Several simple medications can be used to effectively treat most cases of otitis externa. If you have localised otitis externa (where a hair root in your ear canal becomes infected), you may not need treatment as the condition may clear up on its own.

General advice

Whatever type of otitis externa you have, follow the general self-care advice below to assist your treatment:

• Avoid getting your affected ear wet, for example by wearing a shower cap while showering and bathing. Remove any discharge or debris by gently swabbing your ear with cotton wool, being careful not to damage it.
• Remove anything from your affected ear that may cause an allergic reaction, such as hearing aids, earplugs and earrings.
• Treat any underlying skin conditions that may aggravate your otitis externa, such as seborrhoeic dermatitis, psoriasis or eczema.
• Relieve ear pain using painkillers such as paracetamol or ibuprofen. Do not take ibuprofen if you are asthmatic or have stomach problems, such as stomach ulcers (past or present). If you are unsure whether you should take it, check with your GP, practice nurse or pharmacist. Children under 16 years of age should not take aspirin.

Inform your GP or practice nurse if you have an allergic disposition (a tendency to have allergies). Eardrops that contain certain substances, such as neomycin or propylene glycol, are more likely to cause an allergic reaction than others. Your GP, practice nurse or pharmacist will be able to advise you about which type of eardrops are most suitable for you.

Localised otitis externa

If you have localised otitis externa, the condition may heal on its own in a few days. You can relieve any pain using analgesics (painkillers), such as paracetamol or ibuprofen.

Do not take ibuprofen if you are asthmatic or have stomach problems, such as ulcers. Children under 16 years of age should not take aspirin.

It may help to put a warm towel or flannel on your affected ear.

Without treatment, it is likely that the pimple or boil in your ear canal will eventually burst, drain and heal by itself. However, you may not want to wait for this to happen because you may be in considerable pain and discomfort.

See your GP if you have localised otitis externa that has not healed by itself after about a week. If your infection is severe, oral antibiotics may be prescribed. In rare cases, where the pimple or boil is very painful and swollen, your GP may suggest draining it to remove the pus. Your GP may remove the pus using a surgical needle, or you may be referred to a specialist.

Do not scratch your ear or use cotton buds to clean your ear, as this will cause pain in your ear canal.

Acute diffuse otitis externa

If you have acute diffuse otitis externa, analgesics (painkillers), such as paracetamol or ibuprofen, will help relieve any pain you have. Do not take ibuprofen if you have asthma or stomach problems, such as ulcers (past or present). Children under the age of 16 should not take aspirin.

It is likely that you will need treatment to relieve the inflammation caused by acute diffuse otitis externa. Your GP may prescribe a topical ear preparation in the form of eardrops. Topical treatments are those that are applied directly to the area that needs to be treated.
 
There is a wide range of eardrops made up of different ingredients that can treat acute diffuse otitis externa. These include:

• antibiotic preparations
• corticosteroid preparations
• antifungal preparations
• antibiotic and corticosteroid preparations
• acidic preparations

In most cases of acute otitis externa, topical treatments are effective in treating the infection. However, you may need to take strong analgesics (painkillers) during the first few days of treatment. If you are prescribed antibiotic and steroid eardrops, you can expect your symptoms to start improving approximately six days after treatment has started.

If you have severe acute diffuse otitis externa, your GP may refer you for specialist treatment. This may involve using one or more of the methods below to remove earwax and allow eardrops to work more effectively: 

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

You may also need an ear wick, which is a soft cotton gauze plug that is 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 or three days. This type of treatment should only be carried out by a specialist.
 
In very severe cases of infection, an oral antibiotic, such as flucloxacillin, may be prescribed. 

Chronic otitis externa

In most cases of chronic otitis externa, the exact cause of the condition cannot be identified. If this is the case, your GP will probably prescribe a topical preparation in the form of eardrops to be used for seven days. The eardrops will probably contain a corticosteroid (medication to relieve swelling) without an antibiotic.

Your GP may also prescribe an acetic acid spray for you to use at the same time as your eardrops. The spray will prevent any bacterial or fungal infections from growing in your ear canal.
 
As chronic otitis externa is a long-term condition, your treatment may have to continue for two to three months. If your condition has not improved after this time, your GP may prescribe antifungal eardrops instead.

If your chronic otitis externa appears to be caused by an underlying skin condition, such as seborrhoeic dermatitis, psoriasis or eczema, your GP may prescribe a treatment for the skin condition before treating otitis externa.

If your otitis externa appears to be caused by a fungal infection, a topical antifungal preparation in the form of eardrops may be prescribed.

You will only need to have specialist treatment for chronic otitis externa if:

• your condition does not improve following the treatment prescribed by your GP
• your ear canal is in danger of closing up
• you have had an allergic reaction and you need a skin patch test to determine what you are allergic to