From the Guidelines
Otitis externa, or swimmer's ear, is best treated with a combination of thorough cleaning and topical medications, as recommended by the American Academy of Otolaryngology—Head and Neck Surgery Foundation 1.
Key Components of Treatment
- The ear canal should be gently cleaned to remove debris and discharge, which can be done by a healthcare provider or carefully at home using a bulb syringe with warm water.
- The primary treatment involves antibiotic ear drops, typically containing fluoroquinolones like ciprofloxacin or ofloxacin, often combined with steroids to reduce inflammation.
- These drops should be used 3-4 times daily for 7-10 days.
- For proper application, pull the outer ear up and back (in adults) or down and back (in children) to straighten the ear canal, then place 3-4 drops and maintain position for 30 seconds.
- If significant swelling prevents drops from entering the canal, an ear wick may be inserted temporarily.
- Pain management with acetaminophen or ibuprofen is recommended as needed.
- During treatment, keep the ear dry by avoiding swimming and using earplugs or cotton balls coated with petroleum jelly when showering.
Special Considerations
- Patients with diabetes, an immunocompromised state, or both require special consideration because they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to AOE but require different management 1.
- Concurrent middle ear disease can modify treatment of AOE, and patients with a tympanostomy tube or tympanic membrane perforation may develop diffuse AOE because of purulent middle-ear secretions that enter the external ear canal 1.
- Topical antimicrobials are beneficial for AOE, but oral antibiotics have limited utility, and about 20% to 40% of patients with AOE receive oral antibiotics, with or without concurrent topical therapy 1.
Patient Education
- Patients should be informed about the importance of completing the full course of topical therapy, even if symptoms improve before the end of treatment 1.
- Patients should also be advised to avoid scratching or touching the ear, not insert anything into the ear canal, including cotton-tipped swabs, and cover the opening of the ear canal with an earplug or cotton (with petroleum jelly) prior to showering or hair washing to minimize water entry 1.
From the FDA Drug Label
The recommended dosage regimen for the treatment of otitis externa is: 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. The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness which may result from the instillation of a cold solution. The patient should lie with the affected ear upward, and then the drops should be instilled This position should be maintained for five minutes to facilitate penetration of the drops into the ear canal. Repeat, if necessary, for the opposite ear.
Otitis Externa Treatment:
- The recommended treatment for otitis externa is ofloxacin otic solution, 0.3% instilled into the affected ear once daily for seven days.
- The dosage varies 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)
- It is essential to warm the solution and maintain the affected ear upward for 5 minutes after instillation to facilitate penetration into the ear canal 2.
From the Research
Otitis Externa Treatment Options
- Topical antibiotics, such as ofloxacin otic solution, have been shown to be effective in treating otitis externa, with a cure rate of 91% among clinically evaluable patients 3.
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is also an effective treatment for otitis externa, and can be used as a prophylactic measure after exposure to moisture 4.
- Other treatment options, such as ciprofloxacin ear drops, have also been shown to be effective in eradicating bacterial pathogens and achieving clinical improvement in patients with otitis externa 5, 6.
Comparison of Treatment Options
- A systematic review and meta-analysis found that there were no significant differences in cure rates between topical antibiotic treatments and non-antibiotic treatments, such as antiseptics and steroids, for acute otitis externa 7.
- Another study found that ciprofloxacin 0.2% solution was statistically equivalent to reference products, such as polymyxin B, neomycin sulfate, and hydrocortisone, in terms of cure rate and microbiological eradication 6.