Otitis externa

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Target exams

Red flags

• Severe, unrelenting otalgia that is worse at night and out of proportion to the canal findings, with granulation tissue at the bony-cartilaginous junction in a diabetic or immunocompromised child — necrotising (malignant) otitis externa with skull-base osteomyelitis; admit, culture, image and start systemic antipseudomonal therapy and involve ENT and infectious diseases
• A facial-nerve palsy, or any lower cranial-nerve deficit, complicating a discharging painful ear in an immunocompromised or diabetic child — skull-base osteomyelitis spreading through the jugular foramen; this is an emergency, not a routine ear infection
• Spreading periauricular cellulitis with fever and systemic upset, or a fluctuant, exquisitely tender pinna with perichondritis — infection extending beyond the canal that needs systemic antibiotics, not drops alone
• Pain attributed to otitis externa when the canal is too swollen to view the eardrum and acute otitis media or a foreign body has not been excluded — a mislabelled middle-ear infection or retained foreign body will not respond to canal drops

Life stages

Care settings

Clinical exam formats

Board mappings

• General Paediatrics and ENT: otitis externa — definition as external-canal inflammation, the swimmer's ear, furuncular, fungal and necrotising forms, and the red flags that demand escalation.
• Infectious diseases and prevention: water-exposure and trauma risk, aural toilet and topical drops, and the avoidance of cotton-bud use in the ear canal.
• Renewed curriculum — ENT and Infectious diseases: the cerumen-defence and pH pathophysiology, the Pseudomonas and Staphylococcus microbiology, and why the immunocompromised child develops necrotising otitis externa with skull-base osteomyelitis.
• Public health and regional practice: the disproportionate burden in remote and Indigenous communities, swimming-associated outbreaks, and ear-care health promotion.
• General Paediatrics: recognition of tragal tenderness and pain on pinna traction separating otitis externa from acute otitis media, and the stepwise topical management.
• Public health: aural-toilet and topical-first management, oral-antibiotic stewardship, and the safety-net for the immunocompromised child.
• Long Case / Structured discussion: a child with a painful discharging ear — classification, bedside and microbiological work-up, stepwise topical and wick management, and the recognition of necrotising otitis externa.
• Communication station: explaining to a parent why ear drops and keeping the ear dry matter, why cotton buds are avoided, and when a painful ear becomes an emergency.
• Level 2 / 3 — ENT and Infection: otitis externa by form, the water-exposure and trauma risk factors, and the red flags of necrotising disease.
• Public health and health improvement: ear-care promotion and swimming-pool hygiene, and antibiotic stewardship for a topical-responsive condition.
• Foundation of Practice (FOP): the causes and risk factors of otitis externa and the bedside distinction from acute otitis media.
• Applied Knowledge in Practice (AKP): topical-first stepwise management, ear-wick use, and the recognition and systemic treatment of necrotising otitis externa.
• History-taking and management: the child with otalgia and otorrhoea, the canal examination, and the topical and analgesia plan.
• Communication: explaining ear-care, the avoidance of cotton buds, and the emergency features that require same-day review.
• General Pediatrics Content Outline: otitis externa — forms, microbiology, topical-first management and the necrotising form in the immunocompromised child.
• Infectious Diseases: Pseudomonas and Staphylococcus acute otitis externa, otomycosis, and necrotising otitis externa with skull-base osteomyelitis.
• Patient Care: topical-first, analgesia-led, evidence-based management of otitis externa with prompt recognition of the necrotising form.
• Systems-Based Practice and Population Health: aural-toilet and topical-first care, oral-antibiotic stewardship, and ear-care health promotion.
• Medical Knowledge: the cerumen-defence and pH pathophysiology, the Pseudomonas skull-base invasion mechanism, and topical-antimicrobial pharmacology.
• Medical Expert: otitis externa diagnosis, topical-first management and the recognition and treatment of necrotising otitis externa.
• Health Advocate and Collaborator: ear-care promotion in remote and Indigenous communities, swimming hygiene, and antimicrobial stewardship.
• Communicator: explaining ear-care, cotton-bud avoidance, and when a painful ear is an emergency, to families.