Also I've found that after a couple days of topical treatment irrigating the ear with domsboro solution clears the ear canal of pus and dead skin so that the topical medication can better contact the external canal. If there is a perforation I use gentle suction instead
Acute Otitis Externa Guidelines Released — Physician’s First Watch
Acute Otitis Externa Guidelines Released
By Kelly Young
The American Academy of Otolaryngology — Head and Neck Surgery Foundation has released updated guidelines on diagnosing and treating acute otitis externa (AOE) in patients aged 2 years and older.
Among the recommendations:
Patients with diffuse AOE should be assessed for factors that modify management, such as tympanostomy tube or nonintact tympanic membrane.
Clinicians should use topical treatments as first-line therapy for uncomplicated AOE.
Initial treatment with systemic antibiotics is not recommended unless there's extension outside the ear canal or other signs that systemic therapy is needed.
Clinicians should instruct patients on how to apply topical treatments (the guidelines include a table of patient instructions). If the canal is obstructed, clinicians should insert a wick or perform aural toilet.
If the tympanic membrane is perforated, a nonototoxic topical preparation should be prescribed.
If patients fail to respond to initial therapy within 48 to 72 hours, they should be reassessed to rule out other potential causes of illness.