Otitis externa: use the ear wick!


    Otitis externa: use the ear wick!

    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 https://www.uptodate.com/contents/external-otitis-treatment

    Otitis Externa: Review and Clinical Update. AFP. Accessed at https://www.aafp.org/afp/2006/1101/p1510.html

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Reach for the COWS

      Your patient in intake is miserable. Doubled over, complaining of pain everywhere, sweating, ill-appearing but not unstable. He tells you that the last time he used heroin was two nights ago, and he is askingRead more

    • Tis the season, summer edition

      As the late spring rains have begun to fade and the temperature rises mercilessly into the 80s and beyond, summer is finally upon us. And with summer comes a host of diseases for the emergencyRead more

    • Meet the newest member of your team

      We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist. In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know wellRead more

    • In the spirit of roasts and fire-breathing dragons

      You’re on a lovely amble through the backcountry when suddenly you see smoke rising nearby and catch a whiff of a familiar scent that throws you back to your med school OR days: burning flesh.Read more