Primary prevention
Primary prevention of acute otitis externa is aimed at avoidance of risk factors. Prevention mainly centers on the preservation of the natural defense mechanism of the external auditory canal, which includes skin integrity.[1] This can be achieved by preventing the accumulation and retention of water in the ear canal.[1] Factors that might cause water retention include blockage of the external ear canal by wax or a foreign body, prolonged use of hearing protector devices, and swimming. There are no available randomized trials to assess the efficacy of different strategies in prevention, but recommendations have been made in the literature.[1] These include removal of obstructing cerumen, water precautions (e.g., the use of earplugs while swimming), the use of acidifying ear drops after swimming, and avoidance of trauma to the ear canal from cotton-tipped applicators and other objects.[19] Other suggested measures include treatment of underlying skin conditions such as dermatitis, diabetes control, and avoidance of contact with certain products (neomycin drops, some types of ear molds) in patients with known allergies.[1][16]
Secondary prevention
Advise patients to avoid the use of foreign bodies in the ear.[12] Patients with underlying skin disorders should be treated. Advise patients to use well-fitted ear plugs while swimming, as well as to dry the ear canal with a hair dryer and remove water from the ear by performing head-tilt maneuvers after swimming.[12] Patients who have wax accumulation or who have narrow ear canals should be followed up every 6 months to 1 year for wax cleaning. The use of acetic acid-containing ear drops after swimming also helps patients with recurrent otitis externa in relation to swimming; however, trials are needed to confirm effectiveness.[3][12]
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