Drops, not pills, best for swimmers ear

　　Antibiotic 1 or antiseptic drops are the best approach to treating swimmer's ear, according to a new research review. And while oral antibiotics 2 are often prescribed along with ear drops to treat swimmer's ear, this is not necessary, the reviewers say.

Swimmer's ear -- known medically as acute otitis externa -- is an inflammation of the ear canal that may or may not involve infection. A person's ear may feel blocked and touching 3 or gently pulling the ear may be painful.

Eardrops have been the mainstay of treatment for swimmer's ear for over 50 years, but studies have shown as many as 40 percent of these patients may also receive a prescription 4 for oral antibiotics.

To investigate the best approach to treating the condition, Dr. Vivek Kaushik of the Stepping Hill Hospital in Stockport, UK, and colleagues looked at 19 randomized clinical trials including 3,382 patients in all. Treatments evaluated included astringent 5 (drying), antiseptic, antibiotic, and steroid ear drops; various combinations of these topical treatments; oral antibiotics; and ear cleaning.

Overall, the researchers found, antibiotic or antiseptic drops, with or without steroids, produced a 55 percent to 100 percent cure rate for swimmer's ear, compared to a 10 percent cure rate for inactive placebo 6 drops.

Given that all of the topical treatments tested seemed to be equally effective, Kaushik and colleagues say, doctors may decide which therapy to use based on cost, risk of toxicity 7 to the ear, and other concerns.

Typically, symptoms will last for about six days after a person starts treatment, the researchers say, and doctors usually recommend a patient use the treatment for seven to 10 days. "It may be more useful when prescribing ear drops to instruct patients to use them for at least a week," they add. If symptoms persist, according to the researchers, the patient should keep using the drops for up to seven more days; if symptoms last for more than two weeks, another treatment should be tried.

A prescription for oral antibiotics may be warranted in certain cases, Kaushik notes, for example when the infection has spread to the inner ear or face.

The findings appear in the most recent issue of The Cochrane Library, a publication of the Cochrane Collaboration 8, an international non-profit group that evaluates medical research and makes evidence-based recommendations on treatment.

People who are prone 9 to developing swimmer's ear can protect their ears when they swim by using ear plugs or a bathing cap, or even placing petroleum 10 jelly-smeared cotton balls over the ear canal, Dr. Richard Rosenfeld, chairman of otolaryngology at SUNY-Downstate Medical Center in Brooklyn, New York, told the Health Behavior News Service.

Those who get frequent infections can help prevent them by using antibiotic or antiseptic drops after swimming, noted 11 Rosenfeld, who was not involved in Kaushik's study. A home-made mix of half white vinegar, half rubbing alcohol can work just as well as store-bought ear drops, according to Rosenfeld.