otitis externa

• Core treatment: pain control + topical therapy + ear care advice (keep ear dry, avoid trauma).
• Topical choice: use an antibiotic ± corticosteroid drop for suspected bacterial disease; consider antifungal if fungal features dominate.
• Perforation/grommets: choose non-ototoxic drops (avoid aminoglycosides unless specialist-directed).
• Don’t miss malignant otitis externa in older adults/diabetes/immunosuppression: severe pain, granulation tissue, cranial nerve signs → urgent admission.

• Antibiotic + steroid option (example): ciprofloxacin 0.3% + dexamethasone 0.1% ear drops are commonly dosed 4 drops BD for 7 days (per BNF product dosing).
• Analgesia: regular paracetamol/ibuprofen (if appropriate); consider short opioid only if severe pain and no alternatives.
• Ear wick: if canal is very swollen and drops cannot enter; typically placed in ENT/minor ops and soaked with drops.

Review: if not improving within 48–72 hours, reconsider diagnosis, adherence, canal obstruction (needs aural toilet), fungal disease, eczema/psoriasis, or resistant organisms.

• Suspected malignant otitis externa: diabetes/immunosuppression + severe otalgia (often worse at night), granulation tissue, cranial nerve involvement → same-day hospital assessment.
• Spreading cellulitis, systemic illness, or failure of appropriate topical therapy → consider oral antibiotics and ENT review per local pathway.
• Recurrent disease: assess for dermatitis, hearing aid irritation, swimming/trauma, fungal predisposition; consider ENT if persistent.