Otitis externa is relatively common, and it is estimated that around 1 in 10 people will be affected by it at some point in their lives.

Otitis externa is inflammation of the skin of the ear canal which is usually caused by a bacterial infection, but sometimes by irritation, allergy or a fungal infection. While otitis externa can clear up by itself, this can take several weeks without treatment. Medicated ear drops can speed up the recovery process. Typical symptoms may include pain, discharge, itching and reduced hearing. A warm moist environment in the ear canal, debris or any damage to the delicate lining of the ear canal increase the chances of bacteria thriving there.

People with certain long-term conditions such as eczema, asthma and allergic rhinitis are at greater risk of developing the condition. 

Acute otitis media is a bacterial or viral infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.

Anyone can develop a middle ear infection. It can often occur as a complication to the common cold. In most cases, the symptoms of a middle ear infection develop quickly and resolve in a few days on its own. 

The middle ear (small space behind the eardrum) has three bones and is usually filled with air. It is connected to the back of the throat by the Eustachian tube.

During a cold, mucus can fill the space behind the eardrum and may become infected with bacteria or viruses. The Eustachian tube can become swollen and blocked which stops the mucous draining out, resulting in pressure on the eardrum, pain and a middle ear infection (otitis media). 

The main symptoms are an earache and feeling unwell. Even though an earache is common, it does not always occur. A fever and dulled hearing are also common. Sometimes due to the pressure, the eardrum may perforate. This releases the fluid and can often improve the pain. The majority of perforations are small and will heal themselves within a few weeks once the infection settles.

Your immune system will clear up most middle ear infections within a few days without any treatment. If however, you are in a lot of pain or your symptoms are showing no sign of improvement after two or three days, then you may wish to 'Start an Earache Diagnosis' or see a GP.

There are certain treatments you can try at home which may help you to manage your symptoms.

1. Pain medication:

• Paracetamol or ibuprofen can help to manage the symptoms of an earache whilst the immune system fights the infection. Please read the leaflet that comes with the medication to check its suitability for you. If you're still unsure, check with your pharmacist, GP or practice nurse. The medication can help pain and fever. 

2. Keep your ears dry as this will help the current infection to settle and can help to prevent recurrences.

• If water gets in then tip it out. You can use a hairdryer on a low setting to dry the canal.
• Never push the corners of a towel into your ears to dry them, as this can cause damage.
• Use a tightly fitting cap to cover the ears when swimming.
• Silicone earplugs may be used as long as they do not irritate your skin in the ear canal.
• In the shower, you can use some cotton wool coated with Vaseline to prevent water or shampoo from getting in.

3. Don't use cotton wool buds and avoid itching inside your ear canal with your fingers.

• This may damage the delicate lining of the ear canal
• This may push any ear wax further inside the ear. Wax will usually come out itself.
• You can use olive oil or over-the-counter ear wax preparations to help remove the wax if necessary.

4. Remove anything from your affected ear that may cause an allergic reaction, such as earrings, earplugs or hearing aids.

5. Acidifying ear drops

• Try using acidifying ear drops or spray (available from a pharmacy) to help keep your ears clean, particularly before and after swimming. These may help to prevent otitis externa recurring.

6. Decongestants

• For middle ear infections decongestant nasal sprays can sometimes help. They are believed to work by reducing the pressure on the eardrum which can be contributing to the pain, by draining the Eustachian tube.
• They can be bought over the counter from the pharmacy and should be used for a maximum of 5 days. It is important to check with a pharmacist whether this type of medication is suitable for you before using and always read the manufacturer's leaflet before use.
• Steam inhalation may also help as a temporary decongestant, and some people find a hot shower helpful.

This is used to treat Otitis Externa.

Ingredients

Dexamethasone, Framycetin sulfate and Gramicidin

Dose

Apply 2 drops 3-4 times a day to the affected ear.

Contra-indications

Please do not use if you are allergic to any of the ingredients.

Please do not use the drops if you currently have grommets in your ear, or if you have a current perforated ear-drum. 

Duration of Use

This medication is intended for short-term use. Please do not use for longer than 7 days without seeking further medical advice. 

Side Effects

Local sensitivity (frequency is unknown).

This is used to treat Otitis Externa.

Ingredients

Neomycin, Dexamethasone, Acetic acid

Dose

Apply 1 spray 3 times a day to the affected ear.

Contra-indications

Please do not use if you are allergic to any of the ingredients.

Please do not use the drops if you currently have grommets in your ear, or if you have a current perforated ear-drum. 

Duration of Use

This medication is intended for short-term use. Please do not use for longer than 7 days without seeking further medical advice. 

Side Effects

Local sensitivity (frequency is unknown).

This is used to treat Otitis Externa.

