Introduction
Otitis externa is a localised infection of the ear canal. The underlying cause is often inflammation which then 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.
Almost all can be managed in general practice – please see the Primary Care Management page for details.
Consider factors:
- Duration of symptoms
- Hearing loss
- Pain
- Discharge
Who to refer:
Consider referral for:
- Those not responding to primary care treatment
- Recurrent episodes despite appropriate management.
This is often more appropriately referred to Dermatology rather than ENT, as ongoing eczematous changes often are the underlying problem.
Emergency referral requiring discussion with on call ENT:
- Facial palsy
- Signs of spread to pinna or face (perichondritis/cellulitis)-will need antibiotics
- Systemically unwell.
Examine ear for:
- 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)
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. They are only indicated in cases of facial cellulitis.
- Ciprofloxacin / dexamethasone drops if tympanic membrane perforation suspected
- Please refer to the Lothian Joint Formulary for current guidance on other topical treatment
- 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.
Please advise never to undertake any manipulation of the ear canal by patient or parents (cotton buds etc….)!
If unresponsive to treatment, discuss with on call team at RHCYP.
Otitis externa (Chronic)
- This is a form of eczema
- It is best treated with steroid drops or ointment
- Advise patients to keep ears dry (no swimming). Even when showering use cotton wool & vaseline. Strictly avoid use of cotton buds or any other instruments.
- If itchy only, try simple almond oil (ensure patient not allergic to nuts)
- Acetic acid spray
- In not successful, consider referral to dermatology.
