What is the treatment for ear drainage?

Treatment of Ear Drainage

The best treatment for ear drainage is topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone), administered twice daily for up to 10 days, which have superior clinical cure rates (77-96%) compared to oral antibiotics (30-67%). 1, 2

Treatment Based on Cause of Drainage

For Ear Drainage with Tympanostomy Tubes

• Antibiotic ear drops alone (ofloxacin or ciprofloxacin-dexamethasone) are the first-line treatment, placed in the ear canal twice daily for up to 10 days 1, 2
• "Pump" the flap of skin in front of the ear canal (tragus) after placing drops to help them enter the ear tube 1
• Remove drainage buildup with a cotton-tipped swab dipped in hydrogen peroxide or warm water, a cotton ball, or gentle suction with an infant nasal aspirator 1
• Prevent water entry during bathing by using cotton saturated with Vaseline to cover the ear canal opening; swimming should be avoided until drainage stops 1
• Oral antibiotics are unnecessary for most ear infections with tubes unless the child is very ill, has another reason to be on antibiotics, or the infection doesn't respond to ear drops 1, 2

For Otitis Externa (Swimmer's Ear)

• Topical antibiotic/steroid drops are the treatment of choice 3
• For severe cases, a gauze wick soaked with ichthammol 10% in glycerin may be placed into the ear canal and replaced every 24-48 hours 3
• Systemic antibiotics are reserved for more severe cases 3
• Cleaning and drying of the ear canal is essential before application of topical medications 4

For Chronic Suppurative Otitis Media

• Initial management includes cleaning and drying of the ear and application of topical antibiotics 4
• Topical therapy delivers higher drug concentration directly to the infection site with better coverage of likely pathogens including Pseudomonas aeruginosa and Staphylococcus aureus 2

Important Considerations

Diagnostic Approach

• Determine the site of origin and underlying cause of drainage (external ear canal vs. middle ear) 5
• Drainage may be blood, pus, cerebrospinal fluid, or wax 3
• If the ear canal and tympanic membrane are obscured by discharge, use cotton buds, microsuction equipment, or syringing to remove it for proper examination 3

When to Use Oral Antibiotics

• Amoxicillin may be indicated for ear infections due to susceptible β-lactamase-negative organisms such as Streptococcus species, Streptococcus pneumoniae, or Haemophilus influenzae 6
• However, oral antibiotics should be reserved for cases where topical therapy is ineffective or when the patient appears very ill 1, 2

Follow-up Care

• For patients with tympanostomy tubes, routine follow-up every 4-6 months is important to ensure tubes are in place 1
• Once tubes fall out, a final check after 6-12 months is recommended to ensure fluid has not built up again 1

When to Seek Specialist Care

• If ear drainage continues for more than 7 days despite treatment 2
• For frequent recurrences of ear drainage 1
• If the patient has hearing loss, continued ear pain, or discomfort 1
• If there is excessive wax build-up in the ear canal 1
• If the primary doctor cannot see the tympanostomy tube in the ear 1

Prevention of Complications

• Limit antibiotic ear drop use to no more than 10 days at a time to avoid yeast infections of the ear canal 1
• For children with tympanostomy tubes, ear plugs are generally needed only for swimming more than 6 feet underwater, swimming in lakes or non-chlorinated pools, or dunking the head in the bathtub 1
• Prolonged middle ear effusion may affect balance and postural stability in children, so timely treatment is important 7