Acute and Chronic Otitis Externa

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

Otalgia disproportionate with signs in diabetic patient unresponsive to topical therapy (refer immediately to ED to exclude skull base osteomyelitis / malignant otitis externa)
Ear canal occluded by oedema and unable to clear discharge

Immediately contact the on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

To contact the relevant service, please see HealthPathways: Acute ENT Assessment

Presenting issues
Patients must present with chronic otitis externa, of duration greater or equal to one month, causing significant morbidity and not responding to recommended treatment Acute otitis externa will only be seen if not responding to standard treatments or if complications present (granulation tissue in ear canal, facial weakness, severe night time pain, immunosuppressed patients, diabetic patients, pinna cellulitis)

Presenting issues

Patients must present with chronic otitis externa, of duration greater or equal to one month, causing significant morbidity and not responding to recommended treatment
Acute otitis externa will only be seen if not responding to standard treatments or if complications present (granulation tissue in ear canal, facial weakness, severe night time pain, immunosuppressed patients, diabetic patients, pinna cellulitis)

Mandatory referral information (referral will be returned if this information is not included)
History Relevant history, onset, duration of symptoms including: otalgia, hearing loss, otorrhoea, pruritic ear canal, facial cellulitis history of ear canal trauma (e.g. cotton bud/hair pin) Details of previous treatment and outcome Relevant medical history (include diabetic history) Degree of functional impairment (e.g. quality of life) Investigations M/C/S ear swab If unable to attach reports, please include relevant information/findings in the body of the referral Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Mandatory referral information (referral will be returned if this information is not included)

History

Relevant history, onset, duration of symptoms including:
- otalgia, hearing loss, otorrhoea, pruritic ear canal, facial cellulitis
- history of ear canal trauma (e.g. cotton bud/hair pin)
Details of previous treatment and outcome
Relevant medical history (include diabetic history)
Degree of functional impairment (e.g. quality of life)

Investigations

M/C/S ear swab

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
Nil

Indicative triage category

Indicative triage category
Category 1 Appointment within 30 days	Suspected skull base osteomyelitis / malignant otitis externa – severe pain, not responding to topical treatments in an immunosuppressed or diabetic
Category 2 Appointment within 90 days	No defined category 2 criteria
Category 3 Appointment within 365 days	Chronic otitis externa not responding to treatment

Last reviewed: 02-10-2023

Acute and Chronic Otitis Externa

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