Pediatric Otitis Externa Treatment & Management

  • Author: Ariel A Waitzman, MD, FRCS(C); Chief Editor: Glenn C Isaacson, MD, FACS, FAAP   more...
 
Updated: Jan 4, 2010
 

Medical Care

  • Topical treatment
    • Most cases of acute otitis externa (OE) respond well to topical treatment.
    • Antibiotic eardrops, with or without a steroid, are the mainstay of treatment.
    • Topical acidifying and drying agents may be used in mild or resolving cases and are useful in fungal infections.
    • Some patients require strong analgesics for the first few days of treatment.
  • Oral antibiotics
    • Most persons with OE do not require oral medications.
    • Administer oral antibiotics in individuals with cellulitis of the face or neck skin or in persons in whom severe edema of the ear canal limits penetration of topical agents.
    • Consider oral antibiotics in patients who are immunocompromised.
  • Intravenous antibiotics
    • Intravenous (IV) antibiotics are used in individuals with necrotizing OE.
    • They may also be appropriate in patients with severe cellulitis or in persons whose symptoms do not respond to topical and oral antibiotics.
    • A prolonged course of IV antibiotics lasting as many as 6 weeks may be needed for individuals with necrotizing OE.
    • If the patient is stable, IV antibiotics may be administered at home.
    • Begin treatment with antibiotics to cover pseudomonads and alter medication depending on culture results.
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Surgical Care

  • Debridement
    • Surgical debridement is occasionally required in individuals with necrotizing (ie, malignant) OE.
    • Debridement of the ear canal is often necessary in more severe cases of OE or when a significant amount of discharge is present in the ear.
    • An otolaryngologist usually performs debridement using magnification and suction equipment.
    • Debridement is the mainstay of treatment for fungal infections.
  • Incision and drainage
    • Occasionally, an abscess forms in the ear canal. This usually occurs in OE caused by S aureus.
    • The abscess often requires a simple incision and drainage procedure that is usually performed by an otolaryngologist using a needle or small blade.
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Consultations

  • Consider consultation with an otolaryngologist for persons with severe OE or when the patient does not respond to treatment as expected. Debridement of the ear canal is often necessary for resolution of the infection (see Surgical Care).
  • Necrotizing OE necessitates consultation with otolaryngology, infectious disease, and, in some instances, neurosurgery.
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Activity

  • During treatment of OE and for 1-2 weeks following its resolution, advise the patient to keep the ear canal dry.
  • During bathing or showering, advise the patient to place an earplug or cotton ball lightly coated with petroleum jelly in the ear canal to prevent water penetration.
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Contributor Information and Disclosures
Author

Ariel A Waitzman, MD, FRCS(C)  Assistant Professor of Otolaryngology, Wayne State University

Ariel A Waitzman, MD, FRCS(C) is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Michigan State Medical Society, and Ontario Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Orval Brown, MD  Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas

Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John E McClay, MD  Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School

John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Glenn C Isaacson, MD, FACS, FAAP  Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Temple University School of Medicine

Glenn C Isaacson, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Covidien Honoraria Consulting

References

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  2. Roland PS. Chronic external otitis. Ear Nose Throat J. Jun 2001;80(6 Suppl):12-6. [Medline].

  3. Benjamin B, Bingham B, Hawke M. A Colour Atlas of Otorhinolaryngology. London, UK: Martin Dunitz Ltd; 1995.

  4. Bluestone CD, Klein JO. Otitis Media in Infants and Children. Philadelphia, PA: WB Saunders; 1988.

  5. Hawke M, Jahn AF. Diseases of the Ear: Clinical and Pathologic Aspects. Philadelphia, PA: JB Lippincott Co; 1988.

  6. Hawke M, Keene M, Alberti PW. Clinical Otoscopy: An Introduction to Ear Diseases. Edinburgh, UK: Churchill Livingstone; 1990.

  7. Holten KB, Gick J. Management of the patient with otitis externa. J Fam Pract. Apr 2001;50(4):353-60. [Medline].

  8. Hughes E, Lee JH. Otitis externa. Pediatr Rev. Jun 2001;22(6):191-7. [Medline].

  9. Tierney PA, Price T, Gillet D. Improving standards in the treatment of acute otitis externa by the use of a treatment protocol and open access to aural toilet. J Laryngol Otol. Feb 2001;115(2):87-90. [Medline].

  10. Waitzman AA, Hawke, M. Otoscopic examination: what to look for in the external ear. Consultant. 1996;36(5).

  11. Walshe P, Rowley H, Timon C. A worrying development in the microbiology of otitis externa. Clin Otolaryngol. Jun 2001;26(3):218-20. [Medline].

 
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Acute otitis externa. The ear canal is red and edematous, and discharge is present.
 
 
 
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