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Acute Otitis Externa

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Diagnosis Table 2. Summary of Evidence-based Statements Statement Action Strength 1. Differential diagnosis Clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal. R-C/D 2. Modifying factors Clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state) prior radiotherapy. R-C 3. Pain management Clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain. S-B 4. Systemic antimicrobials Clinicians should NOT prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. S-B 5. Topical therapy Clinicians should use topical preparations for initial therapy of diffuse, uncomplicated AOE. R-B 6. Drug delivery Clinicians should instruct patients how to administer topical drops and should enhance delivery of topical drops when the ear canal is obstructed by performing aural toilet, placing a wick, or both. R-C/D 7. Nonintact tympanic membrane When the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube, the clinician should recommend a non-ototoxic topical preparation. R-D 8. Outcome assessment If the patient fails to respond to the initial therapeutic option within 48-72 hours, the clinician should reassess the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. R-C

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