What is the best treatment for external otitis (infection of the outer ear)?

From the Guidelines

The best treatment for external otitis (infection of the outer ear) is topical antibiotic ear drops, which should be used in conjunction with pain management and measures to keep the ear dry. According to the clinical practice guideline published in 2014 by the American Academy of Otolaryngology—Head and Neck Surgery Foundation 1, the primary outcome considered is clinical resolution of acute otitis externa (AOE). The guideline emphasizes the importance of accurate diagnosis and adequate pain relief.

When managing external otitis, it is crucial to consider the following key points:

• Topical antibiotic ear drops containing fluoroquinolones, such as ciprofloxacin or ofloxacin, are effective against bacterial infections, which are the primary cause of diffuse AOE 1.
• Combining antibiotics with steroids can help reduce inflammation and promote healing.
• Pain management is essential and can be achieved with acetaminophen or ibuprofen.
• Keeping the ear dry is vital for both treatment and prevention, as moisture can trap bacteria in the ear canal, creating an ideal environment for infection.

In terms of treatment specifics, applying 3-4 drops of topical antibiotic ear drops into the affected ear canal 2-3 times daily for 7-10 days is a common regimen. Before application, gently cleaning the outer ear with a warm washcloth is recommended, but it is essential to avoid inserting anything into the ear canal. For severe infections, a healthcare provider may need to place a small wick in the ear canal to help medication reach deeper areas. If the infection does not improve within 48-72 hours of treatment, shows signs of spreading beyond the ear, or if the patient has diabetes or a compromised immune system, seeking medical attention promptly is necessary.

From the Research

Treatment Options for External Otitis

The treatment for external otitis, an infection of the outer ear, can vary depending on the cause and severity of the infection. Some key treatment options include:

• Topical antimicrobial therapy, which is often the first line of treatment for uncomplicated cases 2, 3, 4, 5
• Cleaning and debridement of the ear canal to remove debris and promote healing 2, 3, 6
• Use of ear drops, such as antibiotic or corticosteroid drops, to reduce inflammation and fight infection 2, 3, 4
• Systemic antimicrobial therapy, which may be necessary for more severe cases or for patients with certain underlying health conditions 3, 6, 5
• Pain management, which is an important aspect of treatment for external otitis 5

Specific Treatment Recommendations

Some studies recommend the following specific treatment approaches:

• Use of a combinatorial broad-spectrum antibiotic/corticosteroid ear drop for bacterial inflammation 2
• Use of topical acidifying and antifungal agents for mycotic external otitis 3
• Use of topical and systemic aciclovir for viral (herpes) infection 3
• Use of neomycin-polymyxin B association for its synergistic activity against pathogens responsible for otitis externa 4

Important Considerations

When treating external otitis, it is important to consider the following factors:

• The need for adequate pain relief 5
• The potential for underlying health conditions, such as diabetes or immunocompromised state, to modify management 5
• The importance of distinguishing diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the ear canal 5
• The need for regular follow-up and reassessment to ensure that the treatment is effective and to exclude other causes of illness 5