New guidelines are intended to help primary care providers treat acute otitis externa, according to The American Academy of Otolaryngology—Head and Neck Surgery Foundation.
The guidelines appeared online in an open-access article published in the February issue of Otolarynology—Head and Neck Surgery.
According to the guidelines, clinicians should:
• distinguish diffuse acute otitis externa from other causes, such as otalgia, otorrhea and inflammation of the external ear canal,
• assess the patient for non-intact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, or prior radiotherapy,
• assess patients for pain and recommend analgesic treatment based on its severity,
• avoid systemic antimicrobials as a first therapy for diffuse, uncomplicated acute otitis externa unless there is extension outside the ear canal, or there are specific host factors that would require it,
• prescribe topical preparations for first therapy of diffuse, uncomplicated cases,
• tell patients how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed,
• reassess the patient who fails to respond to treatment within 48 to 72 hours to confirm the diagnosis of diffuse acute otitis externa and to exclude other causes, and
• prescribe a non-ototoxic topical preparation when the patient has a known or suspected tympanic membrane perforation.
The guideline is intended for primary care and specialist clinicians, including otolaryngologists, family physicians, emergency physicians, internists, and other clinicians, for any setting or age groups.
The update includes new evidence from 12 randomized, controlled trials and 2 systematic reviews. The 8 guidelines emphasize patient education and counseling, and address common questions with simple answers and instructions for properly administering ear drops.