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
