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Otitis externa - Management
How should I assess someone with acute diffuse otitis externa?

  • Confirm the diagnosis.
  • Assess for the presence of precipitating and risk factors:
    • Diabetes, immunosuppression, older age.
    • Exposure to water, humid climate.
    • Use of hearing aid, ear plugs.
    • Trauma to ear canal from cleaning, scratching, instrumentation.
    • Dermatoses.
    • Atopic, allergic, or irritant dermatitis.
    • Previous topical treatments for otitis externa or otitis media.
    • Previous ear surgery, such as tympanostomy.
    • Radiotherapy to ear.
  • Assess severity of symptoms:
    • Pain or tenderness on moving ear (tragus or pinna) or jaw.
    • Itch.
    • Hearing loss.
    • Ear discharge.
  • Assess impact on work, social life, and activities of daily living.
  • Assess severity of inflammation:
    • Inflammation is more likely to be severe if there any of the following:
      • Ear canal is red, oedematous, narrowed, and obscured by debris.
      • Hearing loss (conductive).
      • Discharge, serous, or purulent.
      • Regional lymphadenopathy.
      • Cellulitis spreading beyond the ear.
      • Fever.
  • Assess need for investigations:
    • Investigations are rarely useful. However, if treatment fails or otitis externa recurs frequently, consider taking an ear swab for bacterial and fungal microscopy and culture.
  • Assess patency of tympanic membrane:
    • It can be difficult to adequately visualize the tympanic membrane in people with otitis externa. However:
    • Perforation can be assumed if the person:
      • Can taste medication placed in the ear, or
      • Can blow air out of the ear when the nose is pinched, or
      • Has had a tympanostomy tube inserted in the past 12 months and there is no documentation of extrusion and closure of the tympanic membrane.
    • Tympanometry, if available, can help show that the tympanic membrane is intact.
Basis for recommendation

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