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Acute Otitis Externa

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Diagnosis Figure. Managing AOE Patient age ≥2 y with diffuse AOE Prescribe analgesics based on pain severity YES Extension outside ear canal or host factors a requiring systemic therapy? Prescribe systemic antimicrobial active against Psuedomonas aeruginosa and Staphylococcus aureus, with or without topical therapy, plus other management based on underlying condition a Factors requiring systemic therapy include diabetes, immune deficiency, or inability to effectively deliver topical therapy despite aural toilet. Perforated tympanic membrane (known or suspected) or tympanostomy tube? NO YES Prescribe topical therapy based on benefits, cost, compliance, preference NO Obstructed ear canal? YES Perform aural toilet to remove obstructing debris. Place wick if edema prevents drug delivery Educate patient or caregiver on how to administer topical drops NO Clinically improved in 48-72 hrs? YES NO Prescribe topical therapy with a non- ototoxic preparation Complete course of therapy Re-assess patient Illness other than AOE? Treat other illness Assess drug delivery, adherence to therapy, need to change therapy YES NO

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