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Clinical practice guideline: acute otitis externa.

Richard M Rosenfeld1, Lance Brown, C Ron Cannon

  • 1Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital. richrosenfeld@msn.com

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|April 28, 2006
PubMed
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This guideline offers evidence-based strategies for managing diffuse acute otitis externa (AOE), emphasizing appropriate antimicrobial use and pain management. It guides clinicians in distinguishing AOE and selecting optimal topical or systemic treatments for better patient outcomes.

Area of Science:

  • Otolaryngology
  • Infectious Disease
  • Evidence-Based Medicine

Background:

  • Diffuse acute otitis externa (AOE) is a common external ear canal inflammation.
  • Effective management requires appropriate antimicrobial selection and pain relief.

Purpose of the Study:

  • To provide evidence-based recommendations for managing diffuse AOE.
  • To promote judicious use of oral and topical antimicrobials.
  • To underscore the importance of adequate pain management in AOE.

Main Methods:

  • Development of a clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF).
  • Inclusion of a multidisciplinary development group.
  • Adherence to an explicit, a priori, evidence-based protocol.

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Main Results:

  • Strong recommendation for pain assessment and analgesic treatment based on severity.
  • Distinguish AOE from other ear conditions and assess for modifying factors.
  • Prioritize topical preparations for initial therapy; reserve systemic antimicrobials for complicated cases.
  • Base topical antimicrobial choice on efficacy, safety, adherence, and cost.
  • Ensure proper administration of topical drops, using aural toilet or wicks if needed.
  • Prescribe nonototoxic preparations for patients with tympanostomy tubes or perforations.
  • Reassess patients failing initial therapy within 48-72 hours.

Conclusions:

  • This guideline offers an evidence-based framework for AOE management.
  • It is intended to assist, not replace, clinical judgment.
  • This is the first AAO-HNSF-produced, explicit, evidence-based guideline for AOE.