What is the treatment for otitis externa (swimmer's ear)?

From the Guidelines

Swimmer's ear (otitis externa) can be effectively treated with topical antibiotic ear drops, such as ciprofloxacin (Cipro HC) or neomycin-polymyxin B-hydrocortisone (Cortisporin), used 3-4 times daily for 7-10 days, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1. The treatment of swimmer's ear typically involves a combination of cleaning, medication, and preventive measures.

• Cleaning the ear canal with a bulb syringe and warm water or a solution of equal parts white vinegar and rubbing alcohol can help remove debris and restore the ear's normal pH.
• Topical antibiotic ear drops, such as ciprofloxacin (Cipro HC) or neomycin-polymyxin B-hydrocortisone (Cortisporin), are effective in treating the infection, with no consistent advantage shown for any one specific drug 1.
• Pain relief can be managed with over-the-counter pain medications such as ibuprofen (200-400mg every 4-6 hours) or acetaminophen (500-1000mg every 4-6 hours).
• Keeping the ear dry during treatment by avoiding swimming and using earplugs or a swim cap when showering can help prevent further irritation.
• A warm compress held against the ear can help reduce pain. It is essential to note that systemic antimicrobials should not be prescribed as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy 1. If symptoms worsen or don't improve after 3-4 days of treatment, it is crucial to consult a healthcare provider, as this may indicate a more serious condition, such as necrotizing otitis externa or otomycosis, which require different management strategies 1.

From the FDA Drug Label

For the treatment of superficial infections of the external auditory canal caused by organisms susceptible to the action of the antimicrobial. For the treatment of superficial bacterial infections of the external auditory canal caused by organisms susceptible to the action of the antibiotics. For the treatment of superficial bacterial infections of the external auditory canal caused by organisms susceptible to the action of the antibiotics, and for the treatment of infections of mastoidectomy and fenestration cavities caused by organisms susceptible to the antibiotics.

Treatment options for swimmers ear include:

• Acetic acid (OTIC) 2
• Neomycin (OTIC) 3
• Polymyxin B (OTIC) 4 These medications are indicated for the treatment of superficial infections of the external auditory canal.

From the Research

Treatment Options for Swimmer's Ear

• The primary treatment for swimmer's ear (otitis externa) includes topical antibiotics and analgesics 5, 6.
• Topical medications such as acetic acid 2%, aminoglycosides, polymyxin B, and quinolones with and without corticosteroids are commonly used 5, 6.
• There is no evidence that any one preparation is clinically superior to another, and the choice of treatment is based on factors such as cost, whether the tympanic membrane is intact, and patient adherence 5, 6.

Prevention and Management

• Avoiding injury to the ear canal and keeping it free of water are key to preventing swimmer's ear 5, 7.
• Thorough cleansing of the canal is essential for diagnosis and treatment, but flushing should be avoided 7.
• Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is effective treatment in most cases and, when used after exposure to moisture, is an excellent prophylactic 7.

Specific Treatment Regimens

• A study comparing an antibiotic ear drop formulation (polymyxin B sulfate, neomycin sulfate, and gramicidin) to glycerol treatment found that the antibiotic formulation was more effective in reducing symptoms of acute bacterial otitis externa 8.
• The use of neomycin/polymyxin B/hydrocortisone preparations is a reasonable first-line therapy when the tympanic membrane is intact 6.
• Oral antibiotics are reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 5, 6.