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Otitis externa - Management
How should I treat acute diffuse otitis externa?

  • Remove or treat any precipitating or aggravating factors.
  • Prescribe or recommend an analgesic for symptomatic relief.
    • Paracetamol or ibuprofen are usually sufficient. Codeine can provide additional analgesia for severe pain.
  • Treat inflammation using a topical ear preparation for 7 days:
    • For mild cases (discomfort and/or pruritus; no pain, deafness, or discharge) topical acetic acid 2% spray can be used first-line.
    • For more severe cases (pain, deafness, discharge), or if treatment with acetic acid for mild otitis externa is not effective, a topical antibiotic with or without a topical corticosteroid should be used:
      • Both a non-aminoglycoside antibiotic and a corticosteroid e.g. flumetasone–clioquinol (Locorten–Vioform®) ear drops.
      • Both an aminoglycoside antibiotic and a corticosteroid (contraindicated if the tympanic membrane is perforated).
      • Topical preparations containing only an antibiotic (gentamicin ear drops are contraindicated if the tympanic membrane is perforated).
  • If there is sufficient earwax or debris to obstruct topical medication, consider cleaning the external auditory canal (may require referral).
  • If there is extensive swelling of the auditory canal, consider inserting an ear wick (may require referral).
  • Provide appropriate self-care advice.

In depth

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