12.1 Drugs acting on the ear

12.1.1 Treatment of otitis externa

First Choice:
Otomize ® if the eardrum is not perforated
orflumetasone pivalate 0.02%, clioquinol 1% ear drops if perforated eardrum suspected
orclotrimazole if suspected fungal infection
Dose
  • Otomize ® (dexamethasone 0.1%, neomycin sulfate 3250 units/mL, glacial acetic acid 2%) ear spray: 1 spray into the ear 3 times daily.
  • flumetasone pivalate 0.02%, clioquinol 1% ear drops: 2–3 drops into the ear twice daily for up to 10 days.
  • clotrimazole (Canesten®) solution 1% in polyethylene glycol (macrogol 400): apply 2–3 times daily continuing for at least 14 days after disappearance of infection.
Prescribing Notes
  • Many cases of otitis externa recover after thorough cleansing of the external ear canal by suction and dry mopping.
  • It is often difficult to differentiate between infection on its own and inflammation, therefore a combined preparation is suitable first choice.
  • Otomize® spray is first choice because the delivery system is more effective in getting the drug to the infected site.
  • Flumetasone pivalate 0.02%, clioquinol 1% should not be used for longer than 10 days to prevent fungal overgrowth.
  • Recurrent or persistent cases should be swabbed and treated according to sensitivities.
  • Otomize® and other products containing aminoglycosides, polymyxin or chlorhexidine should not be used routinely if the eardrum is perforated.
  • Eczema of the outer canal and pinna may need treatment with a steroid cream.
12.1.2 Otitis media
  • See Chapter 5(h).
12.1.3 Removal of ear wax

First Choice:
almond oil [unlicensed preparation]
orsodium bicarbonate
Dose
  • almond oil[unlicensed preparation] ear drops: for hard, impacted wax apply twice daily for a few days before syringing, otherwise soften the wax on the day of syringing.
  • sodium bicarbonate ear drops 5%: for hard, impacted wax apply twice daily for a few days before syringing, otherwise soften the wax on the day of syringing.
Prescribing Notes
  • To soften ear wax the oil should be warmed and a generous amount introduced into the affected ear. The patient should lie with the affected ear uppermost for 5–10 minutes. The treatment should preferably be given for 3–4 days before syringing to ensure maximum softening of the wax.
  • Olive oil is a suitable alternative to almond oil.
  • Some proprietary preparations contain organic solvents which cause irritation of the meatal skin. In most cases, simple almond or olive oil is just as effective, less likely to cause irritation of the skin and less expensive.