Malassezia pachydermatis is a fungal pathogen that often leads to dog dermatitis and ear infections. The current treatment for otitis externa, which involves antifungal, antibiotic, and glucocorticoid drugs, faces challenges due to drug resistance and pet owners' compliance with prolonged treatment. This review delves into alternative treatment methods beyond conventional antifungal drugs and provides recommendations for their practical use. These methods include phytotherapies, chemical substances, drug repositioning, ear cleaners, alternative administration methods, and therapeutic diets. Further research, clinical trials, and comparative studies are needed to validate the efficacy of these alternative treatments and incorporate them into clinical practice. By implementing these methods, traditional treatment protocols can be optimized, drug resistance can be minimized, and the management of M. pachydermatis otitis externa in dogs can be improved, following the One Health approach that promotes prudent antimicrobial use.