From the Guidelines
The most effective treatment for otitis externa is topical ear drops, which may contain antibiotics, antiseptics, steroids, or a combination, and should be used for at least 7 days, even if symptoms improve sooner. According to the clinical practice guideline for acute otitis externa 1, eardrops alone are sufficient to treat the infection in most cases, and oral antibiotics should only be used when the infection spreads beyond the ear canal, eardrops cannot get into the ear, or the immune system is weak. The guideline also states that all eardrops approved for treating acute otitis externa are highly effective, with no consistent advantage shown for any one specific drug 1.
When selecting an eardrop, factors such as cost, dosing frequency, status of the eardrum, and the doctor's experience should be considered 1. It is also essential to inform the doctor about any prior ear surgery, eardrum perforation, or ear tube placement, as well as any history of diabetes or reaction to ear drops or antibiotics 1.
To manage pain, especially in the first few days of treatment, pain medicine can be used, but pain-relieving eardrops are not recommended as they can mask symptoms of a delayed response to therapy 1. Additionally, it is crucial to avoid scratching or touching the ear, inserting anything into the ear canal, and to keep the ear dry during treatment by using earplugs or a shower cap when bathing 1.
Key points to consider when treating otitis externa include:
- Using eardrops for at least 7 days, even if symptoms improve sooner
- Informing the doctor about any prior ear surgery, eardrum perforation, or ear tube placement
- Avoiding scratching or touching the ear and keeping the ear dry during treatment
- Using pain medicine to manage pain, especially in the first few days of treatment
- Notifying the doctor if symptoms persist beyond 7 days or if there are any unexpected side effects from the eardrops 1.
From the Research
Treatment Options for Otitis Externa
- Topical antimicrobials containing steroids are effective in treating otitis externa, with a significant difference in clinical cure rates compared to placebo drops 2
- Topical otic powder, such as Auricularum, has been shown to be effective in treating otitis externa, with a higher probability of healing within 7 days compared to otic drops 3, 4
- Quinolone antibiotics, such as ofloxacin, have been shown to be effective in treating otitis externa, with a clinical cure rate of over 80% in adults and over 95% in children 5
- Acetic acid has been shown to be effective in treating otitis externa, but may be less effective than antibiotic/steroid drops in terms of cure rate at two and three weeks 2
- Steroid-only drops may be effective in treating otitis externa, but the evidence is limited and not robust enough to allow for conclusions or recommendations 2
Comparison of Treatment Options
- No clinically meaningful differences were noted in clinical cure rates between various topical interventions, including quinolone antibiotics, aminoglycosides, and steroid-only drops 2
- Topical otic powder may promote earlier healing and pain relief compared to otic drops 4
- The choice of topical treatment may be determined by factors such as risk of ototoxicity, risk of contact sensitivity, risk of developing resistance, availability, cost, and dosing schedule 2
Role of Topical Antibiotics
- Topical antibiotics may not be necessary in the management of otitis externa, with one study suggesting that an aminoglycoside antibiotic conveys no significant benefit in this condition 6
- The use of topical antibiotics may be associated with risks such as ototoxicity and the development of antibiotic resistance 2