From the Guidelines
Otitis externa is typically treated with topical therapeutic options, including cerumen removal, and a variety of antifungal and antibacterial agents such as acetic acid or boric acid irrigations, and topical antifungal creams and ointments like clotrimazole, and ketoconazole 1.
Treatment Options
- Topical antifungal agents: such as clotrimazole, ketoconazole, and nystatin are commonly used to treat otitis externa caused by fungal infections 1.
- Acetic acid or boric acid irrigations: are described as being beneficial in treating otitis externa, particularly in cases where the infection is caused by Aspergillus species 1.
- Cerumen removal: is an important part of the treatment, as it helps to remove debris and prevent further infection 1.
Special Considerations
- Immunocompromised patients: may require systemic antifungal therapy, in addition to topical treatment, to effectively manage the infection 1.
- Severe cases: may require oral antifungal agents such as itraconazole, voriconazole, or posaconazole, although there are limited studies to support their use 1.
From the Research
Treatment Overview
The treatment for otitis externa (inflammation of the outer ear) typically involves a combination of approaches, including:
- Eliminating infection
- Pain management
- Education
- Preventing recurrence 2
- Debridement (removal of dead tissue or other debris)
- Topical therapy with acidifying and antimicrobial agents
- Systemic antimicrobial therapy when indicated 3
Topical Treatments
Topical treatments are often the primary treatment for uncomplicated otitis externa, and may include:
- Acidifying agents
- Antimicrobial agents
- Antibiotics (such as aminoglycosides, polymyxin B, and quinolones)
- Corticosteroids (to help resolve symptoms more quickly) 4
- Antiseptics (which may be as effective as antibiotics in some cases) 5
Systemic Treatments
Systemic treatments, such as oral antibiotics, may be reserved for cases where the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 4
Specialized Treatments
Specialized treatments may be necessary for certain types of otitis externa, such as:
- Necrotizing (malignant) otitis externa, which may require systemic antibiotics and surgical debridement 3, 6
- Mycotic (fungal) otitis externa, which may require topical antifungal agents 3
- Eczematous otitis externa, which may require treatment of the underlying dermatological condition 3
Prevention
Prevention of recurrent otitis externa is aimed at minimizing ear canal trauma and avoiding exposure to water, and may include the use of topical acidifying agents or 70% alcohol 3