This page was last reviewed 13-08-20
EXAMINATION:
- Look for swelling, inflammation or discharge
Consideration of referral – What you need to ask the patient:
- Duration of symptoms days/weeks/months
- Any hearing loss
- Itch
- Pain or discharge
Urgent referral by phone to on call ENT at St Johns only if:
- Severe pain, hearing loss or bleeding
- Facial Palsy
- Signs of spread to pinna (perichondritis)
Non-urgent referral to clinic, if:
- Not responding to primary care treatment
- Persisting hearing loss
Acute otitis externa
- Advice to patients to keep ears dry (no swimming). Even when showering use cotton wool & vaseline. Strictly avoid use of cotton buds or any other instrument
- Clean canal by cotton wool or irrigation (if no perforation)
- Prescribe antibiotic drops/spray – see Lothian Joint Formulary
- If the canal is swollen and painful, use an ear wick (merocel) with the above drops
- If unresponsive, consider fungal infection
- If persistent, consider microbiology swabs and refer to ENT
- If there is a known perforation CILODEX drops are available
Chronic otitis externa
- This is a form of eczema and itch is a predominant symptom
- If itchy only, use simple almond oil (ensure patient not allergic to nuts)
- A 10% dilution of household vinegar with cold boiled water applied once per day is also useful. This can be bought over the counter as EarCalm.
- Advise patients to keep ears dry (no swimming). Even when showering use cotton wool & vaseline. Strictly avoid use of cotton buds or any other instrument
- It is best treated with steroid drops or ointment (Betamethasone)
