What is the treatment for ear drainage?

Treatment for Ear Drainage

Topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) are the first-line treatment for ear drainage, applied twice daily for up to 10 days. 1 This approach is significantly more effective than oral antibiotics, with clinical cure rates of 77-96% compared to only 30-67% with systemic therapy.

Causes and Assessment of Ear Drainage

Ear drainage can result from several conditions:

• In patients with tympanostomy tubes: Drainage indicates the tube is working properly to drain middle ear infection
• In swimmers: Often caused by acute diffuse otitis externa ("swimmer's ear") with Pseudomonas aeruginosa being the most common pathogen 2
• After water exposure: Typically caused by external auditory canal pathogens like P. aeruginosa and S. aureus 1

Key assessment points:

• Examine for pain on movement of the pinna or tragus (classic finding in otitis externa) 3
• Determine if tympanostomy tubes are present and functioning
• Check for fever (usually absent when tubes are functioning properly) 1

Treatment Algorithm

1. For ear drainage with tympanostomy tubes:

• Primary treatment: Topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) twice daily for up to 10 days 1
• Ear cleaning: Remove drainage with cotton-tipped swab dipped in hydrogen peroxide/warm water, cotton ball, or infant nasal aspirator 1
• Water precautions: Use cotton saturated with Vaseline during bathing; avoid swimming until drainage stops 1
• When to use oral antibiotics: Only if patient is very ill, has another reason to be on antibiotics, or infection doesn't respond to ear drops 1

2. For ear drainage without tympanostomy tubes (otitis externa):

• Primary treatment: Topical antibiotics with acidifying agents 3
• Options include: Acetic acid 2%, aminoglycosides, polymyxin B, or quinolones (with or without corticosteroids) 3
• Pain management: Acetaminophen or NSAIDs for mild to moderate pain; NSAIDs plus opioids for severe pain 4
• Ear care: Keep ear dry; consider acidifying ear drops before/after swimming 4

Special Considerations

For swimmers:

• Avoid swimming in polluted waters
• Avoid cleaning ear canal with cotton-tip applicators
• Dry ear canal with hair dryer after water exposure 4, 2

Duration of treatment:

• Most patients feel better within 48-72 hours of starting appropriate topical therapy
• Symptoms should resolve significantly by 7 days 4

When to Seek Further Medical Care

Call a doctor if:

1. Ear drainage continues for more than 7 days
2. Drainage occurs frequently
3. Hearing loss, continued ear infections, or persistent ear pain occurs
4. Excessive wax build-up in the ear canal develops 1

Common Pitfalls to Avoid

• Overuse of oral antibiotics: Topical treatment is superior and reduces risk of antibiotic resistance 1, 4
• Prolonged use of antibiotic eardrops: Limit to 10 days to avoid yeast infections of the ear canal 1
• Inserting objects into ear canal: Avoid cotton-tipped swabs for cleaning as they can cause further irritation 4
• Inadequate follow-up: Schedule follow-up if symptoms persist beyond 7 days despite treatment 4

Topical therapy is highly effective due to increased drug concentration at the infection site and better coverage of likely pathogens compared to systemic antibiotics 1. This approach minimizes systemic side effects while providing superior clinical outcomes.