Drops preferred over oral antibiotics

Antiseptic or antibiotic ear drops should be the front-line treatment for people suffering from swimmer's ear, while restraint should be exercised in using oral antibiotics, according to treatment guidelines issued by a panel of specialists that includes the chairman of Otolaryngology at the University of Texas Southwestern Medical Center, Dallas.

"The most important feature of these new guidelines is that they are entirely evidence-based," declares Peter S. Roland. "They do not depend on clinicians' opinions, but instead are based on what has been scientifically demonstrated in the medical literature."

Swimmer's ear, a condition formally called acute otitis externa, is an infection of the outer ear and ear canal, often resulting from water becoming trapped in the ear. Water can remove protective earwax, allowing infections to develop. It most often is found in swimmers, but can result from showering or bathing. Other causes can include cleaning or scratching the ear, as well as skin conditions such as psoriasis or acne.

Symptoms usually involve redness and swelling, itching, mild to moderate ear pain, particularly when moving the head, or a feeling that the ears are blocked. There also may be pus drain age, fever, decreased hearing, radiating pain, and swollen lymph nodes. The panel's findings and recommendations include:

* Initially treat the condition with antiseptic or antibiotic ear drops, which inhibit bacterial growth. The drops usually relieve pain within a day and clear up the condition within a week.

* Administer oral antibiotics with restraint unless other conditions are present, such as diabetes or some immune diseases, because studies indicate those medications are less effective and have more side effects.

* Ear candles have not been shown to be effective and can have adverse side effects, including burning or perforating the ear drum. Ear candling, often found in new age shops, involves putting a cone-shaped device--usually a fabric soaked in wax to harden--into the ear to remove impurities with smoke.

* Otolaryngologists caution against putting fingers or other objects in the ear, including cotton swabs, which can cause damage or push material deeper into the canal.

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