Treating Painful Swimmers’ Ear

Each year over 6 million cases of swimmer's ear will cause kids (and adults) painful infections in the ear canal - interrupting many vacations and days of summer fun. People deserve speedy, safe, effective treatment to relieve the pain and get them back in the water. In April 2006, the American Academy of Otolaryngology came out with their first-ever set of evidence-based clinical practice guidelines, and they chose swimmer's ear as the topic. In an effort to help get the important message in their guidelines out, I've joined forces with the YMCA and Daiichi Sankyo , Inc., the makers of Floxin Otic, in the Splash into Health Campaign . According to the 2006 guidelines, antimicrobial ear drops are the best way to treat most cases of swimmer's ear. But right now people are getting a wide variety of treatments that may not be the best choices, from home remedies to prescription oral antibiotics. Let's explore the options. First, what is swimmer's ear? It's a bacterial infection in the skin of the ear canal, usually caused by a type of bacteria called pseudomonas. The bacteria can come from the water or from the surface of your skin. They slip into the skin if the outer layer is rubbed or scratched or becomes “pruney” from water. The ear may start to itch or become red within 48 hours. An earache develops; swimmer's ear hurts! I can still remember being kept awake by the pain from a swimmer's ear when I was about 4 years old.

Up to 40% of swimmer's ear in the United States is now treated with oral antibiotics. But consider, if you take a 1000 mg of oral antibiotics, the medicine is spread throughout your body, from head to toe. It kills beneficial bacteria in your GI tract, and can cause a variety of side effects including rashes, diarrhea, vomiting, and allergic reactions, all while contributing to bacterial resistance. Only a very small amount of the antibiotic makes it to the outer layer of your skin. And an even smaller amount makes it to the tiny patch of skin in the canal of your infected ear - only 0.001 to 0.01 mg. In contrast, if you use once daily antibiotic drops, you take only 1 mg of antibiotics (1000 times less), but 100 to 1000 times more medicine gets to the site of the infection - and it leaves your GI tract alone. Antibiotic drops are fast-acting and easy to use. I prefer once a day drops to make it even easier. With once a day drops, symptoms may be gone within that first day. On the other end of the spectrum, white vinegar drops also work to cure swimmer's ear, but the ear pain lasts for an average of 8 days. I'm a fan of reducing antibiotic use, but to me antibiotic ear drops are a great choice. They can reduce the amount of antibiotics by more than 99%, stay largely on the surface of the body, and provide prompt relief. Of course, preventing Swimmers' Ear is even better. Let's get kids back in the water, staying active and having fun!

Alan Greene MD FAAP