a topical or systemic antibiotic include: Uncomplicated acute bacterial otitis externa (AOE). For symptoms that are not responsive to treatment within 10 days, a physician should evaluate for necrotizing external otitis. Acute otitis media (AOM) self-resolves within 24–48 hours in 80% of cases. If it does not self-resolve, AOM thought to be caused by bacteria is treated with systemic antibiotics. If symptoms do not respond to a week of treatment, a physician should evaluate for mastoiditis. Acute folliculitis. Auricular cellulitis. Suppurative otitis media. There is also a risk for tympanic membrane rupture. Perichondritis. An otorhinolaryngologist should also evaluate it and if a foreign body is present in the cartilage, this foreign body should be removed. If there is cartilage involvement, then more advance care with hospitalization is needed. Sinusitis can cause secondary ear pain. Treating the underlying sinusitis will treat the ear pain. (See sinusitis.) Some bacterial infections may require a more advanced treatment with evaluation by otorhinolaryngology, IV antibiotics, and hospital admission. Necrotizing external otitis is potentially fatal and should be evaluated by an otorhinolaryngologist with admission to the hospital and IV antibiotics.(See otitis externa.) Acute mastoiditis is treated with admission to the hospital, otorhinolaryngology consultation and empiric IV antibiotics. Cases with intracranial involvement are treated with a mastoidectomy with myringotomy. Chondritis. Procedures Some causes of ear pain require procedural management alone, by a health professional, or in addition to antibiotic therapy. Keratosis obturans is treated with removal of impacted desquamated keratin debris in the ear canal. Chronic perichondritis and chondritis that continues to be symptomatic despite appropriate antibiotic management may require surgical debridement. Surgical drainage could be required. Bullous myringitis leads to the development of bullae on the tympanic membrane that can be punctured to give pain relief. Foreign body in the ear canal can cause pain and be treated with careful removal. Infected sebaceous cyst is treated with incision and drainage of the cysts, oral antibiotics and otorhinolaryngology assessment. Other Given the variety of causes of ear pain, some causes require treatment other than antibiotics and procedures. Relapsing polychondritis is an autoimmune disease treated with immunomodulating medications (medications that help modulate the immune system). Temporomandibular joint dysfunction can lead to secondary ear pain and can be initially treated with a soft food diet, NSAIDs, application of a heat pack, massage of local area, and a referral to a dentist. Myofascial pain syndromes are initially treated with NSAIDs