Paediatrics - Queensland Health - Queensland Government

Ear problems
4. Management
• Consult MO who will arrange:
-- urgent referral to hospital with Paediatric and ENT Specialist for management
-- discuss antibiotic regime with Infectious Disease Specialist
• Staff may be required to give first dose of antibiotics prior to evacuation
5. Follow up
As per post discharge orders
6. Referral / consultation
Urgent referral to Paediatrician and ENT Specialist
Otitis externa
Swimmer’s ear or tropical ear
Recommend
In the acute phase with inflammation the canal should not be syringed. However in
established otitis externa aural toilet may be indicated to remove debris. Consult MO
Related topics
Earwick techique for otitis externa
Assessment of the ear
1. May present with
• Infection of the skin of the ear canal; may be acute or chronic
• Varying degrees of canal redness and peeling, debris collects in the canal, ear
pain (sometimes severe) or itch
• Tender, swollen outer ear and ear canal; very painful if outer ear manipulated,
discharge not always present
• Ear blockage, deafness or fullness, a foreign body may be present
2. Immediate management Not applicable
3. Clinical assessment
• Obtain a complete patient history. See Assessment of the ear
• Perform standard clinical observations
• Perform physical examination. See Assessment of the ear
- - often very painful on movement of the pinna - approach gently
4. Management
• Consult MO if fever, cellulitis or enlarged pre / post auricular lymph nodes
• Give analgesia
See Simple analgesia back cover
• Gentle cleaning with dry mopping to keep the ear canal dry, then installation
of drops or in severe cases, a wick soaked with sofradex or cortocosteriod +
antibiotic ointment to remove pus and debris. The ear should be kept dry for at
least two weeks after treatment [10]. Advise not to swim until healed
Primary Clinical Care Manual 2011 Controlled copy V 1.0 597