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Update Summary

The following updates to this chapter were made on May 7, 2021:

  • Added generic availability for Cetraxal and Ciprodex to Table e11-1.

  • Added Cortisporin-TC brand name to Table 1



  • image The most common pathogens in acute otitis externa (AOE) are Pseudomonas aeruginosa and Staphylococcus aureus.

  • image Topical antimicrobials are the medication and route of choice for the treatment of AOE.

  • image Systemic antimicrobials are not warranted for the initial treatment of diffuse, uncomplicated AOE.

  • image Pain should be assessed in all patients and therapy recommended based upon severity.

  • image Appropriate counseling points for otic administration of medication should be provided to each patient.

  • image Cerumen production is a naturally occurring process of the body.

  • image Cerumen impaction may cause discomfort, itching, hearing loss, or tinnitus.

  • image Cotton swabs should not be used as they can worsen cerumen impaction or cause trauma to the tympanic membrane.

  • image Home-treatment options for cerumen impaction include cerumenolytic agents and/or irrigation.

  • image Foreign objects such as pen caps, tweezers, or paper clips should not be inserted in the ear canal.


Preclass Engaged Learning Activity

  1. Otic administration of medications: Working individually or in teams, develop a handout or short video for patients and caregivers to teach them how to administer medication into the ear of a child or an adult. Be creative in the education models used for patient education!

  2. Cerumenolytics: Which one to recommend first? Working individually or in teams, research the various cerumenolytic agents available for patient use and develop a selection algorithm. The algorithm should clearly state which product (with the respective dosing regimen) would be the first they recommend to a patient, the second, and so forth.


Acute otitis externa (AOE) is a diffuse inflammation of the external ear canal secondary to infection.1 The tympanic membrane or pinna may also be involved in this infectious process. AOE may occur at any age but is uncommon in children younger than 2 years.

The hallmark sign of diffuse AOE is intense tenderness of the pinna when pulled, tragus when pushed, or both, which can be inconsistent with signs observed visually, such as redness or areas of cellulitis. Diagnosis of AOE requires a rapid onset (<48 hours) of signs and symptoms of ear canal inflammation within the past 3 weeks.1 The signs of inflammation include tenderness of the pinna, tragus, or both or diffuse canal edema, erythema, or both. Signs may also include otorrhea, regional lymphadenitis, erythema of the tympanic membrane, or cellulitis of the pinna and adjacent skin.

Symptoms of inflammation include otalgia (70%), itching (60%), or fullness (22%), with or without jaw pain or hearing loss (32%).1 Pain best correlates with the severity of the disease.2

This chapter focuses on AOE, but patients ...

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