Ear infection, outer - Treating otitis externa

Otitis externa can usually be treated effectively with ear drops prescribed by your GP and some simple self-care techniques.

In most cases, your symptoms will start to improve within a few days of starting treatment.

If your symptoms are severe or they fail to respond to initial treatment, your GP may refer you to a specialist for further treatment and advice.

Managing your symptoms at home

The advice below should help relieve your symptoms to some extent and help prevent complications:

• avoid getting your affected ear wet – wearing a shower cap while showering and bathing can help, but you should avoid swimming until the condition has fully cleared
• remove any discharge or debris by gently swabbing your outer ear with cotton wool, being careful not to damage it – don't stick cotton wool or a cotton bud inside your ear
• remove anything from your affected ear that may cause an allergic reaction, such as hearing aids, ear plugs and earrings
• use painkillers such as paracetamol or ibuprofen to relieve ear pain – these aren't suitable for everyone, so make sure you check the information leaflet that comes with the medication first; if you're still unsure, check with your GP, practice nurse or pharmacist
• if your condition is caused by a boil in your ear, placing a warm flannel or cloth over the affected ear can help it heal faster

Treatments your GP can provide

While otitis externa can clear up by itself, this can take several weeks without treatment. Your GP can usually prescribe medicated ear drops that speed up the healing process. These usually need to be taken several times a day for about a week.

There are four main types of ear drops used to treat otitis externa:

• antibiotic ear drops – this can treat an underlying bacterial infection
• corticosteroid ear drops – this can help reduce swelling
• antifungal ear drops – this can treat an underlying fungal infection
• acidic ear drops – this can help kill bacteria

Sometimes you may be given medication that's a combination of the above, such as antibiotic and corticosteroid ear drops.

Once treatment is complete and the inflammation has settled, your doctor may want to re-examine your ear to check for any underlying physical problems that could have contributed to the condition, such as having an abnormal or perforated (torn) ear drum.

Applying ear drops

Ear drops may not work as well if they are not used in the right way, so it's important to apply them correctly. Ideally, ask somebody else to apply the drops for you as this makes the process much easier.

You (or your helper) will need to follow these steps:

• gently remove any discharge, earwax or debris from your outer ear using a twist of cotton wool
• warm the ear drops by holding them in your hands for a few minutes, as cold ear drops can make you feel dizzy
• lie on your side with your affected ear facing up before applying the drops directly into your external ear canal
• gently push and pull your ear for about 30 seconds to work the drops in and get any trapped air out
• stay lying down for three to five minutes to ensure that the ear drops do not come out of your ear canal
• leave the ear canal open to dry

Other treatments

If necessary, there are some other treatments your GP can provide to help treat otitis externa, such as:

• stronger prescription painkillers such as codeine for severe cases
• antibiotic tablets or capsules to treat a severe infection – an antibiotic called flucloxacillin is usually the preferred choice
• treatment for underlying skin conditions that may aggravate your otitis externa, such as seborrhoeic dermatitis, psoriasis or eczema
• if a boil develops inside your ear, your GP may decide to pierce it with a sterile needle and drain the pus – this is known as incision and drainage, and you should not attempt to do it yourself

Specialist treatment

If necessary, your GP may refer you to a specialist for further treatment.

The specialist may decide to remove earwax from inside your ears to help make ear drops more effective. This can be done in a number of ways:

• syringing or irrigation – where water is injected through the nozzle of a syringe into the ear canal to dislodge and wash away any earwax
• microsuction – where a small suction device is used to remove any earwax, discharge and debris from your outer ear and ear canal
• dry swabbing – this gently mops out earwax from your ear canal

You may also need an ear wick, which is a soft cotton gauze plug covered with medication and inserted into your ear canal.

An ear wick allows the medication to reach the end of your ear canal. It should be changed every two to three days.

Antibiotic

Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.

Discharge

Discharge is when a liquid such as pus oozes from a part of your body.

Pain

Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Swelling

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.