Synopsis
Identify diffuse canal inflammation and focal follicular infection, deliver effective topical treatment and recognise when pain or spread requires urgent specialist assessment.
- Otitis externa affects the canal skin; pain on moving the tragus or pinna supports this location.
- A furuncle is a focal infected hair follicle and small abscess in the outer hair-bearing canal.
- Check the tympanic membrane and ask about perforation, grommets and previous ear surgery before selecting drops.
Key red flags
Disproportionate nocturnal otalgia or facial weakness in a person with diabetes or impaired immunity requires urgent ENT assessment for skull-base infection.
Investigation priorities
Localise the disease and assess treatment safety.
Management branches
Canal inflammation is present without invasive or spreading features.
- Provide appropriate analgesia and choose a topical preparation after considering eardrum integrity, allergies and the likely inflammatory or infective process.
- Explain the administration method and review whether drops can reach the affected canal; arrange skilled clearance or a wick if significant obstruction prevents delivery.
Key medicines
Acetic acid 2% ear spray for superficial diseaseEarCalm: one metered spray into each affected ear at least three times daily; maximum frequency one spray every 2–3 hours. Continue until two days after symptoms resolve, for no longer than seven days.
Dexamethasone 0.1% / neomycin 0.5% / acetic acid 2% ear sprayOne metered spray into each affected ear three times daily, continuing until two days after symptoms disappear. Stop and reassess if there is no clinical improvement after seven days; avoid prolonged unreviewed courses.