A Systematic Review and Quality Assessment of Clinical Practice Guidelines for Otitis Externa to Support the WHO Package of Ear and Hearing Care Interventions

OBJECTIVE: This systematic review of clinical practice guidelines summarizes key recommendations and interventions related to the prevention, diagnosis, and management of acute otitis externa. The interventions identified in this review will contribute to the development of the World Health Organization (WHO) Package of Ear and Hearing Care Interventions (PEHCI). DATABASES REVIEWED: We searched PubMed, CINAHL, Clinical Key, and TRIP databases to identify clinical practice guidelines related to otitis externa. We hand-searched professional organization websites to identify additional clinical practice guidelines that were not identified from the database search or that were published in languages other than English (Spanish, French, Chinese, and Russian). METHODS: Publications were required to be clinical practice guidelines and published between 2014 and 2024. All review processes were performed by 2 independent reviewers, including the quality assessment with the AGREE II tool. RESULTS: We identified 6 clinical practice guidelines, 4 of which met our prespecified inclusion criteria based on the AGREE II assessment. The 4 included guidelines were published in the United States, Colombia, and 2 in Russia, and in 3 languages. Key interventions focused on prevention (avoiding injury, keeping the ear canal dry, and timely cerumen management), patient education and counseling, comprehensive diagnostic assessment, and pharmaceutical interventions and ear cleaning. CONCLUSION: The clinical practice guidelines identified key interventions related to the prevention, diagnosis, and management of otitis externa. These interventions will be used to inform the development of the PEHCI, which will identify priority ear and hearing care interventions that can be integrated into national health services packages and policies.