The American Academy of Otolaryngology (ENT doctors) has updated its 2006 guidelines for treating acute otitis externa (AOE, including swimmer’s ear). The guidelines are essentially unchanged, with an updated literature review and more input from experts.
The guidelines continue to emphasize not using oral antibiotics but antibiotic drops instead, adequate pain control, and education of patients on how to use drops. There is a little more emphasis in the updated guidelines on not using oral antibiotics to treat swimmer’s ear, and on patient education on how to use the drops. Here are the revised guidelines:
- Doctors should be sure the patient has otitis externa and not something else (seems kind of obvious).
- Look for co-existing conditions that would modify treatment. (In kids, this is mostly an issue of whether the child has ear tubes or a perforated ear drum).
- Be sure the patient’s pain is treated and managed.
- Avoid oral antibiotics unless there is a specific reason they are needed instead of antibiotic ear drops.
- Use antibiotic ear drops to treat otitis externa.
- Teach patients how to use the drops.
- Use drops that are not potentially harmful to the middle ear in cases of ear tubes or perforated ear drums.
- Be sure that symptoms improve in 48-72 hours.
Despite what seems to me to be the somewhat obvious nature of these guidelines (because this is how I practice pediatrics), the guidelines note that many doctors are quick to diagnose otitis externa for a draining ear, when there may be something else causing it. What is more concerning, however, is that they note that 20-40% of patients with AOE are still receiving oral antibiotics. I admit I am somewhat surprised by this, but I really should not be, given the horrid rates of antibiotic prescriptions for colds and flu in the United States, in both children and adults. Maybe the updated guidelines will help reduce their use for this condition at least.
