Discharge Instructions - Otitis Externa

As discussed in the Emergency Department prior to discharge, you have been diagnosed with an infection of the external ear canal known as otitis externa.  Otitis externa is an infection of the outer ear canal.  The outer ear canal is the passageway that leads into your ear – the same canal which we use to put in ear plugs and earbud headphones.  An infection can happen if the canal gets scratched or if there is water trapped inside.

Ear infections can cause a lot of pain and itchiness inside the ear.  Patients who are immunocompromised (such as people with severe diabetes, on high-dose prednisone medication, or on chemotherapy) may have more serious disease and need to be watched closely.  However, healthy patients will generally make a complete recovery using antibiotic ear drops.  If the ear canal is too swollen for the ear drops to get inside, a physician might use a wick (a piece of cotton soaked in medication) to get the medicine into the ear canal.

The most important thing that you can do is to keep your ear canal dry (after the ear drops have been absorbed).

You can take Acetaminophen (same thing as Tylenol) and/or Ibuprofen (same thing as Advil or Motrin) for pain.

You should feel a significant improvement within 2 days of taking the antibiotics.

Return to the Emergency Department if you do not notice an improvement in 2 days (while taking the antibiotics as directed), if fever doesn’t resolve within two days of taking the antibiotics, or you develop a new fever (≥38.0 °C or 100.4 °F), for spreading redness (around or behind the ear), drowsiness, a stiff neck or confusion, or any new or concerning symptoms.

MDM - Otitis Externa

[##]-year-old [male/female] with [ear pain/drainage] with history and exam consistent with likely otitis externa of the [right/left/bilateral ear(s)].

Initial considerations in this patient included otitis externa and malignant otitis externa, auricular hematoma, acute otitis media, mastoiditis, ear foreign body, tympanic membrane rupture, and other upper respiratory infections (URI) among others.

Patient presented with complaint of [right/left]-sided otalgia, and was noted to have associated erythema, swelling, and [otorrhea/debris] in the external auditory canal consistent with otitis externa.  Patient noted to have no evidence of swelling, erythema or tenderness to the [right/left] mastoid process or protrusion of the ear to suggest mastoiditis.  Patient noted to have [no] evidence of fever or other systemic infectious symptoms suggestive of malignant otitis externa in patient [with/without] risk factors [including diabetes/immunocompromise].  [There was no indication for wick placement at this time/A wick was placed prior to discharge and infiltrated with antibiotics]. 

Patient noted to have improvement in pain with [NSAIDs] prior to discharge.  Prior to discharge, we discussed return precautions, specifically for worsening infection, treatment with [oral/otic] antibiotics [and wick with NSAIDs for pain], and follow up with primary care doctor within [2-3 days/1 week] for further evaluation, and the patient demonstrated understanding and agreement with this plan.