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A 30-year-old swimmer presents with right ear pain, itching, and discharge for 2 days. Tugging the auricle worsens the pain. The ear canal is erythematous, swollen, and filled with debris. Tympanic membrane is not visible.
What is the stepwise evidence-based approach to evaluating and managing otitis externa in adults?
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Perform otoscopic exam to confirm canal inflammation
Assess for tragal tenderness and pain with auricle movement
Clean canal of debris (aural toilet) if obstructed
Initiate topical antibiotic drops (e.g., ciprofloxacin + hydrocortisone)
Avoid systemic antibiotics unless severe or spreading
Instruct patient to avoid water entry and use ear wick if needed
Educate on proper ear hygiene and moisture avoidance
Consider fungal causes if no response to antibacterial drops
Reassess in 48–72 hours for improvement
Refer to ENT for refractory or immunocompromised cases
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1
Assess for tragal tenderness and pain with auricle movement
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2
Perform otoscopic exam to confirm canal inflammation
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3
Clean canal of debris (aural toilet) if obstructed
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4
Initiate topical antibiotic drops (e.g., ciprofloxacin + hydrocortisone)
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5
Avoid systemic antibiotics unless severe or spreading
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pic1
6
Instruct patient to avoid water entry and use ear wick if needed
media1
pic1
7
Educate on proper ear hygiene and moisture avoidance
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pic1
8
Reassess in 48–72 hours for improvement
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pic1
9
Consider fungal causes if no response to antibacterial drops
media1
pic1
10
Refer to ENT for refractory or immunocompromised cases
media1
pic1
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Otitis Externa
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