Diagnosis and Management of Acute Otitis Media and Acute Otitis Externa for the Urgent Care Clinician (Pharmacology CME and Infectious Disease CME)

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Delivery Method:	Online
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Publication Date: August 2024 (Volume 3, Number 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 08/01/2027.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 3 Pharmacology CME credits and 4 Infectious Disease CME credits, subject to your state and institutional requirements.

Authors

Peer Reviewer

Abstract

Acute otalgia is a common reason why patients, particularly those in the pediatric population, seek care in the urgent care setting. Although many patients who present with acute otalgia will have acute otitis media (AOM) or acute otitis externa (AOE), the differential diagnosis is complicated by trauma, cerumen impaction, tonsillitis, foreign bodies, or other infections. While most cases of AOM or AOE can be managed in urgent care, more severe disease processes will require referral to otolaryngology and/or the emergency department. This review provides evidence-based recommendations for the evaluation and management of patients with acute otalgia, with a focus on the diagnosis and treatment of AOM and AOE. Current guidelines on antibiotic treatment for AOM and AOE are discussed, including the "watch and wait" approach for AOM in the pediatric population.

Case Presentations

A 7-year-old boy with his parents presents with right ear pain and fever for 2 days...

• You see a bulging, erythematous tympanic membrane on examination.
• You choose to treat for acute otitis media, but Mom tells you this is the patient’s second ear infection in the past month.
• What is the most appropriate course of treatment?

A 17-year-old adolescent girl presents with severe right ear pain for 5 days...

• You see a bulging, erythematous tympanic membrane with erythema and tenderness to the patient’s mastoid process.
• She also has a fever of 102°F.
• What is your next step in management?

A 60-year-old diabetic man presents with left ear pain and drainage for the past 4 days...

• You see a very inflamed, erythematous external ear with otorrhea.
• The patient tells you he was recently on some “antibiotic drops” but they are not helping.
• You wonder if the patient should be transferred to the hospital for further management and possible specialist consultation…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.