From the Guidelines
The management of acute otitis externa (swimmer's ear) primarily involves topical antimicrobial therapy, pain control, and keeping the ear dry. The first-line treatment is topical antibiotic drops, typically containing either ciprofloxacin 0.3% or ofloxacin 0.3%, often combined with a steroid like dexamethasone to reduce inflammation, as noted in the clinical practice guideline: acute otitis externa 1. These should be administered as 3-4 drops into the affected ear canal 2-4 times daily for 7-10 days. For severe pain, oral analgesics such as acetaminophen or NSAIDs are recommended, with the importance of pain assessment and management emphasized in the guideline 1. If the ear canal is significantly swollen, a healthcare provider may need to place an ear wick to facilitate medication delivery into the canal. The ear should be kept dry during treatment by avoiding swimming and using earplugs or cotton balls coated with petroleum jelly during showers, as suggested in the prevention strategies for AOE 1. Gentle cleaning of the external ear canal by a healthcare provider may be necessary if there is significant debris blocking medication penetration, highlighting the need for proper drug delivery to the infected tissues 1. This condition occurs when moisture trapped in the ear canal creates an environment for bacterial growth, most commonly Pseudomonas aeruginosa or Staphylococcus species, which is why keeping the ear dry and using antimicrobial therapy are essential components of treatment, as outlined in the clinical practice guideline executive summary 1. Key considerations include:
- Ensuring adequate delivery of topical medication
- Providing clear instructions for self-administration of eardrops
- Monitoring for potential complications and misdiagnosis
- Reducing pain through appropriate analgesics
- Preventing relapse of infection by using eardrops for at least 7 days.
From the FDA Drug Label
For pediatric patients (from 6 months to 13 years old): Five drops (0.25 mL, 0.75 mg ofloxacin) instilled into the affected ear once daily for seven days. For patients 13 years and older: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear once daily for seven days. Contents of one single-dose container should be instilled into the affected ear twice daily (approximately 12 hours apart) for 7 days.
The management for acute otitis externa (swimmer's ear) includes:
- Instilling ofloxacin (OTIC) drops into the affected ear once daily for seven days, with the dosage varying by age:
- Pediatric patients (6 months to 13 years old): 5 drops (0.25 mL, 0.75 mg ofloxacin)
- Patients 13 years and older: 10 drops (0.5 mL, 1.5 mg ofloxacin)
- Alternatively, instilling ciprofloxacin (OTIC) drops into the affected ear twice daily (approximately 12 hours apart) for 7 days, using one single-dose container per dose 2 3.
From the Research
Management of Acute Otitis Externa (Swimmer's Ear)
The management of acute otitis externa, also known as swimmer's ear, involves a combination of treatments to alleviate symptoms and prevent further complications.
- Symptoms and Diagnosis: Acute otitis externa is characterized by symptoms such as itching, otalgia, otorrhea, and conductive hearing loss 4. The diagnosis is typically based on clinical presentation and may involve microbiologic culture to identify the underlying pathogen.
- Treatment Options: Treatment options for acute otitis externa include:
- Frequent cleansing of the ear canal
- Pain control
- Oral or topical medications
- Acidification of the ear canal
- Control of predisposing factors 4
- Topical Treatments: Topical treatments, such as antibiotic/steroid drops, are effective for uncomplicated acute otitis externa 5. The choice of topical treatment may be determined by factors such as risk of ototoxicity, risk of contact sensitivity, and cost.
- Specific Medications: Studies have evaluated the efficacy and safety of specific medications, including:
- Ofloxacin otic solution, which was found to be effective and well-tolerated in treating otitis externa 6
- Ciprofloxacin plus fluocinolone acetonide, which demonstrated statistical superiority in sustained microbiological response and faster resolution of otalgia compared to ciprofloxacin or fluocinolone alone 7
- Ciprofloxacin/dexamethasone, which was found to be clinically and microbiologically superior to neomycin/polymyxin B/hydrocortisone in treating acute otitis externa 8
- Prevention: Prevention of acute otitis externa involves avoiding swimming in polluted waters and avoiding ear-canal cleaning with cotton-tip applicators 4.