When treating otitis externa, placement of an ear wick can help direct topical antibiotics into a swollen canal. If you don’t have a commercially sold ear wick, you can make one by cutting a small strip of merocel or even ribbon packing gauze (~15mm is a typical length). This video explains insertion. At least 6 drops of oto-antibiotics should be placed on the external end of the wick to prime it, and the patient should then be instructed to continue applying 2-4 drops to the external end of the wick 2-4x/day. The wick should be removed after 2-3 days. If insurance doesn’t cover otic fluoroquinolone drops, ophthalmic fluoroquinolone drops can be used in the ear (but vice versa is not true). If the canal is so swollen that it’s hard to get the ear wick in, use a small well tapered otoscope speculum to direct steroid otic drops into the canal first to decrease swelling.