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Otitis externa - Management
When should I refer or seek specialist advice for someone with acute diffuse otitis externa?
- Admit urgently if malignant otitis is suspected.
- Consider seeking specialist advice if:
- Symptoms have not improved despite treatment and treatment failure is unexplained.
- Treatment with a quinolone is indicated.
- Consider referral to secondary care if there is:
- Extensive cellulitis.
- Extreme pain or discomfort.
- Considerable discharge or extensive swelling of the auditory canal, and microsuction or ear wick insertion is required.
Clarification / Additional information
- Suspect malignant otitis if:
- Pain and headache are more severe than the clinical signs would suggest, or
- There is granulation tissue at the bone–cartilage junction of the ear canal, or exposed bone in the ear canal, or
- The facial nerve is paralysed (drooping of the face on the side of the lesion).
Basis for recommendation
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