The ear has three parts: the external ear (pinna and canal), the middle ear (eardrum, ossicles, air space connected to the throat by the eustachian tube), and the inner ear (cochlea for hearing, vestibular system for balance).

Children get AOM more often because their eustachian tubes are shorter, wider, and more horizontal. Adult AOM is less common; persistent one-sided middle ear fluid in an adult needs evaluation to exclude a nasopharyngeal mass.

Malignant (necrotizing) otitis externa is a severe spreading infection of the skull base, mainly in older adults with diabetes or immunosuppression; it causes severe pain, granulation tissue in the canal, and can involve cranial nerves.

Otitis externa: ear pain worsened by moving the pinna or tragus, itching, swollen red canal, discharge, muffled hearing.

AOM: ear pain (infants tug the ear, are irritable, feed poorly), fever, hearing loss; sudden relief of pain with discharge suggests eardrum perforation.

OME: muffled hearing, speech delay in children, inattention; dull, retracted eardrum with fluid level or bubbles.

Mastoiditis: postauricular tenderness and swelling, fever, headache, persistent drainage.

Ménière disease: vertigo attacks lasting 20 minutes to 12 hours with nausea and vomiting, fluctuating low-frequency hearing loss, roaring tinnitus, fullness.

Pain assessment: use a validated tool such as the Numeric Rating Scale (0–10) for adults; face scales for young children.

Otitis externa

• Topical antibiotic drops are first-line (e.g., ciprofloxacin or ofloxacin, with or without a steroid); oral antibiotics only if infection spreads beyond the canal or the client is immunocompromised
• Canal cleaning (aural toilet) by a clinician; an ear wick if the canal is swollen shut
• If the eardrum may be perforated, use non-ototoxic drops (fluoroquinolone), not aminoglycoside drops
• Analgesics — pain can be severe
• Necrotizing otitis externa: hospital admission, IV antipseudomonal antibiotics, glucose control

Acute otitis media

• Analgesia (acetaminophen or ibuprofen) is a core part of treatment in every case
• Amoxicillin is first-line when antibiotics are needed; amoxicillin-clavulanate if amoxicillin was used in the past 30 days or treatment fails
• In selected children with mild illness, watchful waiting for 48–72 hours with follow-up is an option
• Tympanostomy tubes for recurrent AOM or persistent OME with hearing loss; adenoidectomy may be added

Mastoiditis: IV antibiotics, drainage; mastoidectomy if no response or complications.

Chronic otitis media / cholesteatoma: antibiotic-steroid drops, dry-ear care; tympanoplasty to repair the drum, mastoidectomy to remove cholesteatoma.

Ménière disease

• Sodium restriction, limit caffeine and alcohol, manage stress
• Diuretics (e.g., hydrochlorothiazide) to reduce endolymph; betahistine in some countries
• Acute attacks: vestibular suppressants (meclizine, promethazine) and antiemetics — short-term only
• Intratympanic corticosteroid or gentamicin; surgery for refractory cases

Drug safety

Listed in priority order.

1. Detect complications — watch for meningitis signs (headache, neck stiffness, altered consciousness, fever), facial weakness, severe vertigo, or swelling behind the ear; report at once
2. Safety for vertigo — bed rest during attacks, side rails per policy, assist with walking, dim quiet room, keep head still and fix the gaze on one point
3. Pain relief — analgesics as ordered; warm compress over the ear for AOM comfort; reassess with the same pain scale
4. Medication administration
   • Warm ear drops to body temperature (cold drops cause dizziness)
   • Adult: pull the pinna up and back; child under 3: pull the pinna down and back
   • Instill drops along the canal wall; keep the head tilted with the treated ear up for about 5 minutes; a loose cotton ball may be placed at the opening
5. Infection control and ear hygiene — do not insert swabs into the canal; clinician-performed cleaning only
6. Postoperative ear surgery care — position as ordered (often with the operative ear up); watch for facial nerve weakness, vertigo, bleeding; sneeze and cough with the mouth open; avoid nose blowing

• Finish the full antibiotic course at the prescribed dose and times even if pain improves
• Otitis externa prevention: after swimming, tilt the head to drain water and dry the ears with a hair dryer on the lowest, cool setting held away from the ear; use earplugs; never use cotton swabs or objects in the canal
• Keep the ear dry during treatment; no swimming until cleared
• With a perforated eardrum: keep water out when bathing (earplugs or cotton with petroleum jelly)
• With tympanostomy tubes: routine water precautions are not needed; use earplugs only if advised (e.g., diving, lake water, or pain with water exposure)
• Treat colds and allergies promptly; avoid smoking and secondhand smoke — both impair eustachian tube function
• Children: vaccinations (pneumococcal, influenza), avoid bottle feeding while lying flat, breastfeeding lowers AOM risk
• After ear surgery: blow the nose gently one side at a time with the mouth open, avoid straining and heavy lifting, avoid air travel for the period the surgeon advises (often 2–3 weeks), keep water out
• Ménière: spread sodium evenly through the day, keep a symptom diary, sit or lie down immediately when vertigo starts, do not drive during episodes

• Otitis externa: pain with pinna or tragus movement; topical drops first-line; no cotton swabs
• Swimmer's ear prevention: drain water, dry with a cool/low hair dryer, earplugs
• AOM: red, bulging eardrum; analgesia always; amoxicillin first-line; complete the course
• OME in children is often from adenoid hypertrophy — painless fluid, muffled hearing
• Mastoiditis → watch for meningitis and brain abscess
• Ear drops: warm them; adult pinna up and back, child under 3 down and back; stay tilted about 5 minutes
• Avoid aminoglycoside drops with a perforated eardrum
• Chronic perforation: keep water out; treat upper respiratory infections early; tympanostomy tubes need no routine water precautions
• Ménière: vertigo + fluctuating hearing loss + tinnitus + fullness; low sodium; safety during attacks
• After ear surgery: mouth open to sneeze, gentle one-sided nose blowing, no flying until cleared