HNY Policy and Pathway Repository - York

Inflammation of the ear canal with or without infection. This can be split into infective (usually bacterial or fungal) or non-infective dermatitis (allergic, eczematous).

• Severe unremitting pain, cranial nerve palsy, or fever may represent malignant otitis externa (osteomyelitis of the temporal bone caused by Pseudomonas aerogenosa). More common in diabetic or immunocompromised patients.
• Spreading infection could be mastoiditis, periaural cellulitis, or perichondritis.

• Discuss avoidance of water in the ear and foreign bodies, ear plugs, or hearing aids whilst infected
• Recommend an analgesic for symptomatic relief e.g. paracetamol or ibuprofen are usually sufficient. Codeine can provide additional analgesia for severe pain.
• First line: OTC Acetic acid 2% spray (Ear-calm®)* 1 spray TDS for 7 days
• Alternative: flumetasone 0.02% + clioquinol 1% ear drops (Locorten-Vioform®) 2-3 drops into the affected ear(s) BD
• As per: North Yorkshire Antibiotic Guidance
• In the presence of tympanic membrane perforation topical aminoglycoside use should be limited to 7 days to avoid ototoxicity.
• Oral antibiotics are rarely indicated - consider seeking specialist advice if an oral antibiotic is thought to be required
• If swelling of the external auditory canal or severe blockage by debris limit topical treatment then refer for micro-suction and consideration of using a wick to apply medication.
• Review if symptoms have not settled in 7-10 days and consider referral to ENT.
• If treatment fails or otitis externa is recurrent consider taking an ear swab.
• Remember chronic use of ear drops can lead to allergy to topical treatment and/or fungal infection.

Information to include in referral letter

• Relevant past medical / surgical history
• Current regular medication
• Smoking status
   

Investigations prior to referral

Ear swab

Patient Information

• http://patient.info/health/ear-infection-otitis-externa 
• http://www.nhs.uk/Conditions/otitis-externa/Pages/Introduction.aspx 
   

References

• 10 minute consultation: Otitis Externa BMJ 2012;344:e3623
• http://www.cks.nhs.uk/otitis_externa
• http://www.entuk.org/news/news/attachments/eardrops