A 10yo has marked ear pain, not wanting anyone to touch his ear. The canal is edematous & exudate is present. TM is normal. How would this be managed?

A 10yo has marked ear pain, not wanting anyone to touch his ear. The canal is edematous & exudate is present. TM is normal. How would this be managed?

• A. Topical fluoroquinolone
• B. Oral amoxicillin & topical steroid
• C. Oral amoxicillin & topical anesthetic
• D. Oral steroids & topical neomycin

Answer: (A)

This scenario shows otitis externa: a painful, inflamed ear canal with discharge and a normal tympanic membrane. The key idea is to treat the infection where it lies—the canal skin—using a topical antibiotic that reaches the swollen canal well. A topical fluoroquinolone ear drop is the best choice because it provides high local concentrations and covers the common organisms in otitis externa, notably Pseudomonas aeruginosa and Staphylococcus aureus. Many regimens also include a mild steroid, which helps reduce edema and pain and improves drainage. Oral antibiotics aren’t needed here when the tympanic membrane is intact and the infection is confined to the canal; they don’t offer added benefit and expose the child to unnecessary systemic effects. Avoid topical neomycin-containing products if a perforation might be present, since aminoglycosides can be ototoxic if the membrane is ruptured. If symptoms worsen or fail to improve with topical therapy, reassess for spread or complications.

This scenario shows otitis externa: a painful, inflamed ear canal with discharge and a normal tympanic membrane. The key idea is to treat the infection where it lies—the canal skin—using a topical antibiotic that reaches the swollen canal well. A topical fluoroquinolone ear drop is the best choice because it provides high local concentrations and covers the common organisms in otitis externa, notably Pseudomonas aeruginosa and Staphylococcus aureus. Many regimens also include a mild steroid, which helps reduce edema and pain and improves drainage.

Oral antibiotics aren’t needed here when the tympanic membrane is intact and the infection is confined to the canal; they don’t offer added benefit and expose the child to unnecessary systemic effects. Avoid topical neomycin-containing products if a perforation might be present, since aminoglycosides can be ototoxic if the membrane is ruptured. If symptoms worsen or fail to improve with topical therapy, reassess for spread or complications.