Swimmer's ear or a middle ear infection? How to tell them apart

Swimmer's ear often starts after water stays in the ear. Signs include:

• Itching in the ear or ear canal
• Ear pain that gets worse when you pull on the outer ear or press the small flap in front of it
• Fluid draining from the ear
• A plugged or muffled ear

It is usually treated with antibiotic ear drops, often for 10 to 14 days, and by keeping the ear dry. Pain medicine, like acetaminophen or ibuprofen, can help.

A middle ear infection often starts during or after a cold. Signs include:

• Ear pain or pressure
• Fever
• Muffled hearing
• In children, rubbing or tugging at an ear, fussiness or trouble sleeping

Many middle ear infections get better without antibiotics. A doctor may suggest pain medicine and waiting a couple of days, with an antibiotic to start only if you are not better or you get worse.

• Dry your ears well after swimming or bathing.
• Use earplugs when you swim, and avoid swimming in dirty water.
• Do not put cotton swabs or other objects in your ears.

Get emergency care for redness, swelling or pain on the bone behind the ear, or an ear that is pushed forward. This can be an infection of the bone behind the ear. Also get emergency care for a stiff neck, confusion, a very bad headache or a new rash with ear pain.

See a doctor in person, the same day, for:

• Swimmer's ear with any fever, or redness or swelling spreading onto the outer ear, behind the ear or onto the face
• Severe ear pain or swelling, or pain that gets worse fast
• A high fever (over 102.2°F), or fever with fluid or pus draining from the ear
• New weakness or drooping of the face
• Severe dizziness, trouble walking, or sudden hearing loss
• Severe ear pain with diabetes or a weak immune system
• Something stuck in the ear

If you are in Virginia or West Virginia, you can start a visit online at any time. A board-certified physician reviews your answers. If medicine is right for you, the doctor can send it to your pharmacy. If you need to be seen in person, the doctor will tell you.

Our swimmer's ear visit is for adults and children 4 and older (with a parent or legal guardian) with ear canal pain, itching or drainage, often after water. It is not for a fever, a known or suspected hole in the eardrum, ear tubes or recent ear surgery, new hearing loss, dizziness, or any of the signs above. If it sounds like a middle ear infection, use our ear infection visit instead.

Our ear infection visit is for adults and children 4 and older (with a parent or legal guardian) with ear pain or pressure, often after a cold. The doctor's plan usually starts with pain control and waiting, plus a backup antibiotic prescription to fill only if you are not better in 48 to 72 hours or you get worse. It is not for anyone with ear tubes, ear surgery in the last 3 months, diabetes or a weak immune system, 3 or more ear infections in the last 6 months, an infection that did not get better after the backup antibiotic window, or any of the signs above. Ear pain in a child younger than 4 needs an in-person exam.

Visits start at $59. You see the price before you pay, and you do not need insurance.