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Earache Nurse Management Guidelines

Red Flag Exclusion Criteria

  • Child at risk of significant harm

  • Suspected non-accidental injury

  • Unplanned repeat ED presentation

  • Child ≤ 2 years

  • Aboriginal or Torres Straight Islander Child - see the RCH otitis media guideline

  • Hearing loss

  • Discharge from ear

  • History of direct trauma (including blunt trauma) to ear

  • Vomiting

  • Dizziness

  • Persistent fever

  • History of workplace injury

  • Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observation Charts

Management Principles

  1. Provide analgesia as required according to pain scale. Refer to Pain (any cause) NMG

  2. History of live insect in ear; gently instil olive oil or lignocaine 1% into affected ear which will result in reduced pain and discomfort and drowns the insect (see lignocaine 1% Standing Order for dose).

    DO NOT attempt to syringe the ear or attempt to remove insect – refer to medical officer if further treatment is needed

  3. Document assessment findings, interventions, investigations and outcomes

References / Further Resources

  1. NSW Children’s Hospitals Network (2012) Earache Factsheet NSW Children’s Hospitals Network

  2. ECI Patient Factsheet - Ear Infections in Adults

  3. The Royal Children's Hospital Melbourne (2016) Acute Otitis Media Clinical Practice Guideline

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