eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > External Ear Diseases

External Ear, Infections: Treatment & Medication

Author: Ashutosh Kacker, MD, Associate Professor of Otorhinolaryngology, Department of Otolaryngology, Weill College of Medicine of Cornell University; Consulting Staff, New York Presbyterian Hospital, New York Hospital of Queens
Contributor Information and Disclosures

Updated: Sep 17, 2009

Treatment

Medical Care

In most cases, treatment consists of acidification of the ear canal with drops, with or without topical antibiotics, although systemic antibiotics may also be necessary. Eczematoid or psoriatic otitis externa often responds to topical steroid drops but may be chronic or recurrent. The ear may require frequent suction debridement under a microscope. If significant canal edema develops, an Oto-Wick may be required to allow delivery of otopical medications into the medial canal. Otitis externa can be very painful and may require narcotic analgesics to control pain.

Surgical Care

Surgical debridement is usually reserved for malignant otitis externa or for complications of otitis externa such as external canal stenosis.

Consultations

Refractory otitis externa requires an otolaryngology consult.

Medication

Commonly used topical eardrops are acetic acid drops, which change the pH of the ear canal; antibacterial drops, which control bacterial growth; and antifungal preparations. Oral or parenteral antibiotics are reserved for severe cases.

Acidifying eardrops

Acidifying eardrops reduce ear canal pH, which retards microbial growth.


Acetic acid with and without hydrocortisone (EarSol HC, VoSoL HC, Acetasol HC)

Treats superficial bacterial infections of the EAC.

Adult

5-10 gtt in affected ear tid

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Not for treatment of bacterial infections

Antibiotic eardrops

These eardrops treat bacterial infection and reduce canal edema.


Neomycin, polymyxin B, and hydrocortisone (Cortisporin Otic)

Used for steroid-responsive inflammatory condition for which a corticosteroid is indicated and where bacterial infection or a risk of bacterial infection exists.

Adult

5 gtt in affected ear tid

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Extended use can lead to resistant infections and thinning or atrophy of the skin


Ciprofloxacin (Ciloxan)

Inhibits bacterial growth by inhibiting DNA gyrase.

Adult

5-10 gtt in affected ear bid

Pediatric

Administer as in adults

Documented hypersensitivity; viral, mycobacterial, and fungal eye infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Superinfections may occur with prolonged or repeated antibiotic therapy


Ofloxacin (Floxin)

Inhibits bacterial growth by inhibiting DNA gyrase.

Adult

5-10 gtt in affected ear bid
or
10 drops in affected ear qd

Pediatric

Administer as in adults

Documented hypersensitivity; viral, mycobacterial, and fungal eye infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Superinfections may occur with prolonged or repeated antibiotic therapy

Antifungal agents

These agents are used to treat otomycosis refractory to acidification drops.


Nystatin powder (Mycostatin, Nilstat)

Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei; effective against various yeasts and yeastlike fungi. Changes permeability of fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak.
Treatment should continue until 48 h after disappearance of symptoms. Topical application reduces fungal growth.

Adult

1-2 puffs from handheld nebulizer q1wk administered by treating physician

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Not for treatment of bacterial infections; do not use to treat systemic mycoses

More on External Ear, Infections

Overview: External Ear, Infections
Differential Diagnoses & Workup: External Ear, Infections
Treatment & Medication: External Ear, Infections
Follow-up: External Ear, Infections
Multimedia: External Ear, Infections
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Alva B, Prasad KC, Prasad SC, Pallavi. Temporal bone osteomyelitis and temporoparietal abscess secondary to malignant otitis externa. J Laryngol Otol. Apr 17 2009;1-4. [Medline].

  2. [Guideline] Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. Apr 2006;134(4 Suppl):S4-23. [Medline].

  3. Brook I. Treatment of otitis externa in children. Paediatr Drugs. Oct-Dec 1999;1(4):283-9. [Medline].

  4. Mirza N. Otitis externa. Management in the primary care office. Postgrad Med. May 1996;99(5):153-4, 157-8. [Medline].

  5. Morden NE, Berke EM. Topical fluoroquinolones for eye and ear. Am Fam Physician. Oct 15 2000;62(8):1870-6. [Medline].

  6. Selesnick SH. Otitis externa: management of the recalcitrant case. Am J Otol. May 1994;15(3):408-12. [Medline].

  7. Tierney MR, Baker AS. Infections of the head and neck in diabetes mellitus. Infect Dis Clin North Am. Mar 1995;9(1):195-216. [Medline].

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines
Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, Kokemueller P, Marcy SM, Roland PS, Shiffman RN, Stinnett SS, Witsell DL, American Academy of Otolaryngology--Head and Neck Surgery Foundation. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2006 Apr;134(4 Suppl):S4-23. 2

[ CLOSE WINDOW ]

Keywords

external ear infections, ear infections, infections of the external ear, otitis externa, swimmer ear, swimmer's ear, malignant otitis externa, ear furuncle, external auditory canal, EAC, otomycosis, fungal otitis externa, eczematoid, psoriatic otitis externa, otorrhea, herpes zoster oticus

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ashutosh Kacker, MD, Associate Professor of Otorhinolaryngology, Department of Otolaryngology, Weill College of Medicine of Cornell University; Consulting Staff, New York Presbyterian Hospital, New York Hospital of Queens
Ashutosh Kacker, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

Jack A Shohet, MD, Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine; Otolaryngologist, Shohet Ear Associates Medical Group, Inc
Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association
Disclosure: Envoy Medical Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.