Otitis externa
Questionnaire/history:
Itch of the ear canal?
Ear pain and tenderness of the tragus and/or pinna, with possible jaw pain?
Ear discharge?
Hearing loss due to ear canal occlusion?.
At least one typical symptom above?
Onset of symptoms?
Side?
Examination:
Tenderness of the tragus and/or pinna?
Ear canal red?
Ear canal oedematous?
Debris?
Discharge?
Tympanic membrane erythema?
Cellulitis of the pinna and adjacent skin?
Conductive hearing loss?
Tender regional lymphadenitis?
At least two typical signs?
Investigations:
Ear swab if
Treatment failure?
Severe, recurrent or chronic otitis externa?
Ear canal occlusion due to swelling and debris causing difficulty using topical treatment effectively?
Suspected spread of infection beyond the external ear canal?
Ciprofloxacin 2 mg/ml ear drops, apply 0.25 ml twice daily for 7 days, 0.25 ml unit dose
OR
Ciprofloxacin 0.3% eye drops, apply 5 drops twice daily for 7 days, 5 ml
OR
Ciprofloxacin 0.3%/dexamethasone 0.1% ear drops, apply 4 drops twice daily for 7 days, 5 ml
OR
Ciprofloxacin 3 mg/ml/fluocinolone 0.25 mg/ml (Cetraxal Plus) ear drops 0.25 ml unit dose, instil the contents of one single ampoules in to the affected ear twice daily for 7 days, 15 unit doses
(Note: ciprofloxacin can be used if perforated eardrum)
Cleaning of the external auditory canal (‘aural toilet’) by:
Dry swabbing of secretions
OR
Ear irrigation to remove debris, earwax and exudate if the tympanic membrane is visualised and intact and no immunocompromise
OR
Microsuction
Advised:
Avoid damage to the external ear canal, cottons buds or other objects should not be used to clean the ear canal
Keep the ears clean and dryAvoid swimming and water sports for at least 7-10 days during treatment
Use ear plugs and/or a tight-frighting cap when swimming
Keep shampoo, soap and water out of the ear when bathing and showering for example by inserting ear plugs or cotton wool (with petroleum jelly)
Considering using a hair dryer (at the lowest heat setting) to dry the ear canal after hair washing, bathing or swimming
Paracetamol and/or ibuprofen for pain relief if needed
Patient UK leaflet Ear Infection – Otitis Externa
Follow up if:
New or worsening symptoms
Symptoms are not improving within 48-72 hours of starting initial treatment
Symptoms have not fully resolved after 2 weeks of starting initial treatment
Symptoms are severe and/or there is cellulitis spreading beyond the external ear canal
Immunocompromise
Ear wax impaction or stenosis of the ear canal which prevents the tympanic membrane being visualised to check for an alternative cause of symptoms
Resource(s):
Information for patient/carer(s):