Otitis externa is a localised infection of the ear canal. The underlying cause often is inflammation which leads to superinfection. Occasionally use of antibiotic drops can lead to fungal overgrowth.
Preceding factors often include swimming or other water exposure.
Pain on pulling the pinna backwards for inspection or on touching the tragus makes otitis externa more likely than otitis media, which can also present with a discharging ear. Usually, otitis externa does not cause systemic upset whilst otitis media does.
Please see Primary Care Management for advice about the treatment of acute and chronic otitis externa, which require different approaches.
C.M. & G.T – 12-10-26
Consider:
- Duration of symptoms
- Hearing loss
- Pain
- Discharge.
Who to refer:
Urgent – discussion with on call team if:
- Facial palsy/cranial nerve weakness
- Signs of spread to pinna or face (perichondritis/cellulitis) – will need antibiotics
- Systemically unwell
- Immunocompromised
- Suspicion of foreign body.
Non-urgent referral to clinic, if:
- Not responding to primary care treatment
- Recurrent episodes despite appropriate management.
Examine ear:
- Canal oedema
- Discharge, often malodorous and bloody
- Pain – sharp, tender to touch, worse on pressing on tragus or pulling pinna backwards
- Tympanic membrane if visible.
Otitis externa (acute)
Manage underlying conditions.
Take swab to delineate infection:
- Bacterial (most common)
- Fungal.
Gently dry mop ear if possible.
Prescribe topical treatment – oral antibiotics do not reach sufficient concentration in external ear to have any effect, and are only indicated in cases of facial cellulitis or systemic involvement.
- Ciprofloxacin / dexamethasone drops if tympanic membrane perforation suspected
- Gentamycin / hydrocortisone ear drops
- Clotrimazole if fungal infection – long term (at least 6 weeks – and 2 weeks after symptoms have disappeared).
Advise the patient to keep ears dry when showering/washing hair, and avoid all swimming during acute infection.
Advise patients to keep ears dry when showering / washing hair-no swimming during acute infection. And never any manipulation of the ear canal by patient or parents (cotton buds etc….)!
If unresponsive to treatment, discuss with on call team RHCYP.
Otitis externa (Chronic)
- This is generally a form of eczema
- It is best treated with steroid drops or ointment
- Advice to patients to keep ears dry (no swimming). Even when showering use cotton wool & petroleum jelly. Strictly avoid use of cotton buds or any other instrument.
- If itchy only, try simple almond oil (ensure patient not allergic to nuts)
- Acetic acid spray in patients 12 years and above
- In not successful, discuss with dermatology.
