Acetaminophen or nonsteroidal anti-inflammatory drugs have been proven to be adequate for mild to moderate pain. Pain can be intense and severe therefore, it should be managed appropriately. The mainstay of uncomplicated otitis externa treatment usually involves topical antibiotic drops and pain control. Most patients diagnosed with otitis externa will receive outpatient management. Otitis externa can be classified by severity as follows: Systemic symptoms such as fever greater than 101 F (38.3 C) and malaise suggest extension beyond the external ear canal. It can also present with otorrhea, fullness sensation, and hearing loss. Ear pain is often disproportionate to physical exam findings, and it is due to irritation of the highly sensitive periosteum underneath the thin dermis of the bony ear canal. Initially, patients with OE will complain of pruritus and ear pain that is usually worse with manipulation of the tragus, pinna, or both. Its clinical presentation may vary depending on the stage or severity of the disease. Concomitant otitis media is suspected when there is evidence of an air-fluid level along the tympanic membrane (middle ear effusion). In some cases, the tympanic membrane is erythematous or partially visualized due to edema of the external auditory canal. Otoscopy will reveal an erythematous and edematous ear canal with associated debris (yellow, white, or gray).
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Physical examination should include evaluation of the auricle, assessment of surrounding skin and lymph nodes, and pneumatic otoscopy. Otitis externa is a clinical diagnosis therefore, a complete history and physical examination are required.
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