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

Choice A reason: Irrigation of the external auditory canal is contraindicated in cases of severe swelling or when the tympanic membrane status is unknown. It may worsen inflammation or introduce infection deeper into the canal. Choice B reason: Oral antibiotics are not first-line for uncomplicated otitis externa. They are reserved for cases with systemic symptoms or extension beyond the ear canal, which is not described here. Choice C reason: Insertion of a wick allows the topical 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. They carry systemic risks and are not indicated unless there is a severe allergic or inflammatory component, which is not evident in this scenario.