Acute Otitis Externa (AOE): The Diagnosis, Treatment

  • Acute Otitis Externa is more prevalent in adults
  • AOE is a contagious infection that affects the outer eardrum (Gruber et al., 2021)
  • Mild forms include external acoustic meatus infections
  • Malignant OE has life-threatening symptoms (Wiegand et al., 2019)
  • Swimmer’s ear is one encountered conditions in otolaryngology

The Pathogenesis of the Diagnosis of Acute Otitis Externa

  • Develops where auditory meatus has robust defense systems
  • Blockage results from the skin being inflamed
  • Potential risk factors also alleviate the chances of AOE
  • Swimming is a well-documented potential risk for AOE
  • Dermatologic disorders contribute to the development of AOE

The Clinical Presentation of Acute Otitis Externa

  • Otalgia is the most common symptom with 100% prevalence
  • Ear discharge accounted for 71%
  • Thick white grey with visible hyphae or spores
  • External ear edema characterized by swelling accounted for 85%
  • External ear inflammations accounted for 57% (Marina et al., 2019).

The History and Physical Exam Findings of Acute Otitis Externa (Wiegand et al., 2019)

  • Inspections for erythema on the inner ear
  • Tragal pressure is a sign of external otitis
  • Tympanic membrane-air fluid level suggests middle ear effusion
  • Insufflation is made possible via the pneumatic auriscope
  • The eardrum mobility should be present in persons with external otitis.

Other Possible Differential Diagnoses for Acute Otitis Externa (McKean, 2018)

  • Otomycosis or external fungal otitis
  • Contact dermatitis
  • External acoustic meatus canal carcinoma
  • Chronic suppurative otitis media
  • Psoriasis associated with redness and scaling of external ear canal

The Diagnostic Tests, Screens or Maneuvers of Acute Otitis Externa

  • The diagnosis is based upon a physical examination
  • Cultures are recommended for extreme cases of AOE
  • Severe external otitis requires cultures
  • Conductive hearing loss revealed by tuning-fork test
  • Where eardrum cannot be visualized, hearing test is conducted (Wiegand et al., 2019)
  • The otoscopic assessment is critical for eardrum evaluation

Sensitivity, Specificity, and Predictive Value of the Tests, Screens, or Maneuvers for Acute Otitis Externa

  • Nasopharyngeal cultures as putative predictors for AOE
  • Audiometric testing, frequency of hearing loss was 79.7%
  • Degrees of severity for audiometric testing was positive
  • Physical examinations have had positive predictive value
  • The otoscopic assessment has a high sensitivity value
  • Hearing test has a positive sensitivity and specific values

The Medications that are Prescribed for Acute Otitis Externa (Wiegand et al., 2019)

  • 2% Acetic acid otic solution (VoSoL)
  • Neomycin otic solutions
  • Polymyxin B–hydrocortisone (Otobiotic) prevents neomycin immune responses
  • Eardrops with antibiotics, for instance, Ciprofloxacin 2 mg/mL
  • The Acetic Acid for general medication is affordable
  • Steroid andanalgesic eardrops

The Medications Mechanism of Action

  • Acetic acid works by effectively preventing growth of germs
  • Neomycin otic solutions suppress bacterial protein synthesis
  • Neomycin binds irreversibly to the sensitive bacteria’s 30 S ribosomal subunit
  • Polymyxin B–hydrocortisone engages LPS
  • Polycationic peptide ring associates with outer membrane of LPS
  • Eardrops (Ciprofloxacin) work by preventing bacteria from growing

The Medications Contraindications

  • Continuous burning of the ear canal associated with using Acetic Acid Otic Solution to treat an inner ear infection (Otitis Media)
  • Tiny white result from taking Neomycin otic solutions with hydrocortisone
  • Red lumps on the skin is a result of taking Neomycin with polymyxin
  • Adverse effects to topical corticosteroids when Polymyxin B–hydrocortisone is used with occlusive dressings
  • Defects to unborn of pregnant women occur when Ciprofloxacin 2 mg/Ml is taken during pregnancy

The Medications Potential Interactions with Food and other Medications

  • 2% Acetic acid otic solution (VoSoL) is most likely to interact with food, especially when the victims forget to wash their hands after applying the solution
  • Neomycin otic solution and hydrocortisone are often prescribed together
  • There are higher chances that Ciprofloxacin 2 mg/mL interacts with food as it can be taken with or without food
  • Combining alcohol or smoking with the medications above may also result in interaction

The Medications Patient Education (Wiegand et al., 2019)

  • A prolonged prickling sensation in the ear canal is among the side effects
  • Dizziness is minimized by making warm the vial of droplets while in the hands prior to use
  • When there is no reaction, the care and treatment of the patient should be re-examined closely
  • When the external meatus’s self-cleansing process is impaired, the external meatus should be cleaned by a clinician

Prescription for 2% Acetic Acid Otic Solution

  • Over the counter, one would purchase 2% Acetic Acid Otic Solution (VoSoL)
  • 3-5 drops should be made every 4-6 hours for the ear drop dosage
  • After soaking a small piece of cotton in several drops of this remedy, apply it to the ear
  • Keep the cotton in the ear for 24 hours and moisten it every 4-6 hours with 3 to 5 drops of acetic acid
  • Upon withdrawing the cotton, insert the drips gently into your ear thrice or four times daily

Patient Follow-Up and Education

  • In 48–72 hours, the patient’s reaction to treatment is monitored
  • To minimize additional infections, identifiable risk conditions be avoided
  • Avoid wearing earbuds or in-ear headsets for an extended period
  • Avoiding use of cotton buds or your fingers for scratching or cleaning the inside of the ear
  • For swimmers, avoid swimming in water that is polluted


Gruber, M., Damry, D., Ibrahim, N., Glikman, D., & Ronen, O. (2021). Pediatric acute otitis externa: Characteristics and predictors for the hospital admission. International Journal of Pediatric Otorhinolaryngology, 140, 110-534. Web.

Marina, S., Goutham, M. K., Rajeshwary, A., Vadisha, B., & Devika, T. (2019). A retrospective review of 14 cases of malignant otitis externa. Journal of Otology, 14(2), 63-66. Web.

McKean, S. A. (2018). Acute otitis externa. In ENT Head & Neck Emergencies (pp. 121-126). CRC Press.

Servidoni, A. B., & Conterno, L. D. O. (2018). Hearing loss in the elderly: Is the hearing handicap inventory for the elderly-screening version effective in diagnosis when compared to the audiometric test? International Archives of Otorhinolaryngology, 22(1), 1-8. Web.

Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis externa: Investigation and evidence-based treatment. Deutsches Ă„rzteblatt International, 116(13), 224. Web.

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