Ear drop

Ear drops are a form of topical medication for the ears used to treat infection, inflammation, impacted ear wax and local anesthesia. They are commonly used for short-term treatment and can be purchased with or without a prescription. Before using ear drops, refer to the package insert or consult a health professional for the amount of drops to use and the duration of treatment.

Antibiotic ear drop

Administration and usage

Prior to using the medication, refer to package label for specific instructions or ask a local pharmacist. Check to make sure a tamper-evident seal is intact and the medication is not expired. Let a health care provider know of any drug allergies to any medications or other ingredients in the medication. Let a healthcare provider know what was prescribed and what over the counter medications, vitamins, supplements, and herbal supplements are being taken with this medication. If pregnant, planning to become pregnant, or breastfeeding, make sure to inform a healthcare before using any medications.[1]

Always wash hands with soap and water for 30 seconds prior to administering ear drops and after administering.

Person administering ear drops

For adults and teenagers:[2]

  1. Place a clean folded towel on a stable counter top.
  2. Warm the medication if necessary by rolling the medication bottle between the palms.
  3. Lay the head on the towel with infected ear facing up.
  4. To straighten the ear canal, gently pull the upper ear back and up.
  5. Gently shake the medication if instructed. Administer the medication into infected ear.
  6. Gently push the tragus (ear flap) to help move the medication deeper into ear canal.
  7. Keep the head down for at least one minute.
  8. Repeat with other ear if necessary.

For children under 3:[3]

  1. Follow the steps for adults and teenagers, however, in step 4, gently pull the earlobe back and down to straighten the ear canal.

For children 3 and over:[3]

  1. Follow the steps for adults and teenagers.

Eye drops can generally be used safely in the ears, but ear drops should never be used in the eyes.[4] Prescribers must specifically indicate the use of eye drops for ear drops on the prescription; do not make this substitution without consulting a medical provider.

Side effects

Side effects from using ear drops used to remove ear wax are uncommon, but may result in discomfort, irritation, or pain.[5] Antibiotic ear drops may cause ear discomfort, pain, or itching.[1] When cold ear drops are used, it may cause brief but severe dizziness and/or vertigo.[6]

Seek medical attention immediately if any of the following symptoms occur:

  • Hives
  • Difficulty breathing
  • Swelling of the face, lips, tongue, or throat
  • Severe burning or other irritation after using the ear drops
  • Loss of hearing
  • Skin rash, redness, swelling, itching, dryness, scaling, or other irritation in or around the ear.[1]

Precautions
  • Ear drops should not be shared to prevent the spread of infection.[7]
  • Ear drops should not be used after the expiration date.[7]
  • Ear drops should only be used in the affected ear.
  • Ear drops are usually used for a short duration of time. Make sure to only use it as prescribed.[7]
  • Cotton buds should not be used to clean the inside of the ear since this can cause inflammation and make things worse.[7]
  • Ear drops should not be used for a ruptured eardrum (a hole or tear in the eardrum), unless instructed by a medical provider.[8]

Missed dose

If a dose is missed, do not double up at the next administration to catch up and the dose can be administered when recalled. Additionally if it is close to the next dose, skip that missed dose and resume as normal.[9]

Shelf life

Although ear drops typically contain preservatives that slow the growth of bacteria and other microorganisms, this does not offer long term protection from contamination. The shelf life of ear drops varies with products generally needing to be discarded within 4 weeks after opening.[10][11] With proper use and storage, ear drops should remain effective and safe until the expiration date printed in the medication package insert.

Uses and common types of ear drops

Break up earwax

Ear wax, also known as cerumen, protects the ear from dust, bacteria, and small objects from entering and damaging the ear. It also provides a coating to protect the skin inside the ear canal from irritation from water during showers and water activities.[6]

However, some individuals have more active glands which can produce more ear wax. That can lead to a build up and block the ear canal causing hearing loss, noises in the ear, sensation of ear is plugged and full, and earache.[6] The excess ear wax may also harden causing an impaction and discomfort. Healthcare providers recommend against reaching into the ears to clean it because the ear wax may be pushed even deeper into the ear canal.[6]

