Also known as “swimmer’s ear” or “tropical ear,” acute otitis externa (AOE) is one of the
most common infections encountered by clinicians.
In 2006, the American Academy of Otolaryngology–Head and Neck Surgery Foundation
published a new guideline that provides evidence-based recommendations to manage
diffuse AOE, defined as generalized inflammation of the external ear canal, which
may also involve the pinna or tympanic membrane. The guideline has a strong recommendation about proper pain control of patients with AOE.
The guideline has recommendations that clinicians should:
Image used with permission from Doc’s Proplugs.
- Distinguish diffuse AOE from other causes
of otalgia, otorrhea, and inflammation
of the ear canal. A diagnosis of diffuse
AOE requires rapid onset with signs and
symptoms of ear canal inflammation.
A hallmark sign of diffuse AOE is
tenderness of the tragus (when pushed),
pinna (when pulled up and back), or both.
- Assess the patient with diffuse AOE
for factors that modify management
(nonintact tympanic membrane,
tympanostomy tube, diabetes,
immunocompromised state, prior radiotherapy); and,
- Use topical preparations for initial therapy of diffuse, uncomplicated AOE;
systemic antimicrobial therapy should NOT be used unless there is extension
outside of the ear canal or the presence of specific host factors that would indicate a
need for systemic therapy such as diabetes or HIV infection/AIDS. When systemic
antibiotics are indicated, clinicians should select the ones actively against Paeruginosa and S aureus, the most common pathogens identified in cases of AOE.
The guideline has additional recommendations that:
- The choice of topical antimicrobial therapy of diffuse AOE should be based
on efficacy, low incidence of adverse events, likelihood of adherence to therapy,
and cost; review of randomized trials showed no significant differences in
clinical outcomes of AOE for antiseptic vs. antimicrobial, quinolone antibiotic vs.
nonquinolone antibiotic(s), or steroid-antimicrobial vs. antimicrobial alone.
- Clinicians should inform patients how to administer topical drops, plus aural toilet,
placing a wick, or both when indicated;
- A nonototoxic topical preparation should be used
for the patient with a tympanostomy tube or known
perforation of the tympanic membrane; and,
- The clinician should reassess the patient if no response
to the initial therapeutic option within 48 to 72 hours.
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