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

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

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

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

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

  • imageCerumen production is a naturally occurring process of the body.

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

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

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

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


Patient Care Process for Acute Otitis Externa (AOE)



  • Patient characteristics (eg, age)

  • Patient medical history (eg, history of diabetes mellitus, radiation, eczema, immunocompromised, perforated tympanic membrane, tympanostomy tube, hearing aids)

  • Medication allergies (eg, neomycin)

  • Social history (eg, water exposure)

  • Subjective/objective data: Signs and symptoms of AOE (eg, otalgia, itching, fullness, hearing loss, pain, tenderness, trauma)


  • History of diabetes mellitus, past radiation, immunocompromised states such as HIV, AIDS, chemotherapy, or ototoxicity

  • Presence of tympanostomy tube or perforated tympanic membrane

  • History and severity of pain

  • Risk of adverse effects from topical medication

  • Patient adherence

  • Cost of medication


  • Select a topical antimicrobial therapy with or without accompanying steroidal agent; options include specific medication(s), dose, route, frequency, and duration provided in Table e12-1

  • Select pain medication (nonprescription or prescription)

  • Educate patient (eg, purpose of treatment, drug-specific information, medication administration technique for otic preparations, avoidance of water sports for 7-10 days)

  • Recommend self-monitoring for resolution of signs and symptoms

  • Recommend prevention strategies for AOE (eg, acidifying ear drops, thorough drying of the ear canal)

  • Make referrals to other providers when appropriate (eg, dermatologist, otolaryngologist)


  • Provide patient education regarding all elements of the treatment plan and medication administration technique

  • Use motivational interviewing and coaching strategies to maximize adherence

Follow-up: Monitor and Evaluate*

  • Signs and symptoms improvement (eg, otalgia, itching, fullness, pain, tenderness) within 48-72 hours, symptom resolution may take up to 2 weeks

  • Presence of adverse effects (eg, allergic reaction to topical medication)

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other healthcare professionals.

Patient Care Process for Cerumen Impaction



  • Patient characteristics (eg, age)

  • Patient medical history (eg, immunocompromised state, diabetes mellitus, prior radiation, nonintact tympanic membrane, ear canal abnormalities, hearing aids, dermatologic disorders)

  • Social history (eg, ear-cleaning habits)

  • Current medications including anticoagulant use

  • Subjective data: signs and symptoms of impaction (eg, otalgia, fullness, itching, tinnitus, cough, vertigo, hearing loss)

  • Patient communication abilities


  • History of diabetes mellitus, immunocompromised state, radiation, or ear canal anatomical ...

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