From the Guidelines
External ear dermatitis, also known as otitis externa, can be effectively treated with a combination of gentle cleaning and appropriate medications, prioritizing topical therapy without systemic antibiotics for initial management, as recommended by the clinical practice guideline: acute otitis externa 1.
Diagnosis and Treatment
For mild cases, I recommend cleaning the ear canal with a solution of equal parts white vinegar and water, followed by application of a topical steroid cream like 1% hydrocortisone twice daily for 7-10 days.
- For more severe or infected cases, use antibiotic-steroid combination drops such as ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex), 4 drops twice daily for 7 days.
- Keep the ears dry during treatment by avoiding swimming and using earplugs during showers.
- If fungal infection is suspected, clotrimazole 1% solution applied twice daily for 7-10 days is effective. The underlying cause of external ear dermatitis is often disruption of the ear canal's protective barrier due to moisture, trauma from cotton swabs, or allergic reactions.
Special Considerations
Treatment works by reducing inflammation, fighting infection, and allowing the skin to heal.
- If symptoms persist beyond 10 days of treatment, or if you experience severe pain, fever, or hearing loss, seek medical attention as these may indicate a more serious condition requiring different management, such as necrotizing otitis externa or otomycosis 1.
- Patients with diabetes, an immunocompromised state, or both require special consideration because they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to AOE but require different management 1.
- Allergic contact dermatitis of the external auditory canal can result in refractory AOE in some patients, especially in cases with prolonged use of antimicrobial otic drops, and may be caused by neomycin-containing eardrops or other topical antimicrobials, preservatives, or vehicles in topical otic medications 1.
From the Research
Diagnosis of External Ear Dermatitis (Otitis Externa)
- The diagnosis of otitis externa is based on symptoms such as discomfort limited to the external auditory canal, and signs including erythema and swelling of the canal with variable discharge 2.
- A thorough cleansing of the canal is essential for diagnosis and treatment, but flushing should be avoided 2.
- Symptoms of patients with acute otitis externa include pain, discharge from the ear, swelling of the ear canal, auricle swelling, tenderness, and ear itching 3.
Treatment of External Ear Dermatitis (Otitis Externa)
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is effective treatment in most cases 2.
- Topical ciprofloxacin and hydrocortisone (CHC) is clinically equivalent to topical neomycin/polymyxin b/hydrocortisone (NPH) with systemic amoxicillin (AMX) for the treatment of acute otitis externa (AOE) 4.
- A group III steroid solution without antibiotic components, such as 0.05% solution of betamethasone dipropionate (BD), is an effective cure for external otitis and affords a lower relapse frequency during a six-month follow-up period 5.
- Boric acid and combination of polymyxin, neomycin and hydrocortisone (polymyxin NH) are also effective in the treatment of acute otitis externa, with slight differences in effectiveness 3.
- Ciprofloxacin is a useful and effective agent in the local therapy of otitis externa, with rapid eradication of all bacterial pathogens and marked clinical improvement 6.
Prevention of External Ear Dermatitis (Otitis Externa)
- Avoidance of excessive moisture and trauma, which impair the canal's natural defenses, is the cornerstone of prevention 2.
- Drying the ears with a hair dryer and avoiding manipulation of the external auditory canal may help prevent recurrence 2.
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation, when used after exposure to moisture, is an excellent prophylactic measure 2.