Otitis externa is usually caused by bacteria, either of the streptococcus, staphylococcus or pseudomonas species. If water is frequently present in the ear canal, infections can grow. Excessive exposure to water and poking cotton swabs inside the ear, which damages the delicate skin of the external ear, are also causative factors. Chronic otitis externa can sometimes occur if a person has a nervous habit of scratching the ear frequently. Eczema of the ear causes itchiness and scratching to relieve the itch may also lead to infections.

How are ear infections treated?
Otitis media is often treated with oral antibiotics, although current research suggests that they are frequently not needed, as a significant proportion of infections are viral, not bacterial (antibiotics do not help viral infections and their use in this setting contributes to antibiotic resistance). Guidelines recommend relieving pain in children, especially in the first 24 hours, with ibuprofen or ­acetaminophen. After the acute symptoms settle, up to 40% of children are left with some residual fluid in the ear, which can cause temporary hearing loss for up to six weeks. In most children this problem usually resolves without any further treatment. If your doctor thinks antibiotics are necessary he or she will usually prescribe amoxicillin (Amoxil). Azithromycin (Zithromax) is an alternative that may be used for people allergic to penicillin. If a child has recurrent bouts of otitis media, a decision may be made to insert a tympanostomy tube into the ear. These tubes, also known as grommets, aid the drainage of fluid from the middle ear.

Otitis externa is usually treated with ear drops containing an antibiotic such as ciprofloxacin and ofloxacin (Floxin Otic). Antibiotics are often combined with steroids to reduce swelling and inflammation. Ear drops may contain a combination of a steroid and an antibiotic, such as ciprofloxacin and hydrocortisone or dexmathesone (Cipro HC Otic, Ciprodex Otic), as well as a generic combination of polymyxin B sulfate, neomycin sulfate, and hydrocortisone (Cortisporin Otic Solution, Pediotic). If there is a problem with ear wax blocking the outer ear canal, ear drops to soften the wax to help its removal may be prescribed. Syringing the ear is seldom necessary. If a fungal ear infection is suspected, ear drops containing an antifungal such as chloroxylenol (Zoto-HC) may be prescribed.

Self-help measures

  • Wear earplugs when swimming to avoid recurrence of otitis externa. Check with a doctor prior to swimming again.
  • Do not to scratch the ear or poke things such as cotton swabs inside the ear canal to stop the itching.
  • Steroid lotion such as betamethasone may be prescribed for chronic dermatitis or eczema of the ear. This cannot be used if there is an infection present.

Further Information
Medline Plus: www.nlm.nih.gov/medlineplus/earinfections.html
American Academy of Pediatrics: www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Middle-Ear-Infections.aspx

Last Reviewed: May 2013