A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical medication. What is the next step in treatment for this child?

Choice A reason: Irrigation may worsen inflammation and is contraindicated in cases of severe swelling or when the tympanic membrane status is unknown. It is not a standard next step in refractory otitis externa. Choice B reason: Oral antibiotics are generally reserved for cases with systemic involvement or extension beyond the ear canal. Topical therapy remains first-line unless complications arise. Choice C reason: Insertion of a wick allows the ototopical medication to reach the inflamed tissue when swelling obstructs the canal. This is the recommended next step when topical therapy alone is ineffective due to poor penetration. Choice D reason: Systemic corticosteroids are not routinely used for otitis externa and carry risks. They may be considered in severe allergic or inflammatory cases but are not first-line for persistent canal swelling.