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Timothy C. Hain, MD Page last modified: February 19, 2017


Otitis externa (OE) is an infection of external ear canal


Persons with OE present with pain, drainage and loss of hearing.

Causes of Otitis Externa

Otitis externa is most commonly caused by

Fungi (otomycosis) are usually accompanying organisms, but can be the primary cause of otitis media or otitis externa.

Mites (demodex) are found in roughly 6% of normal human ears and are more common in ears where a local steroid preparation has been used. (Cevlik et al, 2014). Ear mite infection is occasionally are associated with extremely itchy external otitis (Klem et al, 2009). This should not come as a surprise to pet owners who are familiar with ear mites.

Treatment of Otitis Externa

Cultures of draining ears are recommended at the initial visit. However, the impact on management is uncertain.

Prevention measures for recurrence include the following (Sander, 2001)

When acidification fails, antifungal topical preparations are also commonly used. There are numerous of these agents used in animal medicine. None of these is presently FDA approved for human use and for this reason they are used "off-label" in humans. Several of these are available over-the-counter such as clotrimazole -- (Lotrimin AF) cream and tinactin solution. Use of these preparations should be under the supervision of a physician experienced in treating ear infections. Romsaithong et al (2016) reported that 1% clotrimazole solution was more effective than 3% boric acid in 70% alcohol.

Moshtaghi et al (2017) reviewed prices of ear drops in southern California, and stated:

"Data were collected from 108 pharmacies. The mean prices are noted for each of the individual drugs: Cortisporin (brand) 10 mL, $82.70; neomycin, polymyxin B sulfates, and hydrocortisone (Cortisporin-generic) 10 mL, $34.70; ofloxacin (generic) 10 mL, $99.95; sulfacetamide (generic) 15 mL, $40.18; Ciprodex (brand) 7.5 mL, $194.44; Cipro HC (brand) 10 mL, $233.32; Vosol (brand) 15 mL, $120.75; acetic acid (Vosol-generic) 10 mL, $116.55; VosolHC (brand) 10 mL, $204.14; acetic acid/aluminum acetate (Domeboro-generic) 60 mL, $22.91; and Tobradex (brand) 5 mL, $166.47."

As can be seen, the least expensive treatment, on average, is Domeboro-generic ($22.91). This is actually an antiseptic treatment, with the mechanism being making the ear canal more acidic. The safest in regards to lowered risk of hearing loss should there be a perforation, as well as the least painful treatment (in our opinion) is moderately expensive (ofloxacin generic -- $99.95). One wonders why a generic is so expensive in the US. Amazingly enough, drops made of acetic acid (e.g. Vosol-generic) cost $116.55. Considering the cost of the raw ingredients (i.e. vinegar and water), this seems high.

Treatment of fungal external otitis.

This is generally recognized by failure or partial response to treatment for acute external otitis. Typical organisms are candida and aspergillus. One should rule out metabolic and immunological disorders, i.e. diabetes, cancer chemotherapy, leukemia, and HIV among others. The ear should be carefully cleaned, and an anti-fungal cream such as Nizoral or Lotromin considered. There shold be repeat cleaning and application of the antifungal every 10-14 days. (Farrior, 2000)

Treatment of ear mites.

Only a few cases have been reported of ear mites in humans. One paper reported treatment with topical hexachlorocyclohexane (Klemm et al, 2009). They suggested that a more contemporary treatment might be permethrin. These drugs are rarely used in humans and their effect is not well understood.


Copyright February 19, 2017 , Timothy C. Hain, M.D. All rights reserved. Last saved on February 19, 2017