Pathlab: Microbiology testing of ear swabs

The number of ear swabs submitted to Pathlab for microbiological processing has steadily increased over the last few years (PDF). The external auditory canal is not a sterile site, and the value of microbiological culture in the routine management of otitis externa and chronic suppurative otitis media is limited.

Below, Pathlab has outlined the situations they recommend ear swabs are sent to the laboratory.

• Recalcitrant otitis externa which has failed initial treatment with ear drops.
• Recurrent or chronic (>2 weeks) otitis externa.
• Topical treatment cannot be delivered effectively.
• There is evidence the infection has extended beyond the external auditory canal (e.g. osteomyelitis, cellulitis, nerve palsy).
• The condition is complex/severe enough to warrant systemic antimicrobial treatment.
• Presence of systemic symptoms (i.e. fever) or immunosuppression.
• Request by ENT specialist.
• Chronic suppurative otitis media (CSOM) recalcitrant to standard treatment.

The inclusion of clinical details is pre-requisite, and clinical information which does not pertain to the scenarios above may result in the swab being rejected. 

To practice effective diagnostic stewardship, Pathlab would be grateful if clinicians could please follow these recommendations.