Objective Fungal infection of the external auditory canal, otomycosis, is generally a resistant mycotic infection. We designed a prospective, randomized, controlled cohort study to analyse the treatment effect of ear canal lavage on otomycosis. Methods The clinical patients were divided into two groups: an irrigation group and an irrigation + local drug treatment control group. Results From January 2022 to December 2023, a total of 102 patients treated for otomycosis were enrolled, and 98 of the patients were followed up for three months. Twenty-two of the 98 patients (22.45%) had no or minor symptoms. Other common symptoms such as pruritus, pain, hearing impairment, etc., presented solely or in combination (Table 1). Our fungal culture results revealed that, in 83 patients (84.69%) the otomycotic pathogen was Aspergillus. In the lavage group, 48 (48/52, 92.30%) patients were cured with initial treatment after three months of follow-up, two (2/52, 3.85%) patients were cured after one month but were lost to follow-up after three months, and two (2/52, 3.85%) patients failed after initial treatment, received topical miconazole ointment treatment and were eventually cured. In the irrigation + local drug control group, 48 (48/50, 96.00%) subjects responded to initial treatment without recurrent disease after three months; 2 (2/50, 4.00%) subjects were lost to follow-up. According to Fisher’s exact test, there was no significant difference between the two groups (Table 3, P = 0.258). Conclusion Both ear canal rinses and local antifungal creams are effective, and sequential treatment via both methods is reasonable.