Otitis Externa

Please follow NHS Tayside ENT Infection management the majority of which is described below

For all of the grades of infections;

• General advice on aural care (do not poke, keep ears dry etc)
• Adequate analgesia

Mild OE:

• Acetic Acid 2% (Earcalm) for 7 days.
• If no improvement after 3 days, treat as moderate OE.

Moderate OE:

• Otomize or Sofradex
• If no improvement after 1 course of treatment, swab ear (label sample “otitis externa”)
• Treat as per sensitivities considering topical Gentamicin or Ciprofloxacin (as Cilodex®) (especially if a perforation is present)
• For fungal infection: Clotrimazole solution 1% for 14 days
• Oral antibiotics should not routinely be used

If OE extends outside ear/gross ear canal oedema/cellulitis:

• Topical antibiotics as per sensitivities + consider oral antibiotics (treat as facial cellulitis)
• Consider referral to ENT if spreading infection or no response to treatment

Necrotising Otitis Externa

• This is characterised by significant pain deep in the ear associated with an otitis externa. It is an osteomyelitis of the temporal bone with a classical triad of;
  • Pain, relative immunocompromise (e.g. diabetes, immunomodulating drugs, elderly over 85 years) and a swab growing pseudomonas.
• If your patient meets all 3 of these then the diagnosis is likely and refer as below.

Emergency

• Referral ENT oncall (01382 660111) (bleep 4496)
  • If meeting criteria for OE extending outside the ear above and no response to treatment
  • If there is suspicion of necrotising otitis externa.

Urgent referral

• Any red flags (cranial nerve palsy, mass in external canal, associated neck swelling) refer urgently indicating the reason for urgency.

Routine referral

• Not responding to treatment after swab and appropriate topical therapy has been trialled then referral to ENT.

• Tayside Otitis Externa leaflet
• ENT UK leaflet

NICE otitis externa guidance