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
