Referral criteria from primary care - otitis externa

• urgent admission (same day) is indicated if malignant otitis is suspected
  • clinical features that cause clinician to suspect malignant otitis:
    • if otalgia and headache are more severe than the clinical signs would suggest, or
    • the presence of granulation tissue at the bone-cartilage junction of the ear canal, or exposed bone in the ear canal, or
    • paralysis of the facial nerve is present
      
      
• specialist advice should be sought if:
  • no symptomatic improvement despite treatment and treatment failure is unexplained
  • treatment with a quinolone is indicated
    
    
• referral to secondary care if there is (1):
  • extensive cellulitis (same day referral)
    • if cellulitis or disease extending outside ear canal, start oral antibiotics and refer (1)
  • extreme otalgia (same day referral)
  • profuse discharge or extensive swelling of the auditory canal, and microsuction or ear wick insertion is required
    
    
• a review has suggested (2):
  • recommend referring to an ENT emergency clinic if
    • the otitis externa does not respond to 14 days of topical antibiotics
    • the ear canal is completely stenosed where drops cannot penetrate and wick insertion may be required
    • when the canal is full of debris and aural toilet cannot be carried out in primary care

Reference:

• 1. Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation
• 2. Barry V et al. 10-Minute Consultation - Otitis externa. BMJ2021;372:n714http://dx.doi.org/10.1136/bmj.n714