How is Otitis Externa Treated?

A female swimmer wearing a bathing cap and goggles holding her ears
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Otitis externa, which is also called swimmer's ear, is a common infection of the outer ear that affects nearly 1 out of every 100 Americans. Despite its common diagnosis, almost 1/3 of all cases are mistreated with oral antibiotics. In an attempt to standardize treatment of otitis externa, the American Academy of Otolaryngology – Head and Neck Surgery published new guidelines for treatment in February 2014.

Changes were backed by 12 randomized trials and 2 systematic reviews. This article covers the best treatments for otits externa, including the new guidelines.

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

  • Otalgia
  • Otorrhea
  •  Inflammation of the external ear canal

Even though the symptoms of these ear conditions are similar to that of otitis externa they may be treated very differently. While otitis externa is an infection that can be easily resolved with proper treatment, untreated or mistreated otitis externa can lead to a very serious condition called malignant otitis externa. To avoid this complication, your condition should be confirmed by a medical professional before any treatment begins.

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

Other factors that will be considered prior to treatment by your physician may include:

Treating the Infection

As previously mentioned, otitis externa is an infection of the outer ear. It is also called swimmer's ear because it 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 treatment of the infection. Ear drops are the treatment of choice. The ear drops that your medical provider will prescribe will likely include antibiotics, steroids, or anti-inflammatory medication. It is important to get early treatment to prevent cases of acute otitis externa spreading and leading to chronic otitis externa, rupturing an ear drum, or causing malignant otitis externa. If the ear canal becomes obstructed, an ENT can perform aural toileting, where they can remove ear wax or objects from the ear canal with a small suction device and a microscope.

In most uncomplicated cases of otitis externa, you should only be treated with ear drops. Oral antibiotics do not provide the same level of coverage or reach the area of the infection like ear drops. Because the ear drops are delivered right to the area of infection, recovery is often faster with ear drops as compared to taking an oral antibiotic.The most common ear drops used to treat otitis externa are Ciprodex (combination antibiotic and steroid), Floxin (antibiotic), and Xtoro (newest FDA approved antibiotic).

Oral antibiotics have more side-effects as compared to the ear drop antibiotics and can also lead to antibiotic-resistant bacteria that may be more difficult to treat at a later time. Did you know that an antibiotic-resistant infection could cost approximately $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 which cannot be reached with ear drops.

You should begin feeling better within 48 to 72 hours after starting to use the ear drops prescribed by your medical provider. You may still have some lingering side-effects but may feel back to normal after about a week of using the ear drops. It is important to continue using the ear drops as long as prescribed even if you are feeling better. If symptoms are still persisting or getting worse, return to you medical provider to be checked again. For tips on using ear drops properly read: How to Use Ear Drops Correctly.

Treating the Pain of Otitis Externa

Pain control can usually be achieved through mild-to-moderate analgesic like acetaminophen or Ibuprofen. In extreme cases, narcotics or opioids (such as Percocet, Lortab, etc…) may be necessary, however, this is not common. You should NOT use analgesic (pain relieving) ear drops, as they are not to be used during active infections. Alternative non-pharmacologic treatments such as hot/cold therapy, distraction techniques and other methods to relax your body have not currently been shown to be effective therapies. One of the best treatments of pain is actually preventive care through receiving early treatment. Most of your pain should resolve within 48-72 hours after using antibiotic drops.

Treating Inflammation

Otitis externa can cause your ear to become red and inflamed. As previously mentioned, steroid ear drops can help to reduce and control inflammation. Regardless of whether your ear drops contain a steroid most of your inflammation should resolve within 48-72 hours after using antibiotic ear drops.

Preventing Otitis Externa

Of course preventing otitis externa in the first place is superior to any treatment. For tips on preventing this condition read: Can I Prevent Swimmer's Ear?


Rosenfeld, R.M., Schwartz, S.R., Cannon, C.R., Roland, P.S., Simon, G.R., Kumar, K.A., et al. (2014). Clinical Practice Guideline: Acute Otitis Externa. Otolaryngology – Head and Neck Surgery. DOI: 10.117/019459981357083

Consumer Reports, American Academy of Otolaryngology – Head and Neck Surgery. (2013)Oral antibiotics for ear infections: When you need them – and when you don’t. Access: February 19,2014 from

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