How Should Swimmer's Ear (Acute Otitis Externa) Be Managed?

Judith S. Lynch, MS, MA, APRN-BC


July 01, 2011

In This Article

Treatment of AOE

The goal of treatment is to relieve the patient's pain while treating the underlying infection as quickly as possible. The use of oral antibiotics is no longer necessary in the treatment of AOE unless the patient is immunocompromised or has an overt otitis media. Topical treatments are effective in 87% to 97% of cases and include:

  • Dexamethasone 0.1%/ciprofloxacin 0.3% is a combination of steroid and fluoroquinolone inhibits bacterial DNA syntheses and consequently growth. It also reduces canal edema and relieves pain. The dose is 4-5 drops into the affected ear, twice daily, for 7 days. A longer course may be used with severe cases. Fungal infections may occur with prolonged use.

  • Ciprofloxacin otic is the same combination as above without the addition of a steroid. This may be used with mild cases of AOE where edema is not profound. Both compounds may be used safely in patients with perforated tympanic membranes and carry no warnings for ototoxicity. Dose and duration of use are the same as above.[5]

  • Neomycin, polymixin B, hydrocortisone has a broad-spectrum bactericidal effect, may be painful to the ear canal, and rarely results in a Neosporin® hypersensitivity. It must not be used if there is a suspicion of a perforated tympanic membrane.

  • Fungal infections may be treated with acetic acid solutions or with a topical antifungal agent (1% clotrimazole 3-5 drops twice daily). The course of therapy is usually 10-14 days.

Supportive measures in the management of AOE include the following:

  • No swimming! Swimming is not allowed until the infection is completely cleared, usually 10 days to 2 weeks.

  • Analgesics: The short-term use of narcotic pain-relief agents is justified. Prescribe pain relief for 48-72 hours for moderate to severe cases. At the 72-hour recheck visit, switch to an anti-inflammatory agent or acetaminophen.

  • Water protection: The affected ear must be kept dry during showers, shampoos, etc. This can be accomplished by gently placing a small cotton ball in the ear and applying petroleum jelly to the cotton ball.

  • Warm compresses to the area for 10-15 minutes 3 times daily will alleviate discomfort.

  • A soft diet is helpful to minimize pain with jaw movement.

  • Do not use hearing aids, earplugs, or headphones until the infection clears.

Complications Requiring Consultation or Referral

  • Temporary hearing loss: If this does not resolve, refer the patient for audiometric evaluation.

  • Chronic OE lasting longer than 6 weeks.

  • Cellulitis requiring an oral antibiotic (usually a fluoroquinolone).

  • Necrotizing OE with bone and cartilage damage requiring referral and hospitalization

  • Sepsis into the brain or nerves: This is rare but life-threatening.


For moderate to severe cases, recheck the patient in 48-72 hours, especially if the tympanic membrane was not visualized during the initial visit. If the patient is not experiencing immediate relief, consultation with an ear-nose-throat specialist is helpful. A wick can be placed in the ear to help deliver topical medication more effectively.

Additional follow-up a week later is advisable for visualizing the affected ear and continued symptom relief. Debris may be gently removed only if the canal has no erythema or edema. Hearing should be restored as edema resolves.


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