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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.
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.
For adults and teenagers: [2]
For children under 3: [3]
For children 3 and over: [3]
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 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:
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]
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.
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]
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]
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]
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]
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]
Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. The other main type is otitis media with effusion (OME), typically not associated with symptoms, although occasionally a feeling of fullness is described; it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.
Earwax, also known by the medical term cerumen, is a brown, orange, red, yellowish or gray waxy substance secreted in the ear canal of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, and provides protection against bacteria, fungi, and water.
Benzocaine, sold under the brand name Orajel amongst others, is an ester local anesthetic commonly used as a topical pain reliever or in cough drops. It is the active ingredient in many over-the-counter anesthetic ointments such as products for oral ulcers. It is also combined with antipyrine to form A/B otic drops to relieve ear pain and remove earwax. In the US, products containing benzocaine for oral application are contraindicated in children younger than two years old. In the European Union, the contraindication applies to children under 12 years of age.
An earplug is a device that is inserted in the ear canal to protect the user's ears from loud noises, intrusion of water, foreign bodies, dust or excessive wind. Since they reduce the sound volume, earplugs are often used to help prevent hearing loss and tinnitus.
Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). If a conductive hearing loss occurs in conjunction with a sensorineural hearing loss, it is referred to as a mixed hearing loss. Depending upon the severity and nature of the conductive loss, this type of hearing impairment can often be treated with surgical intervention or pharmaceuticals to partially or, in some cases, fully restore hearing acuity to within normal range. However, cases of permanent or chronic conductive hearing loss may require other treatment modalities such as hearing aid devices to improve detection of sound and speech perception.
The ear canal is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the pinna to the eardrum and is about 2.5 centimetres (1 in) in length and 0.7 centimetres (0.3 in) in diameter.
Ear pain, also known as earache or otalgia, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt.
Tympanostomy tube, also known as a grommet or myringotomy tube, is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The operation to insert the tube involves a myringotomy and is performed under local or general anesthesia. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. When it is necessary to keep the middle ear ventilated for a very long period, a "T"-shaped tube may be used, as these "T-tubes" can stay in place for 2–4 years. Materials used to construct the tube are most often plastics such as silicone or Teflon. Stainless steel tubes exist, but are no longer in frequent use.
Otitis is a general term for inflammation or infection, inner ear infection, middle ear infection of the ear, in both humans and other animals. When infection is present, it may be viral or bacterial. When inflammation is present due to fluid build up in the middle ear and infection is not present it is considered Otitis media with effusion. It is subdivided into the following:
Ear mites are mites that live in the ears of animals and humans. The most commonly seen species in veterinary medicine is Otodectes cynotis. This species, despite its name, is also responsible for 90% of ear mite infections in felines.
An otoscope or auriscope is a medical device which is used to look into the ears. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane or eardrum. Because the eardrum is the border separating the external ear canal from the middle ear, its characteristics can be indicative of various diseases of the middle ear space. The presence of earwax (cerumen), shed skin, pus, canal skin edema, foreign body, and various ear diseases can obscure any view of the eardrum and thus severely compromise the value of otoscopy done with a common otoscope, but confirm the presence of obstructing symptoms.
Ciprofloxacin/dexamethasone (Ciprodex) is an antibiotic/steroid combination medication. It contains the synthetic broad-spectrum antibacterial agent, ciprofloxacin hydrochloride (0.3%), combined with the anti-inflammatory corticosteroid, dexamethasone (0.1%), in a sterile, preserved suspension for otic use.
Otitis externa is an inflammation of the outer ear and ear canal. Animals are commonly prone to ear infection, and this is one of the most common manifestations of allergy in dogs. In dogs, those breeds with floppy ears are more prone, since air flow is limited and a warm, moist environment built up, which is conducive to infection. The external ear in animals is longer and deeper than in humans, which makes it easier for infection or wax to build up or be hard to remove. Complete ear canal inspection requires the use of an otoscope by a veterinarian.
Otomycosis is a fungal ear infection, a superficial mycotic infection of the outer ear canal. It is more common in tropical countries. The infection may be either subacute or acute and is characterized by malodorous discharge, inflammation, pruritus, scaling, and severe discomfort. The mycosis results in inflammation, superficial epithelial exfoliation, masses of debris containing hyphae, suppuration, and pain.
Neomycin/polymyxin B/hydrocortisone, sold under the brand Otosporin among others, is a medication used to treat otitis externa and certain eye disorders. It consists of the antibiotics neomycin and polymyxin B, and the steroid hydrocortisone. It is used as an ear drop or eye drop.
Ear instillation is the process of introducing otic medication or other liquids into the ear canal. Proper care is needed in delivering such liquids.
Otitis externa, also called swimmer's ear, is inflammation of the ear canal. It often presents with ear pain, swelling of the ear canal, and occasionally decreased hearing. Typically there is pain with movement of the outer ear. A high fever is typically not present except in severe cases.
Finafloxacin (Xtoro) is a fluoroquinolone antibiotic. In the United States, it is approved by the Food and Drug Administration to treat acute otitis externa caused by the bacteria Pseudomonas aeruginosa and Staphylococcus aureus.
A cerumenolytic is an ear wax (cerumen) softening agent. Common cerumenolytics such as hydrogen peroxide and hydrogen peroxide - urea are topical preparations used to facilitate the removal of ear wax. Their side effects tend to be mild, including ear discomfort, transient loss of hearing, dizziness, and local irritation.
Middle ear barotrauma (MEBT), also known to underwater divers as ear squeeze and reverse ear squeeze, is an injury caused by a difference in pressure between the external ear canal and the middle ear. It is common in underwater divers and usually occurs when the diver does not equalise sufficiently during descent or, less commonly, on ascent. Failure to equalise may be due to inexperience or eustachian tube dysfunction, which can have many possible causes. Unequalised ambient pressure increase during descent causes a pressure imbalance between the middle ear air space and the external auiditory canal over the eardrum, referred to by divers as ear squeeze, causing inward stretching, serous effusion and haemorrhage, and eventual rupture. During ascent internal over-pressure is normally passively released through the eustachian tube, but if this does not happen the volume expansion of middle ear gas will cause outward bulging, stretching and eventual rupture of the eardrum known to divers as reverse ear squeeze. This damage causes local pain and hearing loss. Tympanic rupture during a dive can allow water into the middle ear, which can cause severe vertigo from caloric stimulation. This may cause nausea and vomiting underwater, which has a high risk of aspiration of vomit or water, with possible fatal consequences.
