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Referral criteria from primary care - otitis externa

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • urgent admission (same day) is indicated if malignant otitis is suspected
    • clinical features that cause clinician to suspect malignant otitis:
      • if otalgia and headache are more severe than the clinical signs would suggest, or
      • the presence of granulation tissue at the bone-cartilage junction of the ear canal, or exposed bone in the ear canal, or
      • paralysis of the facial nerve is present

  • specialist advice should be sought if:
    • no symptomatic improvement despite treatment and treatment failure is unexplained
    • treatment with a quinolone is indicated

  • referral to secondary care if there is (1):
    • extensive cellulitis (same day referral)
      • if cellulitis or disease extending outside ear canal, start oral antibiotics and refer (1)
    • extreme otalgia (same day referral)
    • profuse discharge or extensive swelling of the auditory canal, and microsuction or ear wick insertion is required

  • a review has suggested (2):
    • recommend referring to an ENT emergency clinic if
      • the otitis externa does not respond to 14 days of topical antibiotics
      • the ear canal is completely stenosed where drops cannot penetrate and wick insertion may be required
      • when the canal is full of debris and aural toilet cannot be carried out in primary care


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