Otitis Externa

Please referral urgently 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) or face (cellulitis)
• Persistent otitis externa with significant pain in a patient with any cause for immunosuppression – e.g. Diabetes Mellitus – could represent Malignant Otitis Externa which is a form of skull base osteomyelitis

Non-urgent referral to clinic, if:

• Not responding to primary care treatment
• Persisting hearing loss.

Acute otitis externa

• Advise patient to keep ears dry (no swimming, saunas etc). When showering use cotton wool covered by a thin layer of petroleum jelly discarded after every use. Strictly avoid use of cotton buds or any other instrument in the ear. If the patient uses hearing aids / earphones / earplugs they should be encouraged to keep these out while the ear heals and to thoroughly disinfect the part placed in the ear between uses to prevent re-infection.
• Clean canal by cotton wool or irrigation (if no perforation)
• Prescribe antibiotic +/- steroid drops/spray – see East Region Formulary.
• If unresponsive, consider fungal infection
• If persistent, consider microbiology swabs and refer to ENT
• If there is a known perforation, ciprofloxacin with dexamethasone 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 & paraffin jelly. Strictly avoid use of cotton buds or any other instrument
• It is best treated with steroid drops or ointment (Betamethasone)

https://cks.nice.org.uk/otitis-externa