Ingredients

Hydrocortisone, Neomycin and Polymyxin B sulfate

Dose

Apply 3 drops 3-4 times a day to the affected ear.

Contra-indications

Please do not use if you are allergic to any of the ingredients.

Please do not use the drops if you currently have grommets in your ear, or if you have a current perforated ear-drum. 

Duration of Use

This medication is intended for short-term use. Please do not use for longer than 7 days without seeking further medical advice. 

Side Effects

Local sensitivity (frequency is unknown).

Amoxicillin is an antibiotic used to treat Otitis Media unless you are allergic to penicillin.

Before you start the treatment, please read the manufacturer's leaflet contained with the medication. This has further information and lists all the potential side effects.

The dose is to be taken three times a day; it is important that you space out the doses evenly during the day. Swallow the capsule with water and you can take Amoxicillin either before, during or after your meals.

Do not take Amoxicillin if you are allergic to Penicillin.

You can drink alcohol while taking amoxicillin.

Keep taking Amoxicillin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never give your medication to other people even if their condition appears to be the same as yours.

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist. 

The most common ones for Amoxicillin include:

• feeling sick (nausea) or vomiting
• diarrhoea
• redness and itching in the mouth or genital area (thrush)
• a skin rash

This antibiotic can be used to treat Otitis Media if you are allergic to Amoxicillin.

Before you start treatment always read the manufacturers leaflet contained with the medication. This contains more information and lists all the potential side effects.

The dose is to be taken twice a day. It is important that you space out the doses evenly during the day. Swallow the tablet with water and you can take it either before or after food.

Keep taking Clarithromycin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never give your medication to other people even if their condition appears to be the same as yours.

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist. 

The most common ones (occur in about 1 in 10 people) for Clarithromycin include:

• feeling sick (nausea) or vomiting
• diarrhoea
• redness and itching in the mouth or genital area (thrush)
• tooth or tongue discolouration, and changes in the way things taste or smell. This will settle once you finish treatment
• a headache

It is important that you tell your doctor in your assessment of all the medical conditions you have, and all the medications you take. Failure to do so can lead to problems with any treatment you are prescribed. Always read the patient leaflet before you take any medication. 

The following groups of people should not take Clarithromycin:

• those allergic to clarithromycin or macrolide antibiotics
• those with QT prolongation or ventricular cardiac arrhythmia, including torsades de pointe
• those with heart disease
• those with hypokalaemia (low potassium)
• those with problems with the way your liver works
• pregnant women or if breastfeeding 

The following medications can interact with Clarithromycin:

• Statin for lowering cholesterol: you should stop your statin while you are taking Clarithromycin.
• Colchicine used for gout: clarithromycin should not be taken if you are also taking colchicine. 
• Warfarin: Clarithromycin can increase the bleeding risk
• Ergotamine or dihydroergotamine used for migraines: Clarithromycin must not be taken with them
• Sildenafil, tadalafil or vardenafil: Clarithromycin can increase the levels of the erectile dysfunction (ED) medication in the body. Consider reducing the dose of the ED medication while taking Clarithromycin. 

If you develop any of the symptoms listed below, then you must seek urgent medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111). Call an ambulance or go to A&E if the symptoms are severe.

• drowsiness or confusion
• difficulty in breathing or shortness of breath
• difficulty swallowing saliva, and/or you start drooling
• difficulty opening your mouth.
• a severe headache
• weakness on one side of your face
• if you develop redness, swelling and warmth around the ear or eye
• if you are unable to look at bright lights (photophobia)
• chest pain
• persistent vomiting
• neck stiffness
• non-blanching rash

In an emergency call 999 for immediate help for life-threatening conditions.

During working hours you can contact your GP surgery for help or call NHS 111. Alternatively, the following links can help you find Urgent Care Centres or Out of Hours care near you:

England 

Website: NHS Choices or telephone NHS 111

Wales

Website: NHS Direct Wales or telephone NHS Direct Wales on 0845 46 47 or the new 111 Wales Service for Swansea Neath Bridgend & Carmarthen

Scotland

Website: NHS Inform  or call NHS 111

Northern Ireland

Website: Health and Social Care

The contact telephone numbers for out of hours GP services in your area can be found here: NI Direct Government Services

An itchy rash, swollen face or mouth, or difficulty in breathing, may be signs that you are allergic to the medication. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop a sudden onset of any of the symptoms below then you must STOP the medication immediately and seek urgent medical advice. This could be from your GP, Out of Hours Service, Urgent Care Centre or NHS 111. Call an ambulance or go to A&E if the symptoms are severe.

• Wheeze
• Difficulty in Breathing
• Swelling of the eyelids, face or lips
• A rash particularly if affecting your entire body

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course as this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.