Loss of balance
  • Loss of appetite.

3. Seasonal Factors:

Swimmer’s ear is more commonly the culprit of ear pain in the summertime due to humidity and water exposure, explains Dr. Fitzgerald. “Plus, studies show middle ear infections occur more in the fall and winter. However, individuals with seasonal allergies, young children, and those prone to chronic infections may be at higher risk year-round.”


If you are suffering from an ear infection, don’t fret; treatment for both is simple and effective. Middle ear infections require a round of antibiotics, while swimmer’s ear responds better to antibiotic/steroid ear drops.

Swimmer’s ear, treated with prescription ear drops, should clear up in one to two weeks. After it clears, you should start to use homemade ear drops – comprised of a mixture of rubbing alcohol and white vinegar – after being in water again.

Remember to always pay attention to how your ear pain progresses, but, at the same time, don’t let it get you down. It may put a damper on your day, but with proper management, you’ll be able to return to your favorite summer activities in no time.

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