Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear” due to the increased likelihood of developing after prolonged submersion in water, AOE can be caused by trauma, foreign bodies (e.g., q-tips), ear piercing, or exposure to high humidity or temperature.

Patients will present with otalgia, itching, swelling, redness, and possibly hearing loss. Bacterial causes are by far the most common in acute otitis externa, although consider fungal etiologies particularly in chronic cases (over 3 weeks), as this will change management. For mild to moderate cases, topical antibiotics with coverage for Pseudomonas are usually sufficient; consider systemic antibiotics for severe cases.

In severe cases, or if the canal looks very swollen, another trick is to place an ear wick (or otowick); unbeknownst to me, we carry these in intake. The ear wick is a compressed sponge, placed in the canal, which then expands with moisture — ear wicks improve penetration of topical antibiotics to the medial portion of the canal, and increase topical contact time. Place the ear wick in the canal with a forceps or tweezer, then place 5 or so drops of antibiotic solution in the ear to expand the wick. Typically they will fall out on their own, or can be removed at ENT or primary care follow up. These are the ones we carry:

Thanks to Dr. Angela Chen for inspiring this pearl.



Goguen, L. External otitis: Treatment. UpToDate. Accessed at

Otitis Externa: Review and Clinical Update. AFP. Accessed at

June 2024