Some Otitis Externa Reminders

http://www.aafp.org/afp/2012/1201/p1055.html?aafpvlogin=7281773&aafpvpw=&URL_success=http%3A%2F%2Fwww.aafp.org%2Fafp%2F2012%2F1201%2Fp1055.html

As usual, as the weather warms and swimming increases, otitis externa ramps up. The above is an excellent article updating suggestions for otitis externa. The article is from the American Family Physician. Some pearls are:
1. While rare, always be on the lookout for malignant otitis externa, which is a medical emergency and needs the hospital/emergency room. The "prototype" patient is a middle aged poorly controlled type 2 diabetic. However, be on the alert for any immunosupressed, febrile patient with a "severe" otitis externa. In cases where you judge the issue to not need ER evaluation and CT scan, consider documenting in your note "no tenderness on mastoid palpation."
2. Don't forget the aural cotricosteroids (along with the appropriate antibiotics) to lessen pain and inflammation.
3. I also suggest reminding concerned parents they can assist with acetaminophen or ibuprofen.
4. On your discharge instructions, remind the patient to use a cotton ball/ear plugs to keep the ear totally dry- except for your prescription drops- to speed healing.