Clinical Practice Guideline

Acute Otitis Externa

Acute Otitis Externa

(Endorsed, September 2014)

The guideline, Acute Otitis Externa, was developed by the American Academy of Otolaryngology-Head and Neck Surgery and endorsed by the American Academy of Family Physicians.

Key Recommendations

  • Diffuse acute otitis externa (AOE) should be differentiated from other causes of otalgia, otorrhea, and inflammation of the external ear canal.

  • Patients with diffuse AOE should be assessed for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, or prior therapy).
  • Patients with AOE should be assessed for pain and recommended an analgesic treatment based on pain severity.
  • Systemic antimicrobials should not be prescribed as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or presence of specific host factors that would indicate a need for systemic therapy.
  • Topical preparations should be prescribed for initial therapy for diffuse, uncomplicated AOE and delivery enhanced through patient instruction on administration or by performing aural toilet, wick placement, or both, when the ear canal is obstructed.
  • A non-ototoxic preparation should be prescribed when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube.
  • Patients should be reassessed within 48-72 hours if they fail to respond to initial treatment to confirm the diagnosis of diffuse AOE and to exclude other causes of illness.

See the full recommendation for further details, including information for patients and a treatment algorithm.


These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.