ENT/Otic preparations

Ear drops (otitis externa / wax)

also: acetic acid · topical aminoglycoside · olive oil · sodium bicarbonate drops · flumetasone

Overview

Topical treatment of otitis externa and softening of ear wax. The perforated-eardrum aminoglycoside caution is the key exam point.

Mechanism

Topical antibiotic/steroid combinations treat the infection + inflammation of otitis externa. Acetic acid acidifies the canal (antibacterial/antifungal). Wax softeners (olive oil, sodium bicarbonate, urea-hydrogen peroxide) emulsify cerumen.

Indications

Otitis externa (topical antibiotic ± steroid, or acetic acid)
Ear wax softening before removal

The agents

Antibiotic + steroid drops (e.g. neomycin/dexamethasone)otitis externa

Avoid aminoglycoside drops if eardrum perforated (ototoxicity).

Ciprofloxacin dropsotitis externa

Safe with perforation; covers Pseudomonas.

Acetic acid 2% spraymild OE

OTC; acidifies canal.

Olive oil / sodium bicarbonatewax

Soften before irrigation.

Adverse effects

Aminoglycoside ototoxicity if tympanic membrane perforatedserious

The classic caution — use ciprofloxacin drops instead.

Local irritation / contact sensitivity (neomycin)common

Fungal overgrowth with prolonged usecommon

Cautions & contraindications

Aminoglycoside drops with a perforated eardrumall

Cochlear ototoxicity.

Interactions

Monitoring & kinetics

Response; review if not settling (consider swab, malignant otitis externa in diabetics/elderly)

Topical to the ear canal.

Source: NICE CKS — Otitis externa · BNF — Otic preparations