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Further discussion on treating acute otitis externa

The author says that oral antimicrobial therapy “should be reserved for persistent OE, when acute otitis media is present, or when infection has spread locally or systemically.” Separately the author states that recalcitrant cases frequently occur in those patients who are immunocompromised, particularly patients with diabetes. The American Academy of Otolaryngology guidelines for the treatment of acute OE state that systemic as well as local therapy should be considered for any patient with “risk factors that may alter the treatment regimen, including diabetes, HIV/immunocompromised states, a history of radiotherapy, or the presence of a tympanostomy tube/perforated tympanic membrane.” 1