Otitis Externa
Treatment Regime:
Non-fungal, fungal, TM perf, systemic OE, necrotising OE (include non-pharm and clinical features)
Types of AOE: Diffuse vs Localised
Acute Diffuse OE (Swimmer's Ear):
Risk factors: Water exposure, trauma (e.g., scratching, Q-tip use)
Pain, pruritus, discharge, tenderness on tragus, ear canal swelling
Management:
Non-Fungal (Bacterial) OE (1st Line):
Dexamethasone + Framycetin + Gramicidin 3 drops TDS for 7 days
OR Flumethasone + Clioquinol, 3 drops TDS for 7 days
If Suspicious of TM Perf:
Avoid aminoglycosides
Use Ciprofloxacin + Hydrocortisone ear drops 3 drops BD for 7 days
Systemic Sx (fever, severe pinna cellulitis, or immunocompromised):
Prior to Antibiotics: Superficial swab for MCS before starting oral antibiotics
Antibiotic Regimen:
Flucloxacillin 500 mg QID + Ciprofloxacin 750 mg BD for 7 days
If acute and localised → flucloxacillin only
Acute Localised OE (Boil/Furuncle):
Painful/fluctuant lesion in the ear canal, purulent discharge
Management:
Flucloxacillin 500 mg QID for 5 days
If MRSA-suspected, consider Clindamycin 450 mg
Surgical drainage for abscess formation if required
Necrotising Otitis Externa:
Spread to bone surrounding external ear canal and base of skull and cartilage
Risk Factors: Elderly, immunocompromised (e.g., diabetes, HIV, chemotherapy)
Severe pain, fever, cranial neuropathies, granulation tissue in ear canal, progressive infection
Management:
Initial Antibiotic Regimen: Piperacillin + Tazobactam 4.5 g IV 6-hourly
Immediate referral to ED for ENT review
Note:
BOTH fungal and non-fungal OE can be treated with Flumethasone + Clioquinol ear drops (3 drops BD for 7 days)
Other Alternatives:
Otodex/Sofradex: For non-fungal infections
Kenacomb 3 drops TDS for 7/7: For fungal infections
Non-Pharm Management:
Paracetamol 1 g QID, Ibuprofen 400 mg TDS
Dry aural toilet: Rolled tissue spears Q6H
Prevent water exposure to external ear canal: Use earplugs or shower caps (during and 2 weeks post-treatment)
Acetic acid plus isopropyl ear drops: 6 drops post water exposure
Additional Note:
Recurrent OE: Recommend referral for ENT opinion if recurrent episodes (>3 per year) to rule out structural issues or chronic infection.
Fungal OE (Otomycosis): Consider Clotrimazole 1% ear drops (2 drops BD) as an option if fungal infection is identified.
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