What is the treatment for swimmer's ear in patients with tympanostomy (ear) tubes?

From the Guidelines

The treatment for swimmer's ear in patients with tympanostomy tubes typically involves antibiotic ear drops that are safe for use with tubes, such as fluoroquinolone drops like ciprofloxacin or ofloxacin, dosed as 3-4 drops in the affected ear twice daily for 7-10 days. These medications are effective against the common bacteria that cause swimmer's ear while being safe for the middle ear, which is exposed through the tubes 1. It's essential to avoid using alcohol-based drops or neomycin-containing products, as these can potentially cause ototoxicity when they enter the middle ear through the tubes. Before applying drops, gently clean the outer ear canal of any discharge using a soft cloth or cotton swab (only in the outer portion of the canal).

Some key points to consider in the treatment of swimmer's ear with tympanostomy tubes include:

• The use of antibiotic ear drops as the first line of treatment, with fluoroquinolone drops being preferred due to their safety and efficacy 1.
• The importance of avoiding alcohol-based drops or neomycin-containing products to prevent ototoxicity 1.
• Cleaning the outer ear canal before applying drops to ensure effective delivery of the medication.
• Keeping the ear dry during treatment by using ear plugs or a swim cap when bathing or swimming, although routine water precautions are not recommended unless in specific clinical situations 1.
• Monitoring for symptoms that worsen or do not improve within 48-72 hours, which may necessitate medical reevaluation for more aggressive treatment or different antibiotics 1.

The presence of tubes changes the treatment approach because medications can directly enter the middle ear, requiring careful selection of ear drops that won't damage the delicate middle ear structures 1. The most recent and highest quality study supports the use of topical antibiotic therapy, such as fluoroquinolone drops, as the preferred treatment for acute tympanostomy tube otorrhea, with superior outcomes compared to systemic oral antibiotics 1.

From the FDA Drug Label

For an Ear Canal Infection (“Swimmer’s Ear”): The person receiving ofloxacin otic solution should lie on his/her side with the infected ear up Patients (13 and older) should have 10 drops of ofloxacin otic solution put into the infected ear. Pediatric patients under 13 should have 5 drops put into the infected ear. In patients with an Ear Canal Infection (“Swimmer’s Ear”), ofloxacin otic solution ear drops should be given once daily at about the same time each day (for example, 8 AM or 8 PM) in each infected ear unless the doctor has instructed otherwise

The treatment for swimmer's ear in patients with tympanostomy (ear) tubes is:

• Dosage: 5 drops (for pediatric patients under 13) or 10 drops (for patients 13 and older) of ofloxacin otic solution
• Frequency: Once daily at about the same time each day
• Duration: As instructed by the doctor, even if symptoms improve 2, 2

From the Research

Swimmer's Ear Treatment with Ear Tubes

The treatment for swimmer's ear in patients with tympanostomy (ear) tubes involves several key considerations:

• Frequent cleansing of the ear canal to prevent infection 3
• Avoiding swimming in polluted waters and ear-canal cleaning with cotton-tip applicators 3
• Using topical medications, such as ofloxacin, to treat otorrhea caused by acute otitis media in patients with tympanostomy tubes 4
• Controlling predisposing factors, such as avoiding diving and hot tub water, bath water, chlorinated water, or water from stagnant ponds 5

Prevention of Infection

To prevent ear infection in patients with tympanostomy tubes, it is recommended to:

• Avoid diving, as it can pose a risk for ear infection 5, 6
• Use earplugs when swimming, although one study found that swimming without earplugs does not result in an increased incidence of middle ear infections 6
• Swim in clean, chlorinated swimming pools, as surface swimming is considered safe for children with ventilation tubes 3

Treatment Options

Treatment options for swimmer's ear in patients with tympanostomy tubes include:

• Topical antibiotics, such as ofloxacin, which has been shown to be efficacious in treating otorrhea caused by acute otitis media in patients with tympanostomy tubes 4
• Oral medications, such as amoxicillin/clavulanate, which can be used to treat otorrhea caused by acute otitis media in patients with tympanostomy tubes 4