Diseases of the ear, nose, and throat (ENT) are common in pediatrics. Infections are often viral or bacterial in origin, so antibiotics are prescribed when appropriate. Steroids, however, are not routinely prescribed for ENT infections. In OE, there is both inflammation and infection of the external ear canal. Because of the inflammatory nature of OE, steroids can be considered in the management.

Acute or diffuse OE is the most common infection of the external ear canal. It is often referred to as “swimmer’s ear” or “tropical ear.” Patients can present with a range of symptoms including pain, pruritus, erythema, otorrhea, hearing loss, and a feeling of fullness. The most common pathogens in otitis externa are Staphylococcus aureus and Pseudomonas aeruginosa. When treating OE, it is important to eliminate the micro-organisms, while also limiting the patient’s otalgia.

Treatment regimens include cleansing of the canal, avoidance of moisture, ototopical medications, and systemic analgesics, when necessary. The topical otic preparations should focus on eliminating microorganisms, decreasing the pH of the ear canal, and decreasing inflammation of the ear canal. The most commonly used agents are antibiotics, acidifying agents, and steroids. Neomycin is active against gram-positive and some gram-negative organisms; polymyxin is active against gram-negative organisms, including Pseudomonas; and fluoroquinolones provide coverage against both staphylococci and Pseudomonas. Acetic acid is the most commonly prescribed acidifying agent; many bacteria grow best in alkaline environments, so acidifying the ear canal prevents further bacterial growth. Many of the topical otic medications are a combination of steroids with either antimicrobials or acetic acid. Although some patients experience pain that requires oral non-steroidal anti-inflammatory medications, steroid drops have also been shown to decrease the duration of otalgia.