This handout is for acute otitis externa (incl. necrotizing/malignant oe). Your care team identified this based on: acute ear pain + otorrhea + tragal/pinna tenderness with diffuse ear-canal edema/erythema (classic diffuse aoe — rosenfeld aao-hns cpg 2014; roland & stroman laryngoscope 2002 — pseudomonas-predominant).
Other reasons your team may use this plan: severe otalgia out of proportion to exam ± granulation tissue at the bony–cartilaginous junction of the canal floor — necrotizing oe pivot finding (long am j emerg med 2020; loh otolaryngol hns 2013); previously diagnosed otitis externa not responding to topical therapy at 48–72 h — mandatory reassessment trigger (rosenfeld aao-hns cpg 2014 key-action statement); otalgia/otorrhea in a diabetic, immunocompromised, or elderly host — high necrotizing-oe prior, low imaging threshold (long am j emerg med 2020; sideris cureus 2024 — 78.7% immunosuppressed).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aural_toilet_microsuction_and_wick_if_canal_occluded | — | — | — | Rosenfeld AAO-HNS CPG 2014 — clinicians should enhance topical delivery via aural toilet and/or a wick when the canal is obstructed; debris removal is prerequisite to topical efficacy |
| analgesia_titrated_to_pain_severity | — | — | — | Rosenfeld AAO-HNS CPG 2014 STRONG recommendation — assess pain and treat by severity (NSAID/acetaminophen for mild–moderate; opioid short-course for severe) |
| select_non_ototoxic_preparation_if_TM_non_intact_or_tube | — | — | — | Rosenfeld AAO-HNS CPG 2014 — prescribe a non-ototoxic preparation (fluoroquinolone-otic) when TM is known/suspected non-intact or a tube is present; AVOID aminoglycoside (neomycin/gentamicin) and acidic drops |
Plan: Uncomplicated diffuse AOE / otomycosis — topical-first ladder (AAO-HNS CPG 2014)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
AOE recurrence prevention: dry-ear precautions, treat the eczematous/contact-dermatitis substrate, acidifying/drying drops for recurrent swimmer's ear, avoid cotton-bud trauma, hearing-aid hygiene. Necrotizing OE: long-term ENT/ID surveillance for recurrence (relapse can occur months later — re-image and re-check ESR/CRP on any symptom return), sustained glycemic optimization (route endo.dm2.core.v1 — the dominant modifiable recurrence driver), and cranial-nerve rehabilitation follow-up where deficits persist.
Guideline: AAO-HNS Clinical Practice Guideline: Acute Otitis Externa (Rosenfeld et al, Otolaryngol Head Neck Surg 2014; PMID 24491310; executive summary PMID 24492208) — current US authority, replaced the 2006 guideline (PMID 16638473), not superseded as of 2026-05-17. Supplemented by Kaushik Cochrane "Interventions for acute otitis externa" 2010 (PMID 20091565), Roland & Stroman microbiology of AOE 2002 (PMID 12169893), and the necrotizing-OE literature: Loh Otolaryngol HNS 2013 (PMID 23558287 — ESR/CRP markers, ceftazidime+fluoroquinolone), Long Am J Emerg Med 2020 (PMID 32505469 — EM red-flag framing), Haleem Am J Otolaryngol 2025 (PMID 40344787 — diagnostic algorithm + nuclear imaging), Sideris Cureus 2024 (PMID 39534824 — fungal MOE systematic review)