Otitis external (OE) is referred to a spectrum of external ear inflammation. This study aimed to determine the prevalence, risk factors, complication of acute otitis external (AOE) and a total cost in managing one episode of care of AOE treatment. Costing analysis was done by using top-down analysis and activity-based costing with the data provided by the study centers and clinical pathway, which was formulated for the study. A total of 157 patients of AOE were recruited for this study. Out of 157 patients, 23 patients presented with bilateral disease which make a total numbers of 180 ears. The mean age was 29.4 years (5 months - 75 years ). 110 (61.1%) cases were diagnosed with acute diffuse otitis external, 48 (26.7%) with otomycosis, 18 (10.0%) with acute localised otitis external and 4 (2.2%) with eczematous otitis external. A tital of 117 cases (65.0%) had a history of recent cotton bud use as predisposing factor for OE. The disease required RM 234.52 to treat per visit, and the total cost to treat one case of AOE with average 2.3 visits was RM 539.40. The usage of cotton bud or ear digging is a primary risk factor in developing AOE.