From the Guidelines
The recommended treatment for inflammatory ear conditions using otic steroids typically involves corticosteroid ear drops applied directly to the affected ear, with common medications including fluticasone propionate, dexamethasone, hydrocortisone, and betamethasone, usually administered as 2-4 drops in the affected ear 3-4 times daily for 7-10 days 1.
Key Considerations
- For optimal administration, the patient should lie with the affected ear facing upward, pull the outer ear gently upward and backward (for adults) or downward and backward (for children), and maintain this position for 1-2 minutes after application to ensure proper distribution.
- A cotton ball may be placed loosely in the ear canal to prevent medication from draining out.
- These steroids work by reducing inflammation, swelling, and associated symptoms like itching and pain by suppressing the inflammatory response and inhibiting the release of inflammatory mediators.
- They are particularly effective for conditions like allergic otitis externa, eczematous ear conditions, and mild to moderate cases of swimmer's ear.
Important Notes
- If the eardrum is perforated or if there are signs of infection, antibiotic-steroid combination drops may be more appropriate.
- Treatment should be completed for the full prescribed duration even if symptoms improve earlier to prevent recurrence.
- Patients should avoid scratching or touching the ear and not insert anything into the ear canal, including cotton-tipped swabs, to minimize the risk of further irritation or infection 1.
- It is essential to follow up with a healthcare provider if symptoms persist or worsen, as this could indicate a need for alternative treatment or further evaluation 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Carefully remove all cerumen and debris to allow hydrocortisone 1% and acetic acid 2% otic solution to contact infected surfaces directly. To promote continuous contact, insert a wick of cotton saturated with the solution into the ear canal; the wick may also be saturated after insertion. Instruct the patient to keep the wick in for at least 24 hours and to keep it moist by adding 3 to 5 drops of the solution every 4 to 6 hours. The wick may be removed after 24 hours but the patient should continue to instill 5 drops 3 or 4 times daily thereafter, for as long as indicated. In pediatric patients, 3 to 4 drops may be sufficient due to the smaller capacity of the ear canal. INDICATIONS AND USAGE For the treatment of superficial infections of the external auditory canal caused by organisms susceptible to the action of the antimicrobial, complicated by inflammation.
The recommended treatment for inflammatory ear conditions using otic steroids is to apply hydrocortisone 1% and acetic acid 2% otic solution directly to the infected surface, using a cotton wick to promote continuous contact. The patient should keep the wick in for at least 24 hours and keep it moist by adding 3 to 5 drops of the solution every 4 to 6 hours. After 24 hours, the wick may be removed, and the patient should continue to instill 5 drops 3 or 4 times daily thereafter, for as long as indicated 2. This treatment is indicated for superficial infections of the external auditory canal complicated by inflammation 2.
- Key points:
- Use hydrocortisone 1% and acetic acid 2% otic solution
- Insert a cotton wick into the ear canal
- Keep the wick in for at least 24 hours
- Instill 5 drops 3 or 4 times daily after removing the wick
- Important considerations:
- Remove all cerumen and debris before applying the solution
- Keep the wick moist by adding 3 to 5 drops of the solution every 4 to 6 hours
- Pediatric patients may require fewer drops due to the smaller capacity of the ear canal 2
From the Research
Otic Steroids for Inflammatory Ear Conditions
- Otic steroids are used to treat inflammatory ear conditions, such as otitis media with effusion (OME) and idiopathic sudden sensorineural hearing loss (ISSNHL) 3, 4, 5, 6, 7.
- The effectiveness of otic steroids in treating these conditions is still being researched, with some studies showing promising results and others indicating limited benefits 3, 4, 5.
Types of Otic Steroids
- Different types of otic steroids are being used, including dexamethasone phosphate, triamcinolone acetonide, and prednisolone 6, 7.
- Triamcinolone acetonide has been suggested to have superior molecular properties for intratympanic application 7.
- Dexamethasone phosphate and triamcinolone acetonide have been shown to be equivalent in terms of improving hearing function in patients with ISSNHL 6.
Administration Methods
- Otic steroids can be administered through different methods, including oral, topical, and intratympanic injection 3, 4, 5, 6, 7.
- Intratympanic injection is increasingly being used, often as a salvage treatment for patients with ISSNHL 7.
- The choice of administration method may depend on the specific condition being treated and the patient's individual needs 3, 4, 5, 6, 7.
Efficacy and Safety
- The efficacy and safety of otic steroids in treating inflammatory ear conditions are still being researched, with some studies indicating promising results and others raising concerns about potential side effects 3, 4, 5, 6, 7.
- Triamcinolone acetonide has been shown to be a safe and efficacious alternative for intratympanic treatment in idiopathic sensorineural hearing loss 7.
- Further research is needed to fully understand the benefits and risks of otic steroids in treating inflammatory ear conditions 3, 4, 5, 6, 7.