Antibiotic ear drops are the first line treatment for otitis externa. Topical corticosteroids may be added, but oral steroids are not used. While there is little data to support its effectiveness, most healthcare professionals do irrigate the ear with water or saline—but it should be at room temperature to prevent nystagmus, nausea, and vertigo. Oral antibiotics are reserved for patients with systemic symptoms or symptoms beyond the ear canal. They would generally not be used in an afebrile patient.