Medical Treatment

Medications are generally aimed at symptom relief as well as a cure for swimmer's ear. The main steps to treat swimmer's ear can be listed as the following:

• Clean the ear thoroughly
  
  
• Treat inflammation and infection
  
  
• Control pain
  
  
• Obtain sample of any drainage and culture it (to see if any bacteria grows)
  
  
• Avoid factors that may promote inflammation or infection

If there is a large amount of drainage or debris in the ear, the doctor will clean out the ear canal before medicine is placed in the ear.

• The ear canal may be cleaned out using a wire or plastic loop instrument or under direct vision using a suction device.

• After cleaning the ear, the doctor may place a foam wick in the canal. This allows antibiotic or antifungal ear drops or both to be placed onto the wick. The wick swells up inside the ear canal, thus holding the medicine in place against the lining of the skin.

• Oral pain medicines are generally prescribed if over-the-counter medicines are not strong enough. Oral antibiotics are not often prescribed unless the infection is severe.

Topical Remedies

Topical remedies or swimmer's ear drops are generally directed toward the treatment of inflammation and infection and are classified into the following:

• acidifying agents,
  
  
• antiseptics,
  
  
• anti-inflammatory agents, and
  
  
• antibiotics.

Acidifying Agents

Acidifying agents are effective because the common bacteria responsible for outer ear infection cannot survive in a very acidic environment. Examples include acetic acid, hydrochloric acid, salicylic acid, boric acid, sulfuric acid, and citric acid solutions.

Antiseptic Agents

Antiseptic agents work by potentially killing the offending bacteria. Some of these antiseptic solutions are alcohol, gentian violet, m-cresyl acetate, thimerosal, and thymol. Most of these are typically applied into the ear canal by an ear specialist (otolaryngologist).

Anti-inflammatory Agents

Anti-inflammatory agents help with inflammation and may reduce pain. Some studies have shown that the combination of anti-inflammatory and acidifying agents was superior to acidifying agents alone in reducing the duration of symptoms and providing relief for swimmer's ear. Anti-inflammatory steroids such as hydrocortisone (Acetasol HC, Vosol HC) or dexamethasone (Ciprodex) are usually found in products in combination with antibiotics, acidifying agents, and antiseptics.

Antibiotics

Many topical antibiotics are available for treatment of swimmer's ear (otitis externa). Again, these are usually found in combination with the other three groups to increase the effectiveness of treatment.

Some common examples of ear drops for swimmer's ear, which include all four classes of antiseptic, acidifying agent, anti-inflammatory, and antibiotics are:

• neomycin/polymyxin/hydrocortisone (Cortisporin Otic Suspension)
  
  
• neomycin/polymyxin/hydrocortisone (Cortisporin Otic Solution)
  
  
• neomycin/colistin/hydrocortisone (Neomycin Coly-Mycin S Otic
  
  
• tobramycin and dexamethasone (Tobradex)
  
  
• ciprofloxacin/hydrocortisone (Cipro HC Otic)
  
  
• gentamicin and prednisolone acetate) Pred-G

Oral or intravenous antibiotics are generally not used in the treatment of swimmer's ear. However, they may be appropriate in cases of severe infection in people with diabetes or those with weakened immune systems. They may also be used if applying topical ear drops is not possible due to severe swelling and closure of the ear canal.

Less commonly, outer ear infection may be related to a fungal infection (otomycosis). Typically, this condition is suspected in people who do not respond to the usual treatment for swimmer's ear, those in highly tropical climates, or in people with multiple previous infections. Fungal infection can also cause more itching and less pain than bacterial infections. The examination of the ear may reveal a white, mold-like appearance.

The treatment of fungal outer ear canal infection also focuses on the combination of topical antiseptics, acidifying agents, anti-inflammatory agents, and anti-fungal medicines. Clotrimazole (Lotrimin, Mycelex) and miconazole (M-Zole, Micatin, Lotrimin) are the most commonly used anti-fungal medications used to treat fungal ear infections.