A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and 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 may be necessary if symptoms persist or worsen despite treatment, but initial management should begin with topical therapy. Otolaryngology is not the first-line intervention for uncomplicated otitis externa. Choice B reason: Cultures are not routinely indicated unless the infection is recurrent, resistant, or in immunocompromised patients. Empiric topical therapy is typically effective. Choice C reason: Oral antibiotics are not recommended for uncomplicated 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.