Management of mild or moderate external otitis in immunocompetent adults

This algorithm describes the treatment of mild or moderate external otitis in immunocompetent patients. It is not appropriate for patients with severe disease characterized by intense pain and edema that completely occludes the canal, or for patients with disease of any severity who are immunocompromised (eg, patients receiving chemotherapy or chronic high-dose corticosteroid therapy, or those with solid organ or stem cell transplant, neutropenia, or advanced HIV infection). For any patient with diabetes or immunocompromise, unilateral ear pain, and inflammation in the external ear canal, malignant otitis externa should be considered. Antibiotic dosing is standard for adults with normal kidney function.