Acute Otitis Externa (OE)

First use analgesia and aural toilet.

Cure rates similar at 7 days for topical acetic acid or topical antibiotic +/- steroid.

If cellulitis/disease extending outside ear canal, or patient systemically unwell, consider oral antibiotics (flucloxacillin or erythromycin) & refer to exclude malignant OE.

Neomycin is contra-indicated in patients with perforated tympanic membrane.

If fungal or Pseudomonal infection confirmed seek specialist advice.

First Line: acetic acid 2% ear spray

1 spray three times daily

7 days

Second Line: neomycin sulphate 0.5% + betametasone 0.1% (Betnesol-N) ear drops

3 drops three times daily

7 days min to 14 days max