(HealthDay News) — Evidence-based recommendations have been developed for the management of acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The clinical practice guideline has been published in the February issue of Otolaryngology-Head and Neck Surgery.

Richard M. Rosenfeld, MD, MPH, from the SUNY Downstate Medical Center and Long Island College Hospital in Brooklyn, NY, and colleagues updated the 2006 guidelines for management of AOE in a target population aged 2 years or older.

The authors recommend strongly that clinicians should assess patients with AOE for pain and prescribe appropriate analgesic treatment according to the pain severity. For diffuse, uncomplicated AOE, clinicians should not prescribe systematic antimicrobials as initial therapy unless there is extension outside the ear canal or the presence of specific host factors indicating the need for such treatment. Other recommendations include: Clinicians should differentiate diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; patients should be assessed for factors that modify management; topical preparations should be prescribed for initial therapy; clinicians should inform patients how to administer topical drops; and a non-ototoxic preparation should be prescribed when the patient has known or suspected perforation of the tympanic membrane. Patients who fail to respond within 48–72 hours should be reassessed to confirm the diagnosis of AOE and exclude other causes of illness.

This clinical practice guideline “is designed to assist clinicians by providing an evidence-based framework for decision-making strategies,” the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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