Uncomplicated acute otitis externa (AOE) may be managed with at-home measures like acetic acid ear drops (diluted white vinegar, 2% equivalent) to restore acidic pH and inhibit bacterial growth, alongside pain relief using ibuprofen or acetaminophen. Protect ears from water using silicone earplugs and drying with a blow dryer after exposure. Ensure the eardrum is intact before using drops, confirmed with an otoscope or by avoiding use if symptoms of rupture (severe pain, bleeding, hearing loss) are present. For moderate-to-severe cases, consult a physician for prescription antibiotic ear drops or systemic therapy.
January 11, 2025

Swimmer’s Ear Infection: At-Home Remedies vs Professional Treatment

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

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Localized inflammation of the external auditory canal most often the result of a bacterial infection. Acute otitis externa (AOE) is defined as <6 weeks of inflammation of the auditory canal. Risk factors include exposure to water and injury to the skin of the ear canal.

Official medical guidance is to use ear drops prescribed by a physician. These are more effective and less stinging to the ear canal. However, guidelines also list acetic acid as an option, which is a time-honored at-home remedy (vinegar). 

At-home management: 

  • Antiseptic ear drops: Acetic acid is used to restore acidic pH and inhibit bacterial growth and may be combined with hydrocortisone for pain relief. Dose: Acetic acid 2% solution; 5 drops into the affected ear 4-6 times per day. Although this formulation is only available by prescription, an at-home equivalent can be made by diluting 1 part 5% acetic acid (white vinegar) with 1 part distilled water or hydrogen peroxide. Note vinegar has not been officially validated by clinical trials but is a “time-honored” remedy that contains acetic acid. Do not use if eardrum rupture is suspected (see “examination” below). All natural distilled white vinegar.

  • Pain management: Ibuprofen or acetaminophen as needed. Tylenol Rapid-Release Gelcaps (FDA M013).

  • Protect ears from water: wear earplugs and dry ear with a blowdryer after showering. Do not submerge ears underwater. Pillow Soft Silicone Earplugs.

Proper ear drop procedure:

  • Examination: Confirm the eardrum is intact using an otoscope. Symptoms of a ruptured eardrum include severe ear pain, bleeding, hearing loss, and tinnitus or vertigo. Consult a doctor if a hole is visualized in the eardrum. At-home otoscope for caregiver.

  • Procedure: The patient lies down with the affected ear facing upward. The ear is then filled with drops, preferably by another person, and the earlobe is gently moved to help the drops penetrate while the patient remains lying for 3–5 minutes.

Not recommended:

  • Ear candles should never be used in treating AOE. Ear candles have never been shown to be efficacious for AOE but have been shown to produce harm. 

Prescription medications:

  • Antibiotic ear drops: With or without steroids. Potent antibiotic and anti-inflammatory combination for moderate-to-severe cases. Dose as prescribed.

  • Systemic therapy: Oral antibiotics are used for spreading or systemic infection, as well as for certain high-risk patients. Requires medical evaluation

Citation

Rosenfeld, R. M., et al. (2014). Clinical practice guideline: acute otitis externa. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 150(1 Suppl), S1–S24. https://doi.org/10.1177/0194599813517083

Jackson, E. A., & Geer, K. (2023). Acute otitis externa: Rapid evidence review. American Family Physician, 107(2), 145-151.

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