This pre-referral guideline covers Otitis externa in children of all ages.

Initial work-up

• History – usually due to water contamination following swimming or children with dermatitis of the external ear canal.
• Presents with inflammation of the ear canal and pre-auricular tenderness.
• Swab ear discharge for microscopy/culture and sensitivity. 

Pre-referral treatment

• Ear toilet.
• Topical antibiotics (i.e. soframycin).
• An ear wick should be inserted when the ear canal is very oedematous (to maintain patency of the ear canal and allow topical antibiotics to enter the ear canal) and moistened frequently with topical antibiotics.
  

When to refer

• Ear pain is severe and not relieved by regular analgesics.
• Cellulitis has extended beyond the ear canal. Child will need IV antibiotics.
• Bring pathology results if done.
  

Referral form (pdf)

Parent handout (pdf)

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent fact sheets online)

Contact information

References

Paediatric Handbook Ear, Nose and Throat Conditions, Chapter 21 (pp312-324); Robert Berkowitz and Michael Marks; Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia