Acute Otitis Externa

Question 1

Which region of the ear does Otits external affect?

Answer 1

Outer

Question 2

What is Otitis Externa?

Answer 2

Inflammation associated with effusion and a rapid onset of symptoms with signs of an infection

Question 3

Aetiology(Cause)

Answer 3

A bacterial or fungal infection, contact sensitivity, trauma or discharge from otitis media
It is common in patients whose ears have had prolonged exposure to water where the continual moist environment predisposes the ear canal to infections. It is frequently referred to as ‘swimmers’ ear’

Question 4

Presenting symptoms

Answer 4

Itching
Pain/tenderness (which may be severe) and extend to the jaw
Temporary loss of hearing
Discharge, which may include debris
Inflammation – erythema (reddening) and swelling (which may occlude the ear canal)
Usually only one ear affected
Ear may feel ‘blocked’ or ‘full’

Question 5

Otoscopic inspection

Answer 5

May be difficult due to discharge and/or occlusion
There may be tympanic membrane erythema

Question 6

Management

Answer 6

Advice: avoid damage to the ear canal; keep ears clean and dry (swimmers could consider using ear plugs); manage any contact sensitivity/allergy

For patients aged 12 years or more, with mild otitis externa, consider over-the-counter acetic acid 2% ear drops or spray (e.g. EarCalm®)*

Where appropriate, consider a topical antibiotic preparation (with or without a topical corticosteroid) for 7-14 days*

Consider analgesia (medication to treat pain)

Symptoms should improve in 48-72 hours and resolve within two weeks.

Question 7

Safety Netting

Answer 7

The patient should return or seek medical advice if
symptoms worsen suddenly or significantly
or symptoms do not improve or resolve within the expected timeframe
or the patient becomes systemically unwell

Question 8

Red Flag Management

Answer 8

In some cases, pharmacists may have the appropriate training, experience and clinical environment to manage patients with ‘red flag’ symptoms.

However, if this is not the case, referral for medical or specialist attention should be considered for patients who (e.g.)

Are experiencing chronic or recurring otitis externa

Ear canal occlusion prevents topical medication from working effectively

The infection is severe

The patient has complications or other medical conditions which require attention