The American Academy of Otolaryngology (ENT doctors) has issued the first expert guidelines for the treatment of swimmer’s ear (actually, otitis externa, of which swimmer’s ear is one cause). The guideline is interesting because of the authors’ main purpose. They begin by stating that the “primary purpose of this guideline is to promote appropriate use of oral and topical antimicrobials for diffuse acute otitis externa (AOE) and to highlight the need for adequate pain relief.” The main goal of the guidelines is to decrease oral antibiotic use for this simple skin infection which usually responds very well to topical antibiotics. A secondary goal is to increase the use of adequate pain medication. It is indeed a very painful condition, but thankfully one that is easily treated.
After reviewing the available research evidence and expert opinion, the guidelines make the following recommendations:
- Doctors should be sure that the illness is otitis externa and not something else, and look for co-existing conditions that would modify treatment (this seems rather obvious). In kids, this is mostly an issue of whether the child has ear tubes or a perforated ear drum.
- Be sure pain is treated and managed.
- Use antibiotic ear drops. Avoid oral antibiotics unless there is a specific reason they are needed instead of antibiotic ear drops.
- The choice of drops should be evidence-based, taking into account effectiveness, side effects, compliance, and cost.
- Doctors should educate patients on how to use the drops.
- Use the correct drops in cases of ear tubes or perforated ear drums and avoid ones that can be toxic to the middle ear cavity.
- Be sure that symptoms improve in 48-72 hours.
Swimmer’s ear is a very common and painful condition in children, especially during the summer. These guidelines are in accord with currently accepted practice and seem quite straightforward. I would note that it is the newer ear drops that are not potentially harmful to the middle ear; however, some insurance companies are very hesitant to cover them, and it can be difficult to prescribe the best treatment to patients with swimmer’s ear. I am not usually on the bandwagon for every new drug that comes along, but in this case, the newer ones are safer and more effective than the older ones. Unfortunately, here as with most of healthcare these days, it is someone else who decides what treatment a patient gets, not the doctor or the patient.
