Management of Acute Otitis Externa

Acute otitis externa (AOE) is an inflammatory condition of the external auditory canal characterised by pain, oedema, erythema and sometimes pruritus. First-line management centres on meticulous aural hygiene, including gentle cleaning to remove debris and excess moisture, and the application of topical preparations combining antibiotics, corticosteroids and, where indicated, antiseptics. Analgesia is provided through local non-steroidal anti-inflammatory drops or oral analgesics in more severe cases. When canal swelling prevents instillation of drops, insertion of a medicated wick allows delivery of therapeutic agents. Systemic antibiotics are reserved for diffuse or refractory infections, immunocompromised patients and complications such as cellulitis. Adjuncts include avoidance of precipitating factors, such as repeated water exposure or mechanical trauma, and patient education on ear canal care to prevent recurrences. Recent advances have explored novel drug-delivery systems and the role of microbiome restoration in optimising outcomes.

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Management of Acute Otitis Externa publication trend

The graph below shows the total number of articles in management of acute otitis externa across all publications each year (not limited to Nature Index journals).

Technical terms

Medicated wick: A slender, absorbent device inserted into the ear canal to facilitate the delivery of topical agents when canal oedema prevents drop instillation.

Thixotropic hydrogel: A gel formulation that liquefies under shear stress for ease of application and then solidifies to provide sustained release of antimicrobial drugs.

Otic microbiome: The community of microorganisms colonising the ear canal, whose balance influences susceptibility to infection and response to therapy.

Ichthammol glycerine wick: A dressing soaked in ichthammol and glycerine used to reduce inflammation and pain in the external ear canal.

Cotton wick: A traditional ear wick composed of cotton, utilised for drug delivery and mechanical reduction of canal oedema.

References

1. A Systematic Review of Antibiotic Prescription for Acute Otitis Externa. Cureus (2021).
2. A Comparative Study on the Management of Acute Otitis Externa Using Hydroxylated Polyvinyl Acetate Ichthammol Glycerine Wick Versus Cotton Ichthammol Glycerine Wick. Cureus (2024).
3. Perspectives of Italian Physicians and Patients in the Treatment of Otitis Externa: A Real-Life Study. Journal of Personalized Medicine (2023).
4. Clinical evidence in the management of swimmer’s ear. South African Family Practice (2015).
5. A Controlled Antibiotic Release System for the Development of Single-Application Otitis Externa Therapeutics. Gels (2017).