July 05, 2020

Home Remedies for Swimmer's Ear (aka Acute Otitis Externa)

Swimmer's ear is an infection of the skin lining the ear canal. Swimmers are prone to this kind of ear infection, though even non-swimmers can get it as well mainly due to sweating. This condition medically called "acute otitis externa" is very painful and once experienced, most people will do whatever it takes in order to avoid experiencing it again.

Preventative ear drops have been developed over the years to help prevent or treat swimmer's ears, but most commercial ear drop preparations are actually easily made with cheap home supplies.

Here are some recipes for home remedies for swimmer's ears. Keep in mind that none of these home remedies can be used if there's a hole in the eardrum or ear tubes are present!!! Prescription ear drops should be used instead.

You can also purchase empty eye droppers on Amazon.

Recipe(s) #1 utilize some combination of distilled water, rubbing alcohol (aka isopropyl alcohol), hydrogen peroxide, and white vinegar. Here are 3 different preparation variations:

    1. Mix solution such that 50% is rubbing alcohol, 25% white vinegar, and 25% distilled water
    2. Mix half and half white vinegar and distilled water
    3. Mix half and half white vinegar and rubbing alcohol
    4. Mix half and half rubbing alcohol and hydrogen peroxide
    5. Just use undiluted hydrogen peroxide

    Place 2-3 drops into the ear immediately after swimming. Let it sit for a few minutes before allowing the drops to drain back out.

    Be aware that preparations containing rubbing alcohol will severely BURN if there is any inflammation or infection present... imagine what happens when placing alcohol on a skin cut and you'll get some idea of what it'll feel like. White vinegar and hydrogen peroxide may also burn, but not as bad.

    As such, recipe(s) #1 may be most useful as a preventative measure (when no inflammation or infection is present) rather than treatment given the burning that will happen with use.

    So why even bother with rubbing alcohol? Mainly it's because it is the best "drying" agent to help remove any water stuck inside the ear.

    In my practice, I typically recommend #2, the solution containing 50% white vinegar and 50% distilled water.

    As an aside, did you know that vinegar is basically 5% acetic acid with trace amounts of chemical flavorings?

    Recipe(s) #2 are based on Burows Solution, Domeboro Otic, Borofair, or Star-Otic which nowadays are terms used interchangeably though at some point in the past, they were actually different preparations that utilized varying concentrations of aluminum (sub)acetate, glycerol, distilled water, rubbing alcohol, acetic acid, and/or boric acid. These recipes particularly help if the ear canal skin is inflamed and weepy as it helps to dry up and disinfect.

    The official USP method of specifically making a stable Burows solution (5% aluminum subacetate) is as follows and not something that can be easily done at home, but mentioning here for educational purposes.
    The procedure involves the reaction of aluminum sulfate, calcium carbonate and acetic acid to form aluminum sub-acetate, also termed basic aluminum acetate, and a precipitate of calcium sulfate; on removal of the calcium sulfate by filtration, the filtrate is converted to aluminum acetate solution, more commonly called Burows solution, by the addition of acetic acid. 
    A second approved procedure involves a double decomposition reaction of aluminum sulfate with either lead acetate or calcium acetate to produce a solution of aluminum acetate and a precipitate of lead or calcium sulfate. Filtration of the reaction mixture gives Burows solution. 
    Thankfully, there is a dry powder preparation called "Domeboro" you can easily buy over-the-counter, but be aware that the dry powder contains aluminum sulfate tetradecahydrate (1347mg) and calcium acetate monohydrate (952mg) which when combined in solution creates aluminum acetate which does not work as well nor is as potent as aluminum subacetate.

    A good alternative to glycerol are OTC Systane eye drops which contain propylene glycol and polyethylene glycol with added benefit of having a ready to use dropper. Glycerin has also been used.

    Here are 5 different preparation variations:

    1. Mix 1 packet Domeboro in 15mL of distilled warm water creates 5.12% aluminum acetate solution. Make sure to filter out any undissolved powder with filter paper or tissue in a pinch before use.
    2. Mix 1 packet Domeboro in 7.5mL of distilled warm water first, remove any undissolved powder with filter paper or tissue in a pinch, then mix into 7.5mL of glycerol substitute. 
    3. Mix 1 packet Domeboro in 7.5mL of distilled warm water first, remove any undissolved powder with filter paper or tissue in a pinch, then mix into 7.5mL of white vinegar
    4. Mix 400mg of boric acid into 10mL of rubbing alcohol or distilled water creates a 4% boric acid solution (or basically add enough powder until no more goes into solution)
    5. Some reports advocate gently puffing a light coating of boric acid powder directly into the ear canal. This can be accomplished using an ear insufflator.

    Place 2-3 drops into the ear immediately after swimming (or 1 gentle puff of boric acid if using #4). Let it sit for a few minutes before allowing the drops to drain back out.

    I rarely if ever suggest these preparations as they are a bit more of a pain to make/use and I feel do not offer significant additional benefit compared with recipe(s) #1. But there's always 1 or 2 individuals I see each year where these preparations really do work better than recipe(s) #1.

    As mentioned above already, do not use these preparations if there is a hole in the eardrum or ear tubes are present. Prescription ear drops should be used instead.

    Recipes #3 are based on unproven anecdotal reports and incorporate food/herbal products.

    1. Use warmed up onion juice
    2. Crush a few cloves of garlic and mix with 2 tablespoons of olive oil. Warm the oil until garlic turns brown. Use the oil at this point.
    3. Warmed up juice squeezed from 4-5 basil leaves.  

    Place 2-3 drops into the ear immediately after swimming. Let it sit for a few minutes before allowing the drops to drain back out. As mentioned above already, do not use these preparations if there is a hole in the eardrum or ear tubes are present. Prescription ear drops should be used instead.

    The video below demonstrates proper ear drop administration.






    Fauquier blog
    Fauquier ENT

    Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. He is also the chief medical officer of O2Labz, a medical and scientific 3D animation company.

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