A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema, marked swelling of the external auditory canal, and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention?

Choice A reason: Referral to an otolaryngologist may be necessary if the condition does not respond to initial therapy or if complications arise. However, it is not the first-line intervention for typical otitis externa. Choice B reason: Cultures are not routinely obtained for otitis externa unless the infection is recurrent, resistant, or associated with immunocompromise. Empiric treatment is usually effective. Choice C reason: Oral antibiotics like amoxicillin-clavulanate are not indicated for otitis externa unless there is systemic involvement or extension beyond the ear canal. Topical therapy is preferred. Choice D reason: Ototopical antibiotic/corticosteroid drops are the first-line treatment for otitis externa. They address both infection and inflammation and are effective in resolving symptoms when applied correctly.