From the Guidelines
Treatment of otitis externa primarily involves cleaning the ear canal, controlling pain, and using topical medications to reduce inflammation and infection. The mainstay of treatment is topical antimicrobial drops, with options including acetic acid solutions (like VoSol), antibiotic drops (such as ciprofloxacin 0.3% or ofloxacin 0.3%), or combination antibiotic-steroid preparations (like ciprofloxacin-dexamethasone or neomycin-polymyxin B-hydrocortisone) 1. These should be applied 3-4 times daily for 7-10 days. For pain management, acetaminophen or NSAIDs like ibuprofen are effective.
Key Considerations
- Cleaning the ear canal to remove debris and discharge can be done using a bulb syringe with warm water or saline 1.
- For severe cases with significant canal swelling, an ear wick may be inserted to facilitate medication delivery.
- Oral antibiotics are generally reserved for cases with extension beyond the ear canal or in immunocompromised patients 1.
- During treatment, keep the ear dry by avoiding swimming and using earplugs during showers.
Special Considerations
- Patients with diabetes, an immunocompromised state, or both require special consideration because they are susceptible to otomycosis and necrotizing otitis externa 1.
- Aural toilet may be performed by the clinician with a gentle lavage using body-temperature water, saline solution, or hydrogen peroxide, but caution is advised in diabetic patients or immunocompromised patients with AOE 1.
Patient Education
- Patients should be informed that eardrops alone are the most effective treatment for AOE and may contain antibiotics, antiseptics, steroids, or a combination 1.
- Patients should be advised to avoid scratching or touching the ear and do not insert anything into the ear canal, including cotton-tipped swabs, and to cover the opening of ear canal with an earplug or cotton (with petroleum jelly) prior to showering or hair washing to minimize water entry 1.
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. One option to treat otitis externa is ciprofloxacin otic solution, 0.2%, which is indicated for the treatment of acute otitis externa due to susceptible isolates of Pseudomonas aeruginosa or Staphylococcus aureus 2.
- The dosage is twice daily (approximately 12 hours apart) for 7 days.
- Contraindications include a history of hypersensitivity to ciprofloxacin 2.
- Adverse reactions may include application site pain, ear pruritus, fungal ear superinfection, and headache 2.
From the Research
Treatment Options for Otitis Externa
- Topical antibiotics such as ofloxacin otic solution have been shown to be effective in treating otitis externa, with a cure rate of 91% among clinically evaluable patients 3.
- A once-daily regimen of ofloxacin otic 0.3% solution for 7 days has been found to be well tolerated and effective in achieving clinical and microbiologic cure of otitis externa 3.
- Other treatment options include ciprofloxacin/dexamethasone otic suspension, which has been compared to neomycin/polymyxin B/hydrocortisone otic suspension and found to have higher clinical cure rates and microbiologic eradication rates 4.
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is also an effective treatment for otitis externa, and can be used as a prophylactic measure after exposure to moisture 5.
Comparison of Treatment Options
- A study comparing ciprofloxacin/dexamethasone with neomycin/polymyxin/hydrocortisone for otitis externa pain found that ciprofloxacin/dexamethasone provided greater pain relief and reduced inflammation and edema more effectively 6.
- Ofloxacin otic has been found to be as effective as polymyxin/neomycin plus hydrocortisone and ciprofloxacin otic in curing otitis externa in children, and its less frequent dosing may encourage greater patient adherence 7.