Otitis Externa

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Contact ENT if:

  • Cellulitis spreading out from the the ear canal.
  • Cranial nerve palsies or other neurology.
  • Systemic signs of infection such as fever, raised inflammatory markers, severe pain, and infection localised to the ear canal.
  • Patient has diabete mellitus, immunosuppressed including with steroids, or patient is over 75 years old.
  • Concern regarding necrotising otitis externa.

Required investigations

Consider taking an ear swab to determine the causative organism if:

  • Treatment fails.
  • Otitis externa is recurrent or chronic.
  • Topical treatment cannot be delivered effectively, for example, if the ear canal is occluded due to swelling or debris.
  • The infection has spread beyond the ear canal.
  • The condition is severe enough to require antibiotics.

Treatment recommendations

Recommended total duration: 7 days (or as otherwise stated)

Treatment recommendations

Acetic acid 2% ear spray every 8 hours

OR

Otomize (dexamethasone/neomycin/acetic acid) ear spray, 1 spray every 8 hours
Fungal infection

Clotrimazole 1% solution ear drops every 8 hours topically

Continue for 2 weeks after disappearance of infection

Cellulitis of the pinna

OR where infection spreading out from the ear canal

OR patient is febrile or other signs of systemic involvement

Follow recommendations for Cellulitis and discuss with ENT.
  • Do not use Otomize if eardrum perforated or grommet in situ.
  • Maximum treatment duration for Otomize is 14 days

Notes

Likely organisms: Staphylococcus aureus. Fungal infection can arise as a consequence of topical antibiotic treatment. Pseudomonas spp. are implicated frequently in necrotising otitis externa.