Drops to safely break up earwax are available over-the-counter and are labeled 'otic' drops.[12] Products in this category contain carbamide peroxide, which dissolves some of the earwax. Some common brands include Auro and Debrox. When carbamide peroxide ear drops are applied to the ear canal, there may hear some fizzing as a result of the reaction with the earwax. Drops should be used according to the package instructions (typically recommended maximum of 4 days) or as directed by a healthcare provider. If the blockage has worsened or not improved, consult a doctor.[13]

Another method to break up earwax is by using body temperature water. While having the head upright, straighten the ear canal by gently pulling the upper outer ear back and up. Then use a syringe (do not use jet irrigator that is designed for teeth cleaning)[6] to aim a small gently stream of water at the ear canal wall next to the ear wax to be removed. Next, tilt the head to allow water to drain and repeat if necessary. After removing the ear wax, allow the ear to dry thoroughly. Adding a few drops of alcohol in the ear may help to dry the ear.[6]

Person with otitis externa

Do not use irrigation or ear drops if there is a hole in the ear drum or had recent ear surgery to prevent damage or infection in the ears.[6]

Prevent or treat otitis externa

Otitis externa, also known as swimmer's ear, is an inflammation (infectious or non-infectious) of the external auditory canal.[14] Risk factors include retained water in the outer ear, particularly due to swimming, humidity, trauma or external devices, dermatologic conditions, or scratching the ear canal that may lead to bacterial growth.[14][15]

Otitis externa can generally be prevented by keeping the ear canal dry and/or applying ear drops labeled for swimmer's ear (typically a dilution of isopropyl and glycerin) after exposure to water to assist with keeping the ear canal dry.[16]

Treatment of otitis externa is centered around antibiotic ear drops and pain control (e.g. acetaminophen, non-steroidal anti-inflammatory drugs, and opioids including oxycodone or hydrocodone). Antibiotic ear drops are generally safe and well-tolerated. Some studies have demonstrated that the addition of topical steroids to antibiotic ear drops provides quicker pain relief, but these results are conflicting.[17] Symptoms of uncomplicated otitis externa typically improve within 48 hours of initiating antibiotics. If pain does not improve within 48 to 72 hours of antibiotic therapy, individuals should consult their provider to confirm the diagnosis.[17] Common antibiotic ear drops for treating otitis externa include:[14]

  • Polymyxin B, neomycin and hydrocortisone; apply 3-4 drops to the affected ear 4 times daily
  • Ofloxacin; apply 5 drops to the affected ear twice daily
  • Ciprofloxacin with hydrocortisone; apply 3 drops to the affected ear twice daily

Antibiotics to treat bacterial infections

Bacterial ear infections are treated with antibiotics; local administration is preferred over systemic delivery due to increased antibiotic concentration and lack of systemic side effects.[18] Antibiotic ear drops are much faster at killing the bacteria.[19] Ear drops work faster since the medication directly goes to the site of infection whereas oral antibiotics enter the bloodstream first.[19] Some commonly used antibiotics include:

Antibiotics for ear infections are prescribed for infections that are recurrent or difficult for the body to clear. Antibiotic ear drops should be used as prescribed. Do not stop the use of medication even if the infection appears cleared because remaining bacteria can cause the infection to return.[23]

Analgesic and anesthetics to help relieve ear pain

Otic analgestic-anesthetic are drops that can help alleviate swelling, pain and congestion caused by middle ear inflammation. However, these ear drops do not treat the infections because they do not contain any antibiotic properties.[24] A common over-the-counter product sold as Auralgan contained antipyrine (analgesic) and benzocaine (anesthetic). It was prescribed alone or with an antibiotic ear drop to help manage an ear infection. However, Auralgran was reformulated without meeting the FDA requirements to be reapproved and was removed from the market in July 2, 2015.[25]

There is some literature to suggest that anesthetic ear drops helped with acute pain. This study was conducted in Australia in 2008 in a hospital emergency room. It included 63 children who were between the ages of 3 and 17 who presented to the emergency department reporting of ear pain. Children were randomized such that 32 received placebo and 31 children received topical lignocaine prior to being offered an oral pain medication. The study showed that a topical pain medication was helpful while waiting for the an oral pain medication to be effective.[26] There is another small study conducted in England and Wales that reported that an analgestic-anesthetics could reduce the amount of antibiotics being used in children. While the study did show evidence of less antibiotic use, it did not meet the sample size goal of 96 participants. Additionally did not evaluate if pain relief was linked to reduced antibiotic use.[27]

