Otitis Externa Guidelines

Updated: Apr 07, 2022
  • Author: Ariel A Waitzman, MD, FRCSC; Chief Editor: Ravindhra G Elluru, MD, PhD  more...
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AAO-HNSF Guidelines for Acute Otitis Externa

In 2014, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) released updated clinical practice guidelines for the diagnosis and treatment of acute otitis externa (OE). The recommendations included the following [3] :

  • Differentiate diffuse acute OE from other possible causes of otalgia, otorrhea, and inflammation of the external auditory canal (EAC)
  • Assess patients with diffuse acute OE for factors that may modify therapeutic management (eg, nonintact tympanic membrane, immunocompromised state)
  • Assess for pain in patients with acute OE; base the analgesia recommendation on the patient’s pain severity
  • Administer topical medications as initial therapy for diffuse, uncomplicated acute OE
  • Do not administer systemic antimicrobial agents as initial therapy for diffuse, uncomplicated acute OE; reserve such treatment for cases in which there is extension outside of the EAC or there are specific host factors that require systemic agents
  • Instruct patients on how to administer topical drops; perform an aural toilet, place a wick, or both, when the ear canal is obstructed
  • Use a nonototoxic topical agent in patients with a known or suspected perforation of the tympanic membrane (eg, tympanostomy tube)
  • Confirm the diagnosis of acute OE and reassess the differential diagnosis within 48-72 hours in cases refractory to the initial therapy