Earache/otitis outpatient approach
Structured earache triage supporting diagnosis, analgesia-first care, and escalation for severe complications.
Last reviewed February 7, 2026
Red flags
- Toxic appearance, mastoid tenderness/swelling, or neurologic concern.
- Severe persistent pain with systemic deterioration.
- Immunocompromised status with escalating symptoms.
Assessment priorities
- Distinguish acute otitis media from otitis externa and referred pain causes.
- Assess pain severity, fever burden, and hydration status.
- Review age-specific risk profile and recurrent-episode history.
Initial management
- Use analgesia-first approach and guideline-aligned antibiotic thresholds.
- Provide clear dosing guidance and expected recovery trajectory.
- Document watchful-waiting versus treatment rationale.
Follow-up and escalation
- Reassess if fever/pain persists beyond expected window.
- Escalate for worsening symptoms, dehydration, or complication signs.
- Refer for recurrent or complicated disease patterns.
References
- Canadian Paediatric Society position statements (opens in a new tab)
- Choosing Wisely Canada recommendations (opens in a new tab)
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