New Swimmer's Ear Guidelines Call for Use of Antimicrobial Drops, Pain Tx First

Dr. Seth Pransky, a pediatric otolaryngologist at Children's Hospital in San Diego, observed that although the guidelines are new, their advice is familiar to many physicians.

“Perhaps this might be considered new for primary care physicians, but the vast majority of otolaryngologists understand that this is a disease treated with topical rather than oral antibiotics,” Dr. Pransky said.

“There are cases where orals are necessary, and the guidelines point that out—but they're a lot less common than garden variety, run-of-the-mill swimmer's ear, which is very painful.”

Dr. Michael Pichichero, professor of microbiology and immunology at the University of Rochester (N.Y.) Medical Center, also approved of the recommendations. “I think the guidelines are very well written and comprehensive and appear to be evidence based—on as much evidence as we do have,” he said in an interview.

In particular Dr. Pichichero noted that distinguishing between patients who have an intact eardrum and those who don't has a sizeable impact on the antibiotic choice—because if the eardrum is not intact, “we really should move to preference for the chloroquinolone antibiotic preparations, which are not ototoxic.”

The document gave various treatment recommendations for specific AOE etiologies and advised against the use of alternative therapies such as ear candles.

The guidelines, which were published as a supplement to the journal Otolaryngology-Head and Neck Surgery, will be available free of charge at www.entnet.org

Drops don't cause systemic side effects, and you help keep down bacterial resistance. DR. EAVEY