From the Guidelines
Otitis externa is typically treated with topical therapeutic options, including cerumen removal, and a variety of antifungal and antibacterial agents.
Treatment Options
- Topical antifungal agents such as nystatin, amphotericin B 3% topical solution, clotrimazole, and ketoconazole may be used to treat otitis externa caused by fungal infections 1.
- Acetic acid or boric acid irrigations may also be beneficial in treating otitis externa, particularly in cases of Aspergillus otomycosis 1.
- Cerumen removal is an important part of the treatment, as it helps to remove debris and prevent further infection 1.
- In severe cases or in immunocompromised patients, systemic antifungal therapy may be necessary, but there is limited evidence to support the use of specific agents such as itraconazole, voriconazole, or posaconazole 1.
Important Considerations
- Immunocompromised patients may require more aggressive treatment, including systemic antifungal therapy, to prevent complications such as invasive infection of the external ear canal or Aspergillus mastoiditis 1.
- Prolonged therapy may be necessary to ensure complete resolution of the infection, particularly in cases of fungal otitis externa 1.
From the Research
Treatment Options for Otitis Externa
The treatment for otitis externa can vary depending on the severity and type of infection. Some common treatment options include:
- Topical antimicrobials or antibiotics, such as acetic acid, aminoglycosides, polymyxin B, and quinolones, which are often used in combination with topical corticosteroids 2, 3, 4
- Systemic antimicrobial therapy, which may be necessary in cases where the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 2, 5, 4
- Debridement and cleansing of the ear canal, which can help to remove debris and promote healing 2, 6
- Topical acidifying and drying agents, which can help to reduce moisture and prevent further infection 2, 5
- Surgery, which may be necessary in cases of chronic otitis externa or necrotizing otitis externa to allow for cleansing and aeration of the ear canal 2
Specific Treatment Approaches
Different types of otitis externa may require specific treatment approaches, such as:
- Acute localized otitis externa (furunculosis), which can be treated with local heat and systemic antibiotics in the inflammatory stage, and drainage in the abscess state 2
- Mycotic external otitis, which can be managed with topical acidifying and antifungal agents 2
- Viral (herpes) infection, which can be treated with topical and systemic aciclovir (acyclovir) 2
- Necrotizing (malignant) external otitis, which can be treated with systemic antibiotics and, rarely, surgical debridement 2
- Eczematous otitis externa, which can be treated by addressing the underlying dermatological condition and using topical corticosteroids and antimicrobials as needed 2, 4
Prevention and Management
Prevention and management of otitis externa can involve:
- Avoiding exposure to water and moisture, which can help to prevent infection 2, 5
- Using topical acidifying agents or 70% alcohol to help prevent infection 2
- Avoiding trauma to the ear canal, which can help to prevent infection 2, 5
- Educating patients on proper ear care and hygiene, which can help to prevent infection and promote healing 6