GuidelinesPrimary Care STG
Otitis Media, Chronic, Suppurative
Otitis
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ICD-10 Code: H66.1-3
DESCRIPTION
- A purulent discharge from the ear with perforation for >2 weeks. If the eardrum has been ruptured for ≥2 weeks, a secondary infection with multiple organisms usually occurs. Oral antibiotic treatment is generally ineffective
- TB may present with a chronically discharging ear. Consider the diagnosis of TB if other clinical features suggestive of TB are present (e.g. cough, weight loss, failure to thrive, etc.). See: Pulmonary tuberculosis (TB)
GENERAL MEASURES
- Do not send pus swabs collected from the external ear canal for routine bacterial and fungal MC+S (microscopy, culture and sensitivity) or for microscopy and culture for tuberculosis
- Explain to patients and caregivers that a chronically draining ear can only heal if it is dry
- Dry mopping is the most important part of the treatment. It should be demonstrated to the child’s caregiver or patient if old enough. Roll a piece of clean absorbent cloth into a wick
- Carefully insert the wick into the ear with twisting action
- Remove the wick and replace with a clean dry wick
- Repeat this until the wick is dry when removed
- Do not leave anything in the ear
- Do not instill anything else in the ear
- Avoid getting the inside of the ear wet while swimming and bathing
- Check HIV status if unknown
REFERRAL
- All sick children, vomiting, drowsy, etc.
- Painful swelling behind the ear
- Ear discharge still present for ≥4 weeks, despite dry mopping
Note:
These referrals do not all require referral to an ENT. They may be referred to a hospital outpatient department for consideration of topical antibiotic eardrops.
- Any attic perforation
- Any perforation not progressively improving after 3 months or closed by 6 months, even if dry
- Moderate or severe hearing loss
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition