From the Guidelines
Otitis externa, also known as swimmer's ear, is a bacterial or fungal infection of the outer ear canal, typically treated with topical antibiotics such as neomycin or polymyxin B, administered 3-4 times daily for 7-10 days 1. For more severe cases, oral antibiotics like ciprofloxacin 500mg twice daily for 7-10 days may be prescribed 1. Additionally, analgesics like acetaminophen 650mg every 4-6 hours as needed can be used to manage pain and discomfort 1. In cases of fungal otitis externa, antifungal agents like clotrimazole 1% solution, applied 2-3 times daily for 7-14 days, may be effective 1.
Diagnosis
The diagnosis of otitis externa is based on the presence of symptoms such as ear pain, itching, and discharge, as well as the appearance of the ear canal and eardrum 1. A clinical diagnosis of necrotizing otitis externa can be confirmed with a raised erythrocyte sedimentation rate plus an abnormal computed tomography or magnetic resonance imaging scan 1.
Treatment
The treatment of otitis externa depends on the severity of the infection and the presence of any underlying conditions such as diabetes or a compromised immune system 1. Topical antibiotics are the mainstay of treatment, but oral antibiotics may be necessary in more severe cases or in patients with certain underlying conditions 1.
Special Considerations
Patients with a nonintact tympanic membrane, including those with a tympanostomy tube, require special consideration and should be treated with a non-ototoxic topical preparation 1. Patients with diabetes or an immunocompromised state are at increased risk of developing necrotizing otitis externa and require close monitoring and aggressive treatment 1.
Management
The management of otitis externa involves a collaborative effort between the clinician and an informed patient, taking into account factors such as patient preference, cost, and frequency and duration of treatment 1. Patients should be educated on how to administer topical drops and should be informed of the potential risks and benefits of treatment 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnosis of Otitis Externa
- Otitis externa is an inflammatory condition that affects the external ear canal, usually caused by bacterial infection, with Pseudomonas aeruginosa and Staphylococcus aureus being the primary bacterial infections 2, 3, 4.
- Symptoms of otitis externa include pain (otalgia), redness, and swelling of the canal, as well as tenderness on movement of the pinna or tragus 2, 4.
- Diagnosis is typically based on clinical presentation, with tenderness on movement of the tragus or pinna being a classic finding 2, 4.
Treatment of Otitis Externa
- Topical antimicrobials or antibiotics, such as acetic acid, aminoglycosides, polymyxin B, and quinolones, are the treatment of choice in uncomplicated cases 2, 3, 4, 5.
- These agents come in preparations with or without topical corticosteroids, and the addition of corticosteroids may help resolve symptoms more quickly 2, 4.
- The choice of treatment is based on factors such as tympanic membrane status, adverse effect profiles, adherence issues, and cost 2, 4.
- 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 2, 4.
- Duration of topical treatment is usually seven to 10 days, but may need to be extended in some cases 2, 5.
Prevention of Otitis Externa
- Keys to prevention include avoiding injury to the ear canal and keeping it free of water 2.
- Patients can also take steps to prevent otitis externa by avoiding excessive ear cleaning and using earplugs when swimming 6.