{"id":4235,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/otitisexterna\/"},"modified":"2025-03-25T13:41:59","modified_gmt":"2025-03-25T13:41:59","slug":"otitisexterna","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/ear\/otitisexterna\/","title":{"rendered":"Otitis Externa"},"content":{"rendered":"\n<p class=\"has-standard-black-color has-text-color\">There is a <a href=\"https:\/\/cks.nice.org.uk\/topics\/otitis-externa\/\" target=\"_blank\" rel=\"noreferrer noopener\">NICE otitis externa CKS<\/a> guideline outlining diagnostic and management approaches \u2013 please also see the Primary Care Management tab.<\/p>\n\n\n\n<p><strong>C.M. &amp; L.McM. 25-03-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Please referral urgently by phone to&nbsp;on call ENT&nbsp;at St Johns only if:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Severe pain, hearing loss or bleeding<\/li>\n\n\n\n<li>Facial Palsy<\/li>\n\n\n\n<li>Signs of spread to pinna (perichondritis) or face (cellulitis)<\/li>\n\n\n\n<li>Persistent otitis externa with significant pain in a patient with any cause for immunosuppression &#8211; e.g. Diabetes Mellitus &#8211; could represent Malignant Otitis Externa which is a form of skull base osteomyelitis<\/li>\n<\/ul>\n\n\n\n<p><strong>Non-urgent referral to clinic, if:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Not responding to primary care treatment<\/li>\n\n\n\n<li>Persisting hearing loss.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Acute otitis externa<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Advise patient to keep ears dry (no swimming, saunas etc).&nbsp;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.<\/li>\n\n\n\n<li>Clean canal by cotton wool or irrigation (if no perforation)<\/li>\n\n\n\n<li>Prescribe antibiotic +\/- steroid drops\/spray \u2013&nbsp;see <a href=\"https:\/\/formulary.nhs.scot\/east\" target=\"_blank\" rel=\"noreferrer noopener\">East Region Formulary<\/a>.<\/li>\n\n\n\n<li>If unresponsive, consider fungal infection<\/li>\n\n\n\n<li>If persistent, consider&nbsp;microbiology&nbsp;swabs and refer&nbsp;to ENT<\/li>\n\n\n\n<li>If there is a known perforation, ciprofloxacin with dexamethasone drops are available.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Chronic otitis externa<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>This is a form of eczema and itch is a predominant symptom<\/li>\n\n\n\n<li>If itchy only, use simple almond oil&nbsp;<strong>(ensure patient not allergic to nuts)<\/strong><\/li>\n\n\n\n<li>A&nbsp;10% dilution of household vinegar&nbsp;with&nbsp; cold boiled water&nbsp;applied once per day is also useful. This can be bought over the counter as EarCalm.<\/li>\n\n\n\n<li>Advise patients to keep ears dry (no swimming). Even when showering use cotton wool &amp; paraffin jelly. Strictly avoid use of cotton buds or any other instrument<\/li>\n\n\n\n<li>It is best treated with steroid drops or ointment (Betamethasone)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/cks.nice.org.uk\/otitis-externa\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/cks.nice.org.uk\/otitis-externa<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>There is a NICE otitis externa CKS guideline outlining diagnostic and management approaches &ndash; please also see the Primary Care Management tab. C.M. &amp; L.McM. 25-03-25<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3886,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[144],"class_list":["post-4235","page","type-page","status-publish","hentry","category-otitisexterna"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entadult\/ear\/otitisexterna\/\" rel=\"tag\">Otitis Externa<\/a>","rttpg_excerpt":"There is a NICE otitis externa CKS guideline outlining diagnostic and management approaches &ndash; please also see the Primary Care Management tab. C.M. &amp; L.McM. 25-03-25","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4235","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4235"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4235\/revisions"}],"predecessor-version":[{"id":23541,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4235\/revisions\/23541"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3886"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4235"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4235"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}