{"id":7464,"date":"2026-06-20T03:53:52","date_gmt":"2026-06-20T03:53:52","guid":{"rendered":"https:\/\/gothi.gov.eg\/?page_id=7464"},"modified":"2026-06-20T04:05:53","modified_gmt":"2026-06-20T04:05:53","slug":"%d8%a7%d9%84%d8%a7%d9%86%d9%81-%d9%88%d8%a7%d9%84%d8%a3%d8%b0%d9%86","status":"publish","type":"page","link":"https:\/\/gothi.gov.eg\/?page_id=7464","title":{"rendered":"\u0627\u0644\u0627\u0646\u0641 \u0648\u0627\u0644\u0623\u0630\u0646"},"content":{"rendered":"\t\t
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  1. <\/li>\n<\/ol>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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    \u0627\u0644\u0627\u0646\u0641 \u0648\u0627\u0644\u0623\u0630\u0646\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    \n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n Acute Otitis Externa <\/span>\n\n <\/h5>\n\n
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    “last update: 28 April 2024”\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span>Download Guideline<\/strong><\/u><\/a><\/h5>\n<\/div>\n<\/div>\n<\/div>\n
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    – Executive Summary<\/h3>\n
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    \u00a0<\/p>\n

    This Guideline is intended to\u00a0<\/span>provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for applying the clinical practice guideline. The primary outcome considered<\/p>\n

    in this guideline is clinical resolution of AOE<\/p>\n

    \u00a0 \u00a0 \u00a0<\/span>\u25fe\u00a0Clinicians should distinguish diffuse acute otitis externa (AOE) from other causes of otalgia, otorrhea, and inflammation of the external ear canal.<\/p>\n

    \u00a0 \u00a0 \u25fe\u00a0Clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, priorradiotherapy).<\/p>\n

    \u00a0 \u00a0 \u25fe\u00a0The clinician should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain.<\/p>\n

    \u00a0 \u00a0 \u25fe\u00a0Clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy.<\/p>\n

    \u00a0 \u00a0 \u25fe\u00a0Clinicians should use topical preparations for initial therapy of diffuse, uncomplicated AOE.<\/p>\n

    \u00a0 \u00a0 \u25fe\u00a0Clinicians should inform patients how to administer topical drops and should enhance delivery of topical drops when the ear canal is obstructed by performing aural toilet, placing a wick, or both.<\/p>\n

    \u00a0 \u00a0 \u25fe\u00a0When the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube, the clinician should recommend a non-ototoxic topical preparation.<\/p>\n

    \u00a0 \u00a0 \u25fe\u00a0If the patient fails to respond to the initial therapeutic option within 48 to 72 hours, the clinician should reassess the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of illness.<\/p>\n
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    \n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n Acute Rhinosinusitis <\/span>\n\n <\/h5>\n\n
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    “last update: 5 August 2024”\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Download Guideline<\/strong><\/u><\/a><\/h5>\n<\/div>\n<\/div>\n<\/div>\n
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    – Executive Summary<\/h3>\n
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    \u00a0<\/p>\n

    1- Definition:\u00a0<\/b>Acute rhinosinusitis (ARS) is considered when symptoms and signs are present less than 4 weeks.\u00a0(Strong recommendation)<\/b><\/p>\n

    2- Diagnosis of acute ARS through symptoms\/signs and duration:<\/p>\n

    \u00a0 \u00a0 \u00a0-Symptoms must include most of the followings (All can be included in CPODS)<\/p>\n

    \u00a0 \u00a0 C: Congestion, P: Pain, O: Obstruction,D: Drainage\/Discharge,S: Smell affection<\/p>\n

    (Strong recommendation)<\/b><\/p>\n

    3- A thorough physical examination that includes inspection , palpation of the maxillary and frontal sinus, as well as anterior rhinoscopy (evidence of inflammation, mucosal oedema, and discharge).\u00a0(Conditional recommendation)<\/b><\/p>\n

    4- Objective evidence of ARS on nasal endoscopy, antral puncture, or radiographic imaging (X-ray, ultrasonography, or CT) is not required for the diagnosis in uncomplicated cases.\u00a0<\/i>(Strong recommendation against)<\/b><\/i><\/p>\n

    5-\u00a0<\/i>ESR and CRP are inflammatory markers found to be elevated during ARS, but they are not routinely used for diagnosis because of their limited specificity. It can be used in COVID-19 .\u00a0(Conditional recommendation)<\/b><\/p>\n

    6- Differentiate viral from bacterial ARS:\u00a0<\/b>-Duration is thought to be a key\u00a0\u00a0 factor differentiating ABRS from AVR, with persistence of symptoms beyond 7-10 days or worsening of symptoms after 5 days being indicators of development of post-viral ABRS.<\/p>\n

    \u00a0 \u00a0 \u00a0-Clinical factors associated with symptoms and signs ABRS include:<\/p>\n

    \u00a0 \u00a0 \u00a0 Timing of the disease, worsening of the disease, purulent nasal discharge on rhinoscopy, localized unilateral pain, severe pain over the teeth and maxilla, and fever > 38\u02daC.\u00a0(conditional recommendation)<\/b><\/p>\n

    7- Consider initial watchful waiting in uncomplicated\u00a0\u00a0 cases with assurance of follow up.\u00a0(conditional recommendation)<\/b><\/p>\n

    8- Institution of antibiotic therapy if:<\/p>\n

    \u00a0 \u00a0 A. No improvement after 4-7 days or worsening at any time,<\/p>\n

    \u00a0 \u00a0 B. Mitigating circumstances with drug resistance e.g., severe\u00a0\u00a0 symptoms and immunocompromised states<\/p>\n

    \u00a0 \u00a0 C. Concern for impending complications<\/p>\n

    \u00a0 \u00a0 D. Suspected odontogenic source<\/p>\n

    \u00a0 \u00a0 E. Prior antibiotics (1 month), prior hospitalization (5 days) and comorbidities.<\/b><\/p>\n

    (Conditional recommendation)<\/b><\/p>\n

    \u00a09- If a decision is made to treat ABRS with an antibiotic,\u00a0<\/b>the clinician should prescribe amoxicillin with clavulanate\u00a0(conditional recommendation)<\/b><\/p>\n

    10- First time non-responders can be based on lack of clinical improvement following treatment within 5 days in adults and 3 days in children. -Use second line antimicrobial agents.\u00a0(Conditional recommendation)<\/b><\/p>\n

    11- In patients with ABRS suspected to have suppurative complications, axial, coronal and sagittal views with contrast-enhanced computed tomography (CT) is rec\u00adommended.\u00a0(Conditional recommendation)<\/b><\/p>\n

    12- Recurrent acute rhinosinusitis RARS is diagnosed when At least 4 attacks of ABRS\/year are documented\u00a0(Conditional recommendation)<\/b><\/p>\n

    \u00a0 \u00a0 \u00a0-Consider Nasal endoscopy and\/or CT imaging are an option during at least one episode of suspected RARS\u00a0(Conditional recommendation)<\/b><\/p>\n

    \u00a0 \u00a0 \u00a0-Endoscopic sinus surgery (ESS) is recommended for pa\u00adtients with RARS.\u00a0<\/span>(Conditional recommendation)<\/span><\/b><\/p>\n
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