According to the CDC’s May 20, 2011 Morbidity and Mortality Weekly Report, nonhospitalized acute otitis externa (AOE) visits cost the United States healthcare system as much as $500 million each year and about 600,000 clinician hours annually. Looking at national ambulatory care and emergency department databases, the study found that in 2007, an estimated 2.4 million visits (8.1 per 1,000 population) resulted in an AOE diagnosis. The researchers conducting the study estimated that 1 in 123 people was affected by AOE during 2007, accounting for 1 in 324 emergency department visits and 1 in 481 ambulatory care visits.
From 2003 to 2007, the highest estimated annual rates of ambulatory care visits for AOE were among those between the ages of 5 and 9 years (18.6%) and aged 10 to 14 (15.8%). That’s not to say that children are the only ones affected by AOE; 53% of visits were among those aged 20 and older (5.3%). Gender didn’t seem to play a role, with women accounting for 54% of AOE visits. Aside from a larger proportion of AOE visits among those aged 20 to 39, similar demographic distribution was seen among emergency department visits.
Naturally, incidence was highest during summer months—when Americans are most likely to be swimming—and in states in the South (9.1%, compared with 4.3% in the West), where weather is more likely to be warm and humid. Rates did not differ between rural and urban areas.
The authors of the study noted that AOE is easily preventable. What can physicians do to help their patients prevent these occurrences? Based on suggestions from the CDC, it behooves physicians to advise patients to reduce ear exposure to water by using swim caps or ear plugs when swimming and by using alcohol-based ear-drying solutions.
Physician’s Weekly wants to know…
• Why is such an easily avoidable condition so common?
• Aside from the CDC’s suggestions, how else can AOE be avoided?
• Are physicians making a strong enough effort to educate patients and parents on how to prevent AOE? Do you feel the level of importance surrounding the issue warrants greater prevention efforts?
• Do you discuss AOE with your patients or the parents of your pediatric patients? In what circumstances should physicians be especially vigilant about patient education on AOE?
• What advice do you offer to patients on preventing AOE and how do you approach the subject? Among what patient populations do you feel the discussion is most useful?
Readings & Resources (click to view)
1. Agius AM, Pickles JM, Burch KL. A prospective study of otitis externa. Clin Otolaryngol. 1992;17:150-154.
2. Calderon R, Mood EW. An epidemiological assessment of water quality and “swimmer’s ear.” Arch Environ Health. 1982;37:300-305.
3. Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database of Systemic Reviews 2010;1. Available at http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004740/frame.html. Accessed May 12, 2011.
4. Rosenfeld RM, Brown L, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck. 2006;134:S4-S23.
5. Springer GL. Fresh water swimming as a risk factor for otitis externa: a case-control study. Arch Environ Health. 1985;40:202-206.
6. McCoy SI, Zell ER, Besser RE. Antimicrobial prescribing for otitis externa in children. Pediatr Infect Dis J. 2004;23:181-183.
7. Halpern MT, Palmer CS, Seidlin M. Treatment patterns for otitis externa. J Am Board Fam Pract. 1999;12:1-7.
8. Rosenfeld RM, Singer M, Wasserman JM, Stinnett. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. 2006;134:S24-S48.
9. Nussinovitch M, Rimon A, Volovitz B, Raveh E, Prais D, Amir J. Cotton-tip applicators as a leading cause of otitis externa. Int J Pediatr Otorhinolaryngol. 2004;68:433-435.
10. CDC. Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events—United States, 2005-2006. MMWR. 2008;57(No. SS-9).