What to do for someone with swimmer’s ear is, by now, very clear: Use antibiotic eardrops. The issue has been settled in the literature and in expert reviews of the evidence. Oral antibiotics not only tend not to work, but they also promote antibiotic resistance, too (Otolaryngol Head Neck Surg. 2014;150(1 Suppl):S1-S24).
Explore this issue:September 2016
But, frequently, this guideline is not followed. “I cannot tell you how many people have been put on several different oral antibiotics as first-line medical intervention,” said Wendy Stern, MD, a physician at Southcoast Hospital Group in Dartmouth, Mass., and immediate past chair of the board of governors of the American Academy of Otolaryngology–Head and Neck Surgery. “It comes down to pressure not to refer to the specialist. Many patients are treated at walk-in and urgent care centers and by mid-level providers and physicians who may not know the guidelines. By the time they come to us, they have a significant problem, where if they had been treated with antibiotic ear drops they probably would have gotten better very quickly.”
Many of these patients experience compromised hearing and miss work or school due to severe pain. Often the ear canal is so swollen by the time we see them we’re at the point of putting wicks in their ears,” Dr. Stern said. “Sometimes it’s complicated by a fungal infection on top of a bacterial infection. It’s a whole variety of things.”