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Contact: Lindsey Walter
American Academy of Otolaryngology - Head and Neck Surgery

AAO-HNSF updated clinical practice guideline: Acute otitis externa

ALEXANDRIA, VA — With one in every 123 people in the United States affected by Acute Otits Externa or "swimmer's ear" each year, the American Academy of Otolaryngology—Head and Neck Surgery Foundation released an evidence-based guideline to improve the diagnosis and treatment. The guideline, updated from 2006, was published Monday in the journal Otolaryngology–Head and Neck Surgery.

"Swimmer's ear affects nearly 1 in 100 people annually and may cause intense pain. Eardrops offer prompt relief, but about one-third of cases are treated with oral antibiotics, which are ineffective and promote resistant bacteria," says Richard M. Rosenfeld, MD, MPH, chair of the guideline development group. "The updated guideline expands upon prior guidance with new clinical trials, new systematic reviews, and consumer participation, intended to optimize the diagnosis and treatment of this common disorder."

The use of topical treatment by antibiotic eardrops rather than oral antibiotics is among the recommendations made. The Foundation included this recommendation in the national Choosing Wisely® campaign, which encourages physicians and patients to talk about treatment options and pursue only those that are necessary and appropriate for an individual patient. The guideline makes eight recommendations in total.

The clinical guideline for Acute Otitis Externa was created by a panel that included otolaryngologist—head and neck surgeons, pediatricians, infectious disease physicians, family medicine professionals, dermatologists, and consumer advocates.


Otolaryngology–Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF). The guideline was published as a supplement to the journal's February edition.

The guideline's authors are: Richard M. Rosenfeld, MD, MPH; Seth R. Schwartz, MD, MPH; C. Ron Cannon, MD; Peter S. Roland, MD; Geoffrey R. Simon, MD; Kaparaboyna Ashok Kumar, MD, FRCS; William W. Huang, MD, MPH; Helen W. Haskell, MA; and Peter J. Robertson, MPA.

Members of the media who wish to obtain a copy of the guideline or request an interview should contact: Lindsey Walter at 1-703-535-3762, or newsroom@entnet.org. Upon release, the guideline can be found at http://www.entnet.org.


What is Acute Otitis Externa?

Why is the Acute Otitis Externa Guideline Update important?

Updates to the guideline include (since first publication in 2006):

What are significant points made in the guideline?

  1. Clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal.
  2. Clinicians should assess the patient with diffuse AOE for factors that modify management (non-intact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy).
  3. The clinician should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain.
  4. Clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy.
  5. Clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE.
  6. Clinicians should inform patients how to administer topical drops and should enhance delivery of topical drops when the ear canal is obstructed by performing aural toilet, placing a wick, or both.
  7. When the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube, the clinician should prescribe a non-ototoxic topical preparation.
  8. If the patient fails to respond to the initial therapeutic option within 48-72 hours, the clinicians should reassess the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of illness.

About the AAO-HNSF

The American Academy of Otolaryngology—Head and Neck Surgery, one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and lifelong learning. The organization's vision: "Empowering otolaryngologist-head and neck surgeons to deliver the best patient care."

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