Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2023;107(2):online

Related article: Acute Otitis Externa: Rapid Evidence Review

What is acute otitis externa?

Acute otitis externa is an infection of the ear canal. Because the ear canal is warm and dark, bacteria (germs) and fungus can grow and cause an infection.

Acute otitis externa is different from another ear infection, called otitis media, that affects the middle part of the ear.

Acute otitis externa may develop very quickly.

What causes acute otitis externa?

It is common in swimmers, but it can also occur when water gets into the ear canal from showering or bathing.

Anything that injures the ear canal can lead to acute otitis externa. Cleaning the ear canal can remove the protective wax. Putting objects into your ear canal, such as your finger, cotton swabs, bobby pins, or paper clips, can injure the canal and increase the risk of infection.

Skin conditions such as eczema or psoriasis that affect other areas of the body can also happen in the ear canal and can lead to acute otitis externa.

What are the signs and symptoms?

Ear pain is the main sign. It may be severe. Often it is worse when the outer ear is pulled or pressed on. The ear may be itchy or produce drainage, which can be yellow, yellow-green, or smell bad. Your ear may feel full, and sounds may be muffled. Fever is uncommon.

How is acute otitis externa treated?

Most cases are treated with antibiotic ear drops.

Sometimes antibiotic pills are needed.

Ear pain may be treated with acetaminophen or other over-the-counter pain medicine.

If the ear canal is very swollen, it can make using ear drops difficult. Your doctor may insert a tiny sponge called an ear wick into the canal to help carry the medicine into the ear.

How should I use ear drops?

Lie on your side with the sore ear facing the ceiling. If possible, have someone else put the number of drops your doctor recommended into your ear canal; otherwise, you should use enough drops to fill the canal. Warming the bottle by placing it between your hands to bring the medicine to room temperature before using the drops may help keep you from feeling dizzy when the drops are placed in the ear canal.

After using the ear drops, stay in this position for three to five minutes; this allows enough time for the drops to enter the ear canal. Using a timer can help.

Use a gentle to-and-fro movement of the ear to help the drops reach the canal.

Try not to clean the ear yourself while it is still tender because this could lead to more canal irritation or damage (in other words, avoid cleaning with fingers and cotton swabs).

If your doctor placed a wick to help get the drops into the canal, the wick may fall out on its own. This is a good sign and signals that the swelling in the canal is getting better.

Do not try to remove a wick that does not fall out on its own. If the wick does not fall out within two to three days, return to the doctor to have it removed.

How long will I need to use ear drops? What can I do to help heal my ear?

You should use the ear drops for seven to 10 days. Use them until your symptoms have been better for three days. Most symptoms should improve after three days of treatment.

Keep your ears as dry as possible for the seven to 10 days of using the drops. Take baths instead of showers, and avoid swimming or other water sports (if you are on a swim team, ask your doctor when you can return to swimming).

Do not put anything except the prescribed medicine into your ear.

How can I prevent acute otitis externa?

  • Avoid putting anything into your ear canal (for example, fingers, cotton swabs, or other objects).

  • Tip your head from side to side to allow water to drain out of the canal.

  • Keep ears as dry as possible. Use a towel to remove water from the ears. Using a hair dryer on low setting and holding it about 12 inches away from the ear can also help to dry out the canal.

  • Wear a bathing cap or wet suit hood to help keep ear canals dry.

  • Avoid using earplugs unless they fit well.

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