How to treat open sores on the ear?

Treatment of Open Sores on the Ear

The treatment approach depends critically on the location and underlying cause of the open sores: if they are on the external ear canal, perform aural toilet (cleaning) followed by topical antibiotic drops with corticosteroids; if they are on the ear auricle (outer ear), clean and repair any wounds within 12-24 hours and monitor for infection; if they represent dermatologic conditions, treat the underlying skin disorder with topical corticosteroids or other appropriate agents. 1, 2

Initial Assessment: Determine the Location and Cause

Location matters significantly for treatment:

• Ear canal sores suggest acute otitis externa (AOE), dermatologic conditions (eczema, seborrhea, psoriasis), contact dermatitis, or furunculosis 1
• Auricle (outer ear) sores suggest traumatic wounds, lacerations, or burns that require wound repair 2
• Look for key distinguishing features: tragal tenderness indicates AOE 1, vesicles suggest herpes zoster oticus 1, greasy yellowish scaling suggests seborrheic dermatitis 1, and localized pustular lesions suggest furunculosis 1

Treatment Algorithm by Cause

For Acute Otitis Externa (Infected Ear Canal)

Aural toilet is essential before any topical therapy:

• Clean the ear canal using gentle suction or dry mopping to remove debris and allow medication penetration 1, 3
• Avoid irrigation in diabetic or immunocompromised patients as this can precipitate necrotizing otitis externa 4

Topical antibiotic-corticosteroid drops are first-line therapy:

• Use topical fluoroquinolone drops (such as ofloxacin 0.3%) combined with corticosteroids for 7-10 days 1, 4, 5
• The corticosteroid component reduces inflammation, edema, and pain 1
• Oral antibiotics have limited utility and should be avoided unless cellulitis extends beyond the ear canal or the patient is immunocompromised 1, 5
• About 20-40% of patients inappropriately receive oral antibiotics that are usually inactive against the causative organisms (Pseudomonas aeruginosa and Staphylococcus aureus) 1

Consider an ear wick if the canal is severely swollen:

• This facilitates medication delivery when edema prevents drops from reaching the affected area 1

For Dermatologic Conditions (Eczema, Seborrhea, Psoriasis)

These conditions mimic AOE but require different treatment:

• Eczema: Apply emollients, topical corticosteroids, and prevent secondary infection with gentle skin care 1
• Seborrheic dermatitis: Use topical antifungal medications to reduce Malassezia yeast and topical anti-inflammatory medications for inflammation and itch 1
• Psoriasis: Intralesional triamcinolone acetonide injection is effective for ear psoriasis resistant to other therapies 6

For Contact Dermatitis (Allergic or Irritant)

Remove the offending agent immediately:

• Common culprits include nickel (earrings), neomycin in ear drops (5-15% sensitization rate), hearing aid materials, and cosmetics 1
• Avoid neomycin-containing preparations as neomycin causes allergic reactions in 13% of normal volunteers 1
• Apply topical corticosteroids or calcineurin inhibitors (tacrolimus 0.1% ointment or pimecrolimus 1% cream) 1

For Furunculosis (Infected Hair Follicle)

This presents as a localized pustular lesion on the outer third of the ear canal:

• Apply local heat, perform incision and drainage if needed 1
• Use systemic antibiotics covering S. aureus only if necessary 1

For Traumatic Wounds on the Auricle

Time is critical—repair within 12-24 hours:

• Clean the wound thoroughly using sterile technique 2
• For simple skin lacerations: Use skin-to-skin sutures under local anesthesia without epinephrine 2
• For lacerations involving cartilage: Combine skin sutures with intercartilage sutures to prevent cartilage warping 2
• Never use epinephrine in local anesthesia as it compromises the already tenuous blood supply 2

Monitor closely for perichondritis in the first month:

• Watch for painful swelling, warmth, and redness that spares the earlobe 2
• If perichondritis develops, start fluoroquinolone antibiotics immediately to cover Pseudomonas 2
• If abscess forms, surgical incision and drainage are necessary 2

For Burns

Second-degree burns require regular cleansing and topical antimicrobials:

• Deeper burns require debridement, biologic dressings, or burying cartilage subcutaneously for later reconstruction 7

Critical Pitfalls to Avoid

• Do not prescribe oral antibiotics for uncomplicated AOE—they are ineffective against the causative organisms and promote resistance 1, 5
• Do not use neomycin-containing drops if there is any history of sensitivity or chronic external otitis 1
• Do not delay wound repair beyond 12-24 hours as this increases infection risk 2
• Do not irrigate ears in diabetic or immunocompromised patients due to risk of necrotizing otitis externa 4
• Do not use epinephrine in ear anesthesia as it compromises blood supply 2

When to Escalate or Refer

• Persistent or worsening discharge despite appropriate treatment 4
• Recurrent episodes of drainage or infection 4
• Signs of perichondritis (painful swelling sparing the earlobe) 2
• Suspected necrotizing otitis externa in diabetic or immunocompromised patients 1, 4
• Vesicular lesions suggesting herpes zoster oticus (Ramsay Hunt syndrome) 1

Analgesics

• Pain control is essential as AOE causes severe otalgia disproportionate to visual findings 1, 5
• Use appropriate analgesics based on pain severity 1