Outer ear infections affect the skin of the ear canal. In medical speak, they are called "otitis externa". They can be triggered by swimming, using cotton buds, or touching the ear. The ear canal swells up and the hearing can become muffled. The ear can become exquisitely painful. Patients are often inadequately treated with multiple courses of oral antibiotics in the community and the infection can fester for weeks and months.
When patients come to see me there is often some smelly green or yellow discharge lining the ear canal. I use a microsuction device to vacuum away discharge so the antibiotic ear drops to can be in contact with the infected ear canal skin. I would suggest lying on your side for 5-10 minutes and allowing the drops to percolate into the ear. Within a few days the pain should settle, but I would normally suggest you carry on with the drops for 2 weeks.
Some particularly difficult infections can recur. This is because they are cause by fungi rather than bacteria. Fungi are not effectively treated by antibiotics, so I often prescribe an anti fungal solution, in combination with an antibiotic drops. You can use both at the same time. The antifungal drops can burn when you put them in. This is normal. I would carry on with the antifungal solution for 8 weeks. If you stop the treatment early, the fungus can grow back from spores.
It is really important not to touch your ears, and to keep them dry. You can use a new piece of cotton wool smothered in Vaseline to make it waterproof. This is placed in the outer bowl of the ear to prevent water getting in during a shower. If you use hearing aids or ear plugs, bacteria or fungi can grow on these, so it is worth avoiding them until the infection has settled.
In some diabetic or immunocompromised patients this infection can invade deeply into the bone of the ear and skull. This is called malignant otitis externa. It often requires microsuction to remove the infection and admission into hospital for at least 6 weeks of antibiotics through a drip into a vein (IV antibiotics).