12.1.1 / 2 Otitis Externa and Otitis Media


Choices:  BETAMETHASONE SODIUM PHOSPHATE 
                BETNESOL-N® 
                GENTISONE-HC® 
                CLOTRIMAZOLE
 

Betamethasone sodium phosphate (0.1% ear/eye/nose drops) is recommended for inflammatory conditions of the ear.  It should not be used when the inflammation is thought to be secondary to an infection, avoid prolonged use.

*Betnesol-N® (ear/eye/nose drops containing betamethasone sodium phosphate 0.1%, neomycin sulphate 0.5%) is an alternative preparation for use in otitis externa if an infection is present, avoid prolonged use.

Gentisone HC® (ear drops containing gentamicin 0.3%, hydrocortisone acetate 1%) is used in otitis externa, chronic suppurative otitis media, and pre- and post- surgery to the ear.  It is active against Gram-positive and Gram-negative bacteria, including Pseudomonas.  Avoid prolonged use.

Clotrimazole (solution) is recommended for fungal infections of the outer and middle ear.  Occasionally, patients may experience mild burning or irritation after applying the solution.

SPECIAL INDICATIONS

*Sofradex® (ear/eye drops containing dexamethasone, framycetin sulphate, gramicidin) is for use in otitis externa, avoid prolonged use.

Otocomb Otic® ointment [unlicensed product] is available for restricted hospital use for the topical treatment of otitis externa.  Use is restricted to prescribing in hospital by Ear, Nose and Throat specialists for the treatment of otitis oxterna.  To be administered by impregnating ribbon gauze prior to insertion into the auditory canal.

* The CSM states that treatment of otitis externa with a topical aminoglycoside antibiotic is contra-indicated in those with a perforated ear drum in order to avoid the risk of ototoxicity.  However, many specialists do use these drops with great caution in patients with a perforation.  Local sensitivity may occur with the use of topical aminoglycosides.

PRESCRIBING POINTS FOR INFLAMMATORY CONDITIONS OF THE EAR

  • It is recommended that thorough aural toilet be performed before commencing treatment for otitis externa.
  • When otitis externa is treated topically with preparations containing chlorhexidine, it is important to ensure that the eardrum is not perforated in order to avoid the risk of ototoxicity.
  • Ear drops containing local anaesthetics or mild analgesics should not be used for relieving pain in acute otitis media.  A simple oral analgesic should be used.
  • Severe attacks of otitis media of bacterial origin should be treated with systemic antibiotics (see Chapter 5).  There is no benefit in using antibiotic ear drops unless the eardrum has been perforated.  If there is perforation and the patient has not responded to systemic treatment, specialists may recommend cautious use of antibiotic ear drops if it is considered that the pus in the middle ear carries a higher risk of ototoxicity than the drops themselves.
  • Prolonged use of antibiotic/steroid combination drops may result in fungal overgrowth.

PAEDIATRIC NOTES - DRUGS ACTING ON THE EAR

All the products listed above are licensed for use in children.
Otosporin® ear drops may be useful for treating resistant infections and is less irritant to children as it has a water-based formulation.  Acute otitis media is the commonest cause of severe ear pain in children; many infections are viral especially those accompanying coryza and should only be treated with paracetamol.  In acute bacterial otitis media additional treatment with a systemic antibiotic is required (see Chapter 5).