Update on Swimmer's Ear Treatment

"Swimmer's ear" is the common name for otitis externa, which is an infection of the external (outside the eardrum [tympanic membrane]) ear canal. It is a common affliction of swimmers, sometimes affects divers, and can rapidly become debilitating if it's not treated promptly and properly.

Swimmer's ear is commonly caused by the bacterium Pseudomonas aeruginosa. When the external canal is kept moist, it is easier for bacteria to invade the skin and cause infection. The earliest symptom may be itching. Subsequent symptoms include a white to yellow-green liquid or cheesy discharge from the ear, pain, and decreased hearing. Occasionally, the victim complains of exquisite tenderness when the earlobe is tugged or the jaw is moved and has tender, swollen lymph glands in the neck on the affected side. In a severe case, the victim may have a fever and appear toxic.

Standard treatment recommendations are that if the victim has only a discharge without fever or swollen lymph glands, he may be treated with ear drops, such as 2% nonaqueous acetic acid (VoSoL or Domeboro Otic). Household vinegar diluted 1:1 with fresh water or with rubbing (isopropyl) alcohol (approximately 70%) can be used as a substitute. These ear drops should be administered four to five times a day and may be retained with a cotton or gauze wick gently placed into the external ear canal, or by using an expanding foam ear sponge (such as a Speedi-Wick). To avoid injuring the eardrum, do not attempt to clean out the ear with a cotton swab or similar object. The solution should be retained in the ear for a minimum of 5 minutes with each application. If there is any suggestion that the eardrum may be punctured (e.g., the presence of bleeding), then do not use this solution.

If the victim has a discharge with fever and/or swollen lymph glands, the ear drops should contain hydrocortisone (VoSoL HC); he should also be given oral ciprofloxacin, erythromycin, or penicillin. An ear drop that may be useful is ciprofloxacin with hydrocortisone (Cipro HC otic suspension). Another is ofloxacin otic solution (Floxin otic) 0.3%. These ear drops are used twice a day. If the discharge from the ear is gray or black, a fungal infection may also exist, in which case tolnaftate 1% solution may be added to the treatment regimen. Aspirin, ibuprofen, or acetaminophen should be used to control fever. To avoid Reye syndrome (postviral encephalopathy and liver failure), do not use aspirin to control fever in a child under the age of 17.

To prevent swimmer’s ear, the external ear canal should be irrigated with VoSoL, Domeboro Otic solution (2% acetic acid, aluminum acetate, sodium acetate and boric acid) or diluted vinegar/alcohol (described above) after each immersion episode in the water. Keep the solution in the canal for a full five minutes before allowing it to drain.

The Sahara™ DryEar warm air ear dryer is a small, portable device to prevent and treat ear disorders by drying the ear canal. The airflow from this device runs for 80 seconds at a comfortable temperature and dries the outer ear canal. The device has a customized computer chip that directs a heater and fan to regulate the flow of warm air into the ear canal. The DryEar™ is equipped with a rechargeable lithium ion battery and can run 50 times before requiring a recharge. The device is not waterproof, so one must take care when carrying it near the water, and it should be stored in a safe, dry location.

An article was published in the American Journal of Otolaryngology in 2008 by PS Roland and colleagues of the Department of Otolaryngology at the University of Texas, Southwestern Medical School, entitled "A single topical agent is clinically equivalent to the combination of topical and oral antibiotic treatment for otitis externa."

The paper describes a clinical study, in which the objective was to demonstrate clinical equivalence of topical ciprofloxacin and hydrocortisone (CHC, Cipro HC) and topical neomycin/polymyxin b/hydrocortisone (NPH, Cortisporin) with systemic (oral) amoxicillin (AMX, Amoxil) for treatment of acute otitis externa (AOE). Two hundred and six patients were enrolled. They were at least one year of age and had AOE for more than 2 days with at least mild symptoms. The patients were administered ciprofloxacin and hydrocortisone 3 drops twice daily for 7 days (adults and children) or NPH 4 drops (adults) or 2 drops (children) with AMX 250 mg (adults and children) 3 times daily for 10 days, as directed in approved product labeling.

The primary efficacy variable was response to therapy 7 days after treatment ended. Secondary variables included time to end of pain, symptom scores (earache and tenderness) and microbiological eradication of the causative bacteria. The results indicated that response to therapy was higher for CHC (95.71% vs 89.83%) and was therefore not inferior to NPH + AMX with respect to all measurements. Median time to end of pain was 6 days for both groups. Thus, the conclusion of the study was that ciprofloxacin and hydrocortisone is clinically equivalent to NPH + AMX for the treatment of AOE in adults and children. It was the opinion of the authors that low systemic exposure, absence of ear toxicity, and less frequent dosing clearly favor Cipro HC.

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

Tags: otitis externa, swimmer's ear, ciprofloxacin, wilderness medicine, outdoor medicine, healthline

Labels: ciprofloxacin, otitis externa, swimmer's ear

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