Drugs Acting on the Ear

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

For severe pain associated with otitis externa, a simple analgesic, such as PARACETAMOL or IBUPROFEN, can be used.

A systemic antibacterial can be used if there is spreading cellulitis or if the patient is systemically unwell. Further information can be found in the NHSL Antimicrobial Guidelines for Adult Primary Care - ACUTE OTITIS EXTERNA

The skin of the pinna adjacent to the ear canal is often affected by eczema. A topical corticosteroid cream or ointment is then required, but prolonged use should be avoided. For formulary options refer to Chapter 13. Skin (Topical Corticosteroids).

Otitis Externa: Anti-Inflammatory Preparation

Preferred list (P)

BETAMETHASONE 0.1% eye/ear/nose drops (Vistamethasone®)

  • Contraindication: Perforated eardrum due to the risk of ototoxicity.

Otitis Externa: Anti-Inflammatory With Antibacterial Preparations

Preferred list (P)

BETAMETHASONE WITH NEOMYCIN drops (Betnesol-N®)

  • Betamethasone sodium phosphate 0.1% with neomycin 0.5%
  • Contraindications: Patent grommet, perforated eardrum (although may be used by specialists).

 

Total list (T)

HYDROCORTISONE WITH NEOMYCIN AND POLYMYXIN B SULFATE (Otosporin®)

  • Indication: Bacterial otitis externa

Otitis Externa: Astringent Preparation

Total list (T)

ACETIC ACID 2% pump spray

  • Acts as an antifungal and antibacterial in the external ear canal.
  • Available to purchase over-the-counter (OTC).

Otitis Externa: Antibacterial Preparation

Total list (T)

CIPROFLOXACIN 2mg/ml ear drops (Cetraxal®)

  • Indication: Treatment of acute otitis externa in patients with an intact tympanic membrane.

  • SMC restriction: when off-label or unlicensed ciprofloxacin formulations would otherwise be used. SMC advice no 1320/18 (April 2018)

Otitis Externa: Antifungal Preparation

Total list (T)

CLOTRIMAZOLE 1% solution

  • Indication: Fungal otitis externa and otomycoses

Otitis Media

Total list (T)

DEXAMETHASONE WITH CIPROFLOXACIN ear drops (Cilodex®)

Prescribing Notes:

  • Most uncomplicated cases resolve without antibacterial treatment and a simple analgesic, such as PARACETAMOL, may be sufficient.
  • Perforation of the tympanic membrane in patients with acute otitis media usually heals spontaneously without treatment; if there is no improvement, e.g. pain or discharge persists, systemic antibacterial can be given.
  • Topical treatment of acute otitis media is ineffective and there is no place for drops containing a local anaesthetic.
  • For systemic treatment please see the NHSL Antimicrobial Guidelines for Adult Primary Care- ACUTE OTITIS MEDIA.

Removal of Ear Wax

Preferred list (P)

OLIVE OIL ear drops

  • Softens ear wax

Total list (T)

SODIUM BICARBONATE 5% ear drops

  • May cause dryness of the ear canal

Prescribing Notes:

  • Ear wax (cerumen) is a normal bodily secretion which provides a protective film on the meatal skin and need only be removed if it causes hearing loss or interferes with a proper view of the ear drum.
  • The patient should lie with the affected ear uppermost for 5 to 10 minutes after a generous amount of the softening remedy has been introduced into the ear.
  • Allow ear drops to warm to room temperature before use.
  • If the wax is hard and impacted, drops can be used twice daily for several days and this may reduce the need for mechanical removal of the wax.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.