In the presented case scenario, an adolescent patient developed right-sided otitis externa after swimming in a freshwater lake. Otitis externa is defined as an inflammation of the external auditory canal, sometimes involving the pinna and the tympanic membrane (Wiegand et al., 2019). The most common causes of otitis externa are Staphylococcus aureus and Pseudomonas aeruginosa, and polymicrobial infection may occur (Wiegand et al., 2019). In uncomplicated cases, like in this 13-year-old patient, the management includes cleaning the ear canal with an antiseptic like chlorhexidine or acetic acid, oral analgesic, and topical antimicrobial therapy (Wiegand et al., 2019). Specifically, eardrops containing polymyxins, neomycin, or ciprofloxacin can be prescribed (Wiegand et al., 2019). If left untreated, it may lead to such complications as necrotizing otitis externa and skull base osteomyelitis (Rout et al., 2021). If the ear canal were too swollen to introduce medications, it would require cleansing using an aural hook and suction under microscopic supervision by an experienced otolaryngologist.
I agree with your proposed treatment plan of general cleansing and topical antimicrobial therapy. I understand that it is reasonable to use normal saline or distilled water for cleaning, which is appropriate in uncomplicated cases. However, I consider that it would be better to remove the debris from the ear canal using a stronger antiseptic due to the bacterial etiology of the disease, especially if tympanic membrane damage is suspected. Although topical antibiotics will be used, antiseptics like acetic acid, silver nitrate, chlorhexidine, or others should still be used because ear exudate may contain bacterial toxins (Wiegand et al., 2019). Moreover, I believe your suggestion about using suction and gauze to drain the excess liquid effectively reduces the inflammatory process.
References
Rout, M. R., Prakash, S. K., & Laxmi, P. S. V. S. (2021). A clinical study on malignant otitis externa. Journal of Dental and Medical Sciences, 20(8), 51-56. Web.
Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis externa. Deutsches Arzteblatt International, 116(13), 224–234. Web.