Evidence base: Acute otitis externa

A summary of the evidence behind the diagnosis and management of acute otitis externa

Grade III of the Brighton Grading Scheme for severity of acute otitis externa includes tympanic membrane obscured by oedematous ear canal (Author images)
Grade III of the Brighton Grading Scheme for severity of acute otitis externa includes tympanic membrane obscured by oedematous ear canal (Author images)

The main issue surrounding the management of acute otitis externa is the choice between topical and systemic treatment and indications for aminoglycoside/non-aminoglycoside antibiotic drops.

Clinical trials

The main outcome showed a lower rate of persistent infection and subsequent consultation after treatment with topical steroids with/without antibiotics over oral therapy. This is supported by a Cochrane review into chronic suppurative otitis media.7

  • Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial. BMJ 2003; 327: 1201-5.

This trial shows that using steroid drops in combination with acetic acid or antibiotics improves outcomes with reduction in duration of symptoms over acetic acid drops alone.

This Cochrane review recommended using ciprofloxacin eye drops in the ear as an effective alternative to aminoglycoside ear drops in patients with perforation of the tympanic membrane and otitis media, which can also be applied to acute otitis externa.

Guidelines

This independently produced guideline by the American Academy of Otolaryngology and Head and Neck Surgery Foundation is an excellent tool.

Key text

  • Carney SA. Otitis externa and otomycosis. In: Gleeson MJ (ed). Scott-Brown's Otorhinolaryngology, Head and Neck Surgery. London, Hodder Arnold, 2008; 3351-7.

An excellent text, frequently updated.

Online

Useful patient advice with diagrams and explanation of causative factors.

 

Contributed by Ms Jessica Bewick, ENT SpR, Mr Edward Lindisfarne, surgical trainee and Mr Prodip Das, ENT consultant, at the Royal Sussex County Hospital, Brighton.

 

 

 

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