From the Guidelines
When the tympanic membrane cannot be visualized in cases of otitis externa, the recommended ear drops are non-ototoxic preparations such as acetic acid solutions (like VoSol), ciprofloxacin (Ciprodex), or ofloxacin (Floxin Otic). These are preferred because they are safe even if the tympanic membrane is perforated, as noted in the clinical practice guidelines 1. A typical regimen involves:
- Cleaning the ear canal gently
- Instilling 3-4 drops of the medication into the affected ear 2-4 times daily for 7-10 days For severe cases, a wick may be placed to facilitate medication delivery. It's essential to avoid potentially ototoxic preparations containing aminoglycosides (like neomycin) when TM status is unknown, as these could cause hearing damage if a perforation exists, as warned against in 1. Patients should:
- Keep the ear dry during treatment
- Avoid inserting objects into the ear
- Complete the full course of medication even if symptoms improve quickly This approach balances effective treatment of the infection while protecting against potential inner ear damage that could occur if ototoxic medications were to enter the middle ear through an undetected perforation. Key considerations for management include:
- The status of the eardrum, if known
- Patient history of ear surgery or presence of an ear tube
- Potential allergies or reactions to specific medications
- The need to prevent water entry into the ear canal during treatment, as advised in 1 and 1. By following these guidelines and considering the individual patient's circumstances, clinicians can provide effective and safe treatment for otitis externa, even when the tympanic membrane cannot be visualized.
From the Research
Recommended Ear Drops for Otitis Externa
When the tympanic membrane (TM) cannot be visualized, the choice of ear drops for otitis externa is crucial. The following options are recommended:
- Ofloxacin otic solution 0.3%: This fluoroquinolone antibacterial agent has been shown to be effective in the treatment of otitis externa, with clinical cure rates of over 80% in adults and over 95% in children 2, 3.
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone: This treatment is effective in most cases of otitis externa and can be used as a prophylactic measure after exposure to moisture 4.
- Topical antiseptics or steroids: These agents have been shown to be effective in the management of acute otitis externa, with no significant differences in cure rates compared to topical antibiotics 5.
Considerations
When choosing ear drops for otitis externa, it is essential to consider the potential for ototoxicity and the effectiveness of the treatment. Ofloxacin otic solution 0.3% has been shown to be non-ototoxic and effective in the treatment of otitis externa 2, 3. Topical antiseptics or steroids may also be effective options, but more research is needed to determine their relative effectiveness compared to topical antibiotics 5.
Key Findings
- Ofloxacin otic solution 0.3% is effective in the treatment of otitis externa, with clinical cure rates of over 80% in adults and over 95% in children 2, 3.
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone is effective in most cases of otitis externa 4.
- Topical antiseptics or steroids are effective in the management of acute otitis externa, with no significant differences in cure rates compared to topical antibiotics 5.