How to Treat Otitis Externa

Acute otitis externa, more commonly called swimmer's ear, is an infection of the outer ear. According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 123 Americans get swimmer's ear each year.

While otitis externa can occur in any person of any age, most cases are diagnosed in kids between the ages of 5 and 14. It tends to occur in the summer months when people are more likely to go swimming.

You should avoid self-treatment, as other ear conditions can cause symptoms that are similar to otitis externa, including:

• Otalgia (ear pain)
• Otorrhea (ear drainage)
• Inflammation of the external ear canal

While symptoms of these ear conditions are similar to those of otitis externa, the conditions may need to be treated differently. For example, depending on the cause of the infection, antibiotics may be of limited use.

Otitis externa can be easily resolved with proper treatment, but if left untreated or mistreated, a serious condition called malignant otitis externa can result. This is usually only seen in patients with diabetes or in those who are immunocompromised. A timely diagnosis by a medical professional is essential to help prevent the condition from developing.

In addition to resolving the infection that causes otitis externa, treatments focus on controlling ear pain and other symptoms that accompany the condition.

Other factors that will be considered before starting treatment include:

• Damaged tympanic membrane (eardrum)
• Ear tubes (tympanostomy)
• Diabetes
• Weakened immune system
• Previous radiation therapy

Treating the Infection

As of 2014, the American Academy of Otolaryngology-Head and Neck Surgery published new guidelines to help standardize the treatment of otitis externa.

As previously mentioned, otitis externa is an infection of the outer ear. It's called swimmer's ear because it often occurs when contaminated water sits in the outer ear and creates a suitable environment for bacteria to grow.

The main focus of treating otitis externa is addressing infection. Otitis externa can be caused by bacteria, fungi, or other germs. Antibiotic eardrops are the treatment of choice. The eardrops that your medical provider will prescribe will likely include antibiotics, steroids, or anti-inflammatory medication.

It is important to get early treatment to prevent acute otitis externa from spreading and leading to chronic otitis externa, rupturing an eardrum, or causing malignant otitis externa.

If the ear canal becomes obstructed, an ENT (ear, nose, and throat healthcare provider) can clean the ear canal. During this procedure, they can remove ear wax or objects from the ear canal with a small suction device and microscope.

In most uncomplicated cases of otitis externa, you should only be treated with eardrops. Oral antibiotics do not provide the same level of coverage or reach the area of the infection. Because the eardrops are delivered right to the area of infection, recovery is often faster compared to taking an oral antibiotic.

Some common eardrops used to treat otitis externa are:

• Ciprofloxacin/dexamethasone (antibiotic and steroid combination)
• Ofloxacin
• Finafloxacin

Make sure you are using drops prescribed by your healthcare provider. There is no evidence that over-the-counter drops are effective for treating swimmer's ear.

Oral antibiotics have more side effects compared to the eardrop antibiotics and can also lead to antibiotic-resistant bacteria that may be more difficult to treat (according to a study published in 2018, an antibiotic-resistant infection can cost as much as $29,000 to treat ).

Oral antibiotics may be considered by your medical provider if the infection has started to spread to other parts of the body that cannot be reached with eardrops.

You should begin feeling better within 48 to 72 hours after starting to use the eardrops prescribed by your medical provider. You may still have some lingering side effects, but you may feel back to normal after about a week of using the eardrops.

It is important to continue using the eardrops for as long as prescribed, even if you are feeling better. If symptoms are still persisting or getting worse, return to your medical provider to be checked again.

Treating the Pain

Pain control can usually be achieved through a mild-to-moderate analgesic like acetaminophen or ibuprofen. In extreme cases, narcotics or opioids (such as Percocet or Lortab) may be necessary. However, this is not common.

You should not use analgesic (pain-relieving) eardrops, as they are not to be used during active infections.

Nonpharmacologic or alternative treatments such as hot/cold therapy, distraction techniques, and other "home remedies" may help some people manage pain or discomfort and may help prevent swimmer's ear, but they are not sufficient to cure an infection. You can ask your healthcare provider about using these remedies with a course of antibiotics.

Treating Inflammation

Otitis externa can cause your ear to become red and inflamed. Steroid eardrops can help to reduce and control inflammation. Whether or not your eardrops contain a steroid, most of your inflammation should resolve within 48 to 72 hours after using antibiotic eardrops.

Prevention

Preventing otitis externa in the first place is superior to any treatment. If you are prone to otitis externa, wearing earplugs can help keep water out of your ears when you're swimming or bathing. You can also try using a hairdryer on the low setting to completely dry your ears after spending time in the water.