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    • CHFT : DISCHARGING EAR PATHWAY ←Click to view pathway image

      Source of image goes here

    • Patient with discharging ear:
      green or yellow fluid coming from the ear canal

      ↓

    • Features that warrant urgent referral

      • Severe ear pain or out of proportion to ear signs
      • Swollen ear canal and therefore unable to instill drops
      • Cellulitis/perichodritis
      • Vertigo
      • Severe H/L
      • Failure to improve after 2 weeks of treatment, especially if immunocomprimise
      • Mastoid inflamed, swollen, tender
      • Polyp or other soft tissue swelling in ear
      • CN palsy

    • ↓

    • Refer to emergency ENT clinic at Calderdale Royal
      01422 222336

    • Itch, pain, non-mucoid discharge with hearing unaffected in the early stages.

    • ↓

    • Topical antibiotic and steroid e.g. Gentisone HC | Sofradex | Otomize
      +
      Aural care advice →

      ↓

      If symptoms do no clear after 2 courses of treatment
      Refer to ENT nurse led aural care clinic

    • Associated with URTI, initial pain and hearing loss. Followed by pus with blood coming from ear

    • ↓

    • Aural care advice for all ear infections:

      • No water must enter the ear
      • Use cotton wool and Vaseline plug to prevent water getting in when in the shower / bath
      • Avoid using ear phones, head phones and hearing aids
      • Avoid clearing the ear with cotton buds etc
      • Avoid swimming. Once infection has settled use swimming plugs and a swimming cap.

      Note:

      Aminoglycoside ear drops may in theory be ototoxic in the presence of a non-intact tympanic membrane, but in general are safe to use for up to 2 weeksin the presence of definite infection. However, aminoglycoside ear drops are not recommended in the better or only hearing ear. Consider ciprofloxacin drops as an alternative (unlicensed indication).

    • Topical antibiotic and steroid drops. May need to dry mop ear before instilling drops. If doesn't clear, consider oral Amoxicillin or Clarithromycin
      +
      Aural care advice →

      ↓

      If symptoms do not resolve or ear examination is abnormal
      Refer to ENT witht the following information

      • History
      • Examination findings
      • Treatment tried
      • Results of any investigations

      ↓

      If appropriate, will be discharged from ENT clinic with specific managment paln

    • i.e. discharge which can be mucoid and smelly, usually not painful, long-standing hearing loss.

    • ↓

    • Aural care advice for all ear infections:

      • No water must enter the ear
      • Use cotton wool and Vaseline plug to prevent water getting in when in the shower / bath
      • Avoid using ear phones, head phones and hearing aids
      • Avoid clearing the ear with cotton buds etc
      • Avoid swimming. Once infection has settled use swimming plugs and a swimming cap.

      Note:

      Aminoglycoside ear drops may in theory be ototoxic in the presence of a non-intact tympanic membrane, but in general are safe to use for up to 2 weeksin the presence of definite infection. However, aminoglycoside ear drops are not recommended in the better or only hearing ear. Consider ciprofloxacin drops as an alternative (unlicensed indication).

    • 10 day course of topical antibiotic and steroid drops. May need to dry mop ear before instilling drops.
      +
      Aural care advice →

      ↓

      If symptoms do not resolve or ear examination is abnormal
      Refer to ENT with the following information

      • History
      • Examination findings
      • Treatment tried
      • Results of any investigations

      ↓

      If appropriate, will be discharged from ENT clinic with specific managment paln

    • Aural care advice for all ear infections:

      • No water must enter the ear
      • Use cotton wool and Vaseline plug to prevent water getting in when in the shower / bath
      • Avoid using ear phones, head phones and hearing aids
      • Avoid clearing the ear with cotton buds etc
      • Avoid swimming. Once infection has settled use swimming plugs and a swimming cap.

      Note:

      Aminoglycoside ear drops may in theory be ototoxic in the presence of a non-intact tympanic membrane, but in general are safe to use for up to 2 weeksin the presence of definite infection. However, aminoglycoside ear drops are not recommended in the better or only hearing ear. Consider ciprofloxacin drops as an alternative (unlicensed indication).