Otitis externa

Revision as of 21:38, 24 September 2018 by Kxl328 (talk | contribs) (Hygiene)



Risk Factors

  • Swimming
  • Excessive Q-tip use

Clinical Features

Mild otitis externa
Severe otitis externa
Rapid onset (generally within 48 hours) in the past 3 weeks, AND.[1]
  • Symptoms
    • otalgia (often severe)
    • itching, or fullness, WITH OR WITHOUT
    • hearing loss or jaw pain AND...
  • Signs
    • tenderness of the tragus, pinna, or both OR
    • diffuse ear canal edema, erythema, or both WITH OR WITHOUT
    • otorrhea
    • regional lymphadenitis
    • tympanic membrane erythema, or
    • cellulitis of the pinna and adjacent skin

Differential Diagnosis

Ear Diagnoses





  • Normally clinical



  • Clean the ear canal (Grade C)
    • Cerumen wire loop or cotton swab usually works best
    • 1:1 dilution of 3% hydrogen peroxide if tympanic membrane is visible and intact
    • Acetic acid wash for debridement of dead skin
    • Place a wick if the ear canal is fully obstructed



  • Keep ear canal dry
    • Abstain from water sports for 7-10 days


  1. Floxin otic: 5 drops in affected ear BID x 7 days[1]
    • Safe with perforations
  2. Cipro HC otic: 3 drops in affected ear BID x 7 days
    • Contains hydrocortisone to promote faster healing
    • Not safe with perforation
  3. CiproDex: 4 drops in affected ear BID x 7 days
  4. Cortisporin otic (neomycin/polymixin B/hydrocortisone)
    • 4 drops in ear TID-QID x 7days
    • Use suspension (NOT solution) if possiblity of perforation
    • Animal studies suggest possible toxicity from the neomycin although rigorous data is lacking[2]


  • Follow up in 1-2wks for patients with moderate disease

See Also

External Links


  1. 1.0 1.1 Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
  2. Wright, C. et al. Ototoxicity of neomycin and polymyxin B following middle ear application in the chinchilla and baboon. Am J Otol. 1987 Nov;8(6):495-9.