From the Guidelines
For chronic otalgia, the best ear drops depend on the underlying cause, and prescription antibiotic drops like Ciprodex (ciprofloxacin/dexamethasone) or Cortisporin (neomycin/polymyxin B/hydrocortisone) are typically most effective for infection-related pain. The choice of ear drops should be guided by the specific cause of the pain, as improper treatment could worsen certain conditions like a perforated eardrum 1.
Some key considerations for managing chronic otalgia include:
- Identifying the underlying cause of the pain, such as infection, inflammation, or excessive earwax
- Selecting the most effective ear drops for the specific cause, such as antibiotic drops for infection or steroid drops for inflammation
- Using ear drops as directed, typically 3-4 times daily for 7-10 days for prescription options, and 1-2 drops twice daily for 3-4 days for over-the-counter options
- Avoiding the use of topical anesthetic drops, as they may mask progression of underlying disease while pain is being suppressed 1
It's also important to note that ear pain can stem from various causes, including infections, inflammation, pressure changes, or referred pain from nearby structures, so targeted treatment addressing the specific cause is essential for effective relief. Additionally, patients with risk factors such as diabetes or immunocompromised state may require special consideration and atraumatic cleaning with aural suctioning under microscopic guidance 1.
In terms of specific ear drop options, some commonly used prescription drops include:
- Ciprodex (ciprofloxacin/dexamethasone) for infection-related pain
- Cortisporin (neomycin/polymyxin B/hydrocortisone) for infection-related pain
- Sofradex (framycetin/gramicidin/dexamethasone) for pain associated with inflammation
- Over-the-counter options like Debrox (carbamide peroxide) or Cerumenex (triethanolamine polypeptide) for excessive earwax
- Analgesic drops containing benzocaine like Auralgan for general pain relief without infection.
From the Research
Ear Drops for Chronic Otalgia
- The choice of ear drops for chronic otalgia depends on the condition of the eardrum, microbial pathogens present, and the efficacy of the components of the ear drop 2.
- In case of an open eardrum, aluminium acetotartrate 1.2% and a combination preparation of bacitracin-colistin-hydrocortisone are recommended as the first choice for local application of antiseptics 2.
- For a closed eardrum (external otitis), aluminium acetotartrate 12% is advised, and combination preparations with corticosteroids are not recommended in these cases 2.
- Topical antibiotics, such as ciprofloxacin, may be effective in resolving ear discharge in patients with chronic suppurative otitis media (CSOM) when compared to placebo or no treatment 3.
- However, the certainty of evidence for the effectiveness of topical antibiotics in improving resolution of ear discharge is limited due to the low quality of available evidence 3.
Considerations for Ear Drop Selection
- Ototoxicity, contact allergy, and the development of bacterial resistance should be taken into account when selecting ear drops 2.
- Aminoglycoside-containing ear drops may have a higher risk of ototoxicity and contact allergy 2.
- The use of fluoroquinolones, such as ciprofloxacin, should be considered as reserve medication only due to the risk of developing resistant strains 2.
Alternative Treatments
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation may be an effective treatment for otitis externa 4.
- Thorough cleansing of the canal is essential for diagnosis and treatment, but flushing should be avoided 4.
- Prophylactic measures, such as drying the ears with a hair dryer and avoiding manipulation of the external auditory canal, may help prevent recurrence of otitis externa 4.