References
  1. "Ciprofloxacin Otic: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2022-07-28.
  2. "How to Use Ear Drops" (PDF). Safe Medication. American Society of Health-System Pharmacists. 2021.
  3. "How to Give Ear Drops to a Child". HealthyChildren.org. Retrieved 2022-07-28.
  4. "Drug Shortage Detail: Ofloxacin Otic Solution". www.ashp.org. Retrieved 2022-07-28.
  5. Aaron K, Cooper TE, Warner L, Burton MJ (July 2018). "Ear drops for the removal of ear wax". The Cochrane Database of Systematic Reviews. 7 (7): CD012171. doi:10.1002/14651858.CD012171.pub2. PMC 6492540. PMID 30043448.
  6. "Ear wax: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2022-08-01.
  7. Zealand (www.bka.co.nz), Site designed and developed by bka interactive ltd, Auckland, New. "Ear drops". Health Navigator New Zealand. Retrieved 2022-08-01.
  8. "Ruptured eardrum (perforated eardrum) - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-08-01.
  9. "SingleCare- Ear Drops Overview". SingleCare- Ear Drops Overview. August 1, 2022. Retrieved August 1, 2022.
  10. "Otex Ear Drops Urea Hydrogen Peroxide 5% w/w Package Leaflet" (PDF).
  11. "Chloramphenicol 10% w/v Ear Drops Package Leaflet" (PDF).
  12. "Earwax Removal: How to Safely Remove It At Home". Cleveland Clinic. 2021-11-29. Retrieved 2022-07-25.
  13. "Carbamide Peroxide ear solution". Cleveland Clinic. Retrieved 2022-07-29.
  14. Medina-Blasini Y, Sharman T (2022). "Otitis Externa". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32310515. Retrieved 2022-08-01.
  15. "Swimmer's ear - Symptoms and causes". Mayo Clinic. Retrieved 2022-07-26.
  16. "Swimmer's ear : MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2022-07-28.
  17. Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, et al. (February 2014). "Clinical practice guideline: acute otitis externa". Otolaryngology–Head and Neck Surgery. 150 (1 Suppl): S1–S24. doi:10.1177/0194599813517083. PMID 24491310. S2CID 40005605.
  18. McWilliams CJ, Smith CH, Goldman RD (November 2012). "Acute otitis externa in children". Canadian Family Physician. 58 (11): 1222–1224. PMC 3498014. PMID 23152458.
  19. "Oral Antibiotics for Ear Infections | Choosing Wisely". www.choosingwisely.org. 2013-10-01. Retrieved 2022-08-01.
  20. "Ciprofloxacin And Dexamethasone (Otic Route) Side Effects - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-08-01.
  21. "Kenacomb Otic". NPS MedicineWise. Retrieved 2022-08-04.
  22. "Sofradex Ear/Eye Drops - Patient Information Leaflet (PIL) - (emc)". www.medicines.org.uk. Retrieved 2022-08-01.
  23. "Ear Infection (Otitis Media): Symptoms, Causes, Prevention & Treatment". Cleveland Clinic. Retrieved 2022-07-28.
  24. "Antipyrine-Benzocaine Otic: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2022-07-26.
  25. "Regulations.gov". www.regulations.gov. Retrieved 2022-08-01.
  26. Bolt P, Barnett P, Babl FE, Sharwood LN (January 2008). "Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial". Archives of Disease in Childhood. 93 (1): 40–44. doi:10.1136/adc.2006.110429. PMID 18156478. S2CID 1495097.
  27. Hay AD, Downing H, Francis NA, Young GJ, Clement C, Harris SD, et al. (July 2019). "Anaesthetic-analgesic ear drops to reduce antibiotic consumption in children with acute otitis media: the CEDAR RCT". Health Technology Assessment. 23 (34): 1–48. doi:10.3310/hta23340. PMC 6661537. PMID 31304912.
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