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Otitis externa - Management
How should I treat chronic otitis externa?
- Apply general measures to keep the ear canal dry and free of debris and discharge while avoiding injuring it; relieve itch and pain; remove any precipitating antigens or irritants; treat any underlying skin condition such as seborrhoeic dermatitis. See Initial management for acute diffuse otitis externa.
- Treatment may be difficult, and may require trials of more than one strategy.
- If fungal infection is suspected (signs of fungal growth in ear canal) — prescribe a topical antifungal preparation and seek specialist advice if there is inadequate response.
- If the cause seems to be seborrhoeic dermatitis — treat topically with an antifungal–corticosteroid combination.
- If no cause is evident:
- Prescribe a 7-day course of a topical preparation containing only a corticosteroid without antibiotic. Consider co-prescribing an acetic acid spray.
- If there is an adequate response:
- The corticosteroid treatment may need to be continued. Reduce the potency of the corticosteroid and/or the frequency of application to the minimum required to maintain control.
- If treatment cannot be withdrawn after 2 or 3 months, seek specialist advice.
- If the response is inadequate, consider a trial of a topical antifungal preparation.
In depth
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