Otitis Externa

Duration

7 days

First Line

Therapy

Analgesia and localised heat (warm flannel)

Second Line

Therapy

A proprietary preparation containing acetic acid 2% (EarCalm® spray) is on sale to the public. Note acetic acid 2% (EarCalm® spray) is licensed only for Adults and Children aged 12 years and above.

Or Betamethasone with neomycin eardrops (Not licensed for use in children under 2 years)

 Apply 2 - 3 drops 3 - 4 times a day

If cellulitis is present, or disease extends outside the ear canal

Therapy

Duration: 5 days

Flucloxacillin PO dosed as per BNF for Children

or  Clarithromycin PO dosed as per BNF for Children

Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus and tacrolimus.

Notes:

If systemic antibiotics are thought to be required for treatment, or if there is cellulitis extending from the ear canal or the ear canal is occluded, seek advice from an ENT specialist.

Notes

NICE provide a Clinical Knowledge Summary on this topic.

  • Symptoms of otitis externa are ear pain, pruritus, discharge, and hearing loss, often after water exposure (swimmer’s ear), instrumentation (cotton buds) or use of occluding devices (bud ear phones).
  • Aural toilet is an essential component of treatment; it facilitates healing and improves penetration of ear drops.
  • If first line topical treatment has failed, consider taking an ear swab for bacterial and fungal culture. Review any culture results and ensure that an appropriate antibiotic has been prescribed.