Earache: What medications help in inflammations in the auditory canal?

Some ear drops, which are only available on prescription, seem to ease earache due to an inflammation of the external auditory canal very effectively. There is no evidence that disinfectant drops, which are available as over-the-counter-medications, are similarly effective.

One of the common signs of an inflammation in the external auditory canal is the auditory canal being red and swollen. This inflammation is also called otitis externa – otitis being the Latin term for inflammation of the ear. The outer ear begins at the auricle and ends at the eardrum. Behind the eardrum is where the middle ear starts. Click here to see the structure of the ear.

Otitis externa is one of the most common causes for earaches. It is also called “swimmer’s ear”, because it affects people who regularly go swimming more often. Children and people with hearing aids are also more prone to getting this illness. A bacterial infection is the most common cause of an inflamed auditory canal. Another reason might be a fungal infection, for example a yeast fungus.

If you have otitis externa, your ear can hurt or feel uncomfortable – especially when you touch or pull on it. The ear may also be blocked and you might not hear as well as you usually do. Liquid might also flow out of the ear. In about 1 out of 3 people symptoms are so severe that it affects their every-day lives. About 1 out of 5 people stays in bed because of the symptoms.

Painkillers and disinfectant ear drops are some of the common treatments available in pharmacies as over-the-counter medications. Prescription-only ear drops are also often used in an infection. If the inflammation is severe or persists for several weeks, your doctor might place a little sponge or a strip of gauze soaked with ear drops into the auditory canal.

Trials indicate that some prescription-only ear drops can reduce inflammation

A group of researchers from the Cochrane Collaboration – an international network of researchers – looked for randomized controlled trials that tested different treatments for inflammations of the auditory canal. You can read more about how this kind of trials is done here. The researchers found 19 trials including almost 3,400 children and adults with acute otitis externa. Acute otitis externa means that the inflammation does not last longer than a few days or weeks. The researchers did not evaluate trials on chronic inflammations.

The evaluation of the trials showed that prescription-only ear drops containing antibiotics and cortisone seemed to be very effective in relieving the symptoms of otitis externa. Further trials indicated that other medications seemed to be of similar effectiveness, however. They compared antibiotics, cortisone or drugs against fungal infections with one another, for example. Some trials also looked at combinations of different types of drugs. There were mostly no clear advantages or disadvantages of certain medications. You can talk to your doctor about the appropriate medication for your case.

There is no evidence that “disinfectant” ear drops are similarly effective as drops containing antibiotics or cortisone.

On the whole, most of the trials were small and had other flaws, so that no final conclusion can be drawn regarding the advantages and disadvantages of the different ear drops and sprays. Ear drops can also have adverse effects like causing a burning sensation or skin rashes. Adverse reactions are unlikely, however, if you use the ear drops as intended. If you are not sure how to use them, you can consult the package insert or ask your doctor.

Things you could try out to prevent further infections

People who have already had otitis externa are at a higher risk of getting another infection. The Cochrane researchers did not look for research on strategies to prevent a new inflammation. But they suggest trying out the following things:

• It is important not to damage the auditory canal. This can happen if you clean your ears using a cotton swab or something else. It is therefore better not to do that. You can find out more about how to keep your ears clean here. Shampoo or soap can also contain chemicals and favor an inflammation.
• If you like swimming, you can still go even if your auditory canal is inflamed. If you wear a swimming cap when swimming or bathing or under the shower, water cannot enter the ear so easily.
• Some swimmers use ear plugs. Plugs that are soft and fit well do not damage the auditory canal as easily.
• If water does get into your ear, it is usually sufficient to tilt your head to one side for the water to get out. Jumping up and down a little at the same time also helps.
• Earbuds placed in the ear to listen to music may also damage the auditory canal. One option is to use a different type of headphones instead.

If one ear is inflamed, be careful not to spread the infection to the other ear, for example by mixing up your ear plugs.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

 
Next planned update: June 2014. You can find out more about how our health information is updated here.

© IQWiG (Institute for Quality and Efficiency in Health Care)