To treat swimmer's ear, use eardrops.
That was the conclusion of a panel of physicians called together by the American Academy of Otolaryngology-Head and Neck Surgery Foundation to create medicine's first clinical guidelines for treatment of acute otitis externa, commonly known as swimmer's ear. The new guidelines were published in the April edition of the Academy's medical journal, Otolaryngology-Head and Neck Surgery.
"The guidelines are necessary because there is a lot of variation in the way swimmer's ear is managed. The particular concern was that oral antibiotics, which are not effective, were being used too frequently, and antibiotic eardrops and other eardrops, which are effective, were being used less often than they should be," explains Dr. Richard M. Rosenfeld with the State University of New York Downstate Medical Center and Long Island College Hospital in Brooklyn, N.Y. An otolaryngologist, Rosenfeld chaired the group that created the guidelines.
In particular, the guidelines recommend prescription drops with the main ingredient being an antibiotic, some form of antiseptic such as acetic acid, a steroid or perhaps even a combination.
"Pretty much all the prescription drops had about the same effectiveness in relieving the pain and resolving the swimmer's ear," Rosenfeld says. With prescription eardrop treatment, pain is usually somewhat relieved in 24 hours, and a majority of symptoms disappear in two to four days.
Rosenfeld says the panel was convened because physician surveys on the subject showed that between 20 and 40 percent of cases are managed using oral antibiotics. "Quite simply, it's not appreciated how effective the drops are," he says. "With all the concerns we have now about resistant bacteria and antibiotic side effects, any efforts to avoid oral antibiotics would seem prudent."
Determining that a patient suffers from swimmer's ear "is pretty straightforward," Rosenfeld adds, so the problem hasn't been misdiagnosis. Symptoms include: pain or discomfort in or around the ear, severe pain when moving the outer ear, itching of the outer ear, swelling of the ear or lymph nodes in the neck, a feeling of fullness or stuffiness in the ear and hearing loss. Swimmer's ear also may cause the outer ear to appear red, with scaly or flaking skin.
Swimmer's ear is generalized inflammation of the external ear canal. It's caused when water is trapped in the canal, allowing normally occurring bacteria to multiply and infect and irritate the canal. Fungi can also cause the inflammation. Parents know that children are most susceptible to swimmer's ear, particularly in the summer months and in hotter climates. The common condition affects one in 100-to-250 Americans annually.
Otolaryngologists, pediatricians, family physicians, internists, emergency room physicians and even infectious disease specialists were represented on the Academy panel. "We had pretty much a representative of every discipline involved in treating swimmer's ear at the table when we created these guidelines," Rosenfeld says.
By using Medline®, the panel initially identified 2,860 medical articles about acute otitis externa published from 1966 through July 2005, of which 509 were potential randomized trials. The panel also considered writings from other sources, and then narrowed the field to the most pertinent. The group met twice during the seven months devoted to development of the guidelines, which were peer-reviewed extensively in draft form. As chair, Rosenfeld then compiled and reviewed those comments.
A seminar on the new guidelines will be held at the Academy's annual meeting, scheduled for September 2006 in Toronto. Rosenfeld hopes members of the panel in other disciplines will help spread the word to their colleagues about the new guidelines.
