What is the treatment for otitis externa (inflammation of the external ear)?

From the Guidelines

The most effective treatment for otitis externa involves the use of topical antibiotic ear drops, such as ciprofloxacin or neomycin-polymyxin B-hydrocortisone, applied 3-4 times daily for 7-10 days, as recommended by the clinical practice guideline for acute otitis externa 1.

Key Considerations

• The ear should be gently cleaned to remove debris and discharge before applying the ear drops.
• Pain management is crucial, and over-the-counter analgesics like acetaminophen or ibuprofen can be used.
• It's essential to keep the ear dry during treatment by avoiding swimming and using earplugs or cotton balls coated with petroleum jelly when showering.
• Severe cases may require oral antibiotics, especially if the infection has spread beyond the ear canal.

Topical Therapy

• All eardrops approved for treating acute otitis externa are highly effective, with no consistent advantage shown for any one specific drug 1.
• The choice of eardrop should be based on factors such as cost, dosing frequency, status of the eardrum, and the doctor's experience.
• Patients should inform their doctor about any prior ear surgery, eardrum perforation, or ear tube placement, as well as any history of diabetes or reaction to ear drops or antibiotics.

Duration of Treatment

• Eardrops should be used for at least 7 days, even if symptoms improve sooner, to prevent relapse of infection 1.
• If symptoms persist beyond 7 days, patients should notify their doctor and continue the drops until symptoms resolve, for a maximum of 7 additional days.

Activity Restrictions

• Patients should avoid scratching or touching the ear and not insert anything into the ear canal, including cotton-tipped swabs.
• Covering the ear canal with an earplug or cotton (with petroleum jelly) prior to showering or hair washing can help minimize water entry.
• Patients should check with their doctor regarding swimming or other water activities during or after the infection.

From the FDA Drug Label

Ciprofloxacin otic solution, 0.2% is a quinolone antimicrobial indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus. The contents of one single-dose container (deliverable volume: 0. 25 mL) should be instilled into the affected ear twice daily (approximately 12 hours apart) for 7 days.

The treatment for otitis externa is ciprofloxacin otic solution, 0.2%. The recommended dosage is to instill the contents of one single-dose container into the affected ear twice daily for 7 days 2.

• Key points:
  • Instill the solution into the affected ear twice daily.
  • Treatment duration is 7 days.
  • Wash hands before use and warm the solution by holding the container in the hands for at least 1 minute to minimize dizziness.
  • The patient should lie with the affected ear upward and maintain this position for at least 1 minute to facilitate penetration of the drops into the ear.
• Alternative treatment: Ofloxacin otic solution can also be used to treat otitis externa, with a recommended dosage of 5-10 drops instilled into the affected ear once daily for 7 days 3.

From the Research

Treatment Options for Otitis Externa

• The treatment of otitis externa typically involves a combination of analgesia, cleansing of the external auditory canal, and the application of antiseptic and antimicrobial agents 4.
• Topical antimicrobial treatments have been shown to lead to a higher cure rate than placebo, and corticosteroid preparations can help lessen swelling, erythema, and secretions 4.
• Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is an effective treatment in most cases 5.

Use of Antibiotics and Non-Antibiotic Treatments

• Oral antibiotics are indicated if the infection has spread beyond the ear canal or in patients with poorly controlled diabetes mellitus or immunosuppression 4.
• Topical antibiotic and corticosteroid preparations have been found useful, but there have been no large-scale randomized controlled trials of their use 4.
• A systematic review and meta-analysis found that antiseptic, steroid, and antibiotic monotherapies are all effective for the management of acute otitis externa, with no significant differences in cure rates between them 6.

Specific Treatment Regimens

• A study found that ciprofloxacin plus fluocinolone acetonide ear drops were more effective than ciprofloxacin alone in the treatment of diffuse otitis externa, with a higher rate of clinical cure and lower mean total symptom score 7.
• The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends the use of topical preparations for initial therapy of diffuse, uncomplicated otitis externa, with systemic antimicrobial therapy reserved for cases with extension outside of the ear canal or specific host factors 8.

Prevention and Prophylaxis

• Excessive moisture and trauma are common precipitants of otitis externa, and avoidance of these factors is the cornerstone of prevention 5.
• Thorough cleansing of the canal is essential for diagnosis and treatment, but flushing should be avoided 5.
• Prophylactic measures such as drying the ears with a hair dryer and avoiding manipulation of the external auditory canal may help prevent recurrence 5.