Is dexamethasone available in an otic (ear) formulation?

Dexamethasone Availability in Otic Formulation

Yes, dexamethasone is available in otic (ear) formulations, most commonly as a combination product with antibiotics such as ciprofloxacin in the form of ear drops. 1

Available Formulations

Dexamethasone is available in several otic preparations:

• Ciprofloxacin 0.3% and Dexamethasone 0.1% Otic Suspension - FDA-approved combination product for ear infections 1
• Dexamethasone alone - Used for intratympanic injections at various concentrations:
  • 4 mg/mL (stock solution)
  • 10 mg/mL (stock solution)
  • 16 mg/mL (compounded)
  • 24 mg/mL (compounded) 2

Clinical Applications

Dexamethasone otic formulations are used in several ear conditions:

1. Sudden Sensorineural Hearing Loss (SSNHL)

• Used as intratympanic injections when systemic steroids are contraindicated or as salvage therapy
• Dosing: 0.4-0.8 mL injected into middle ear space, administered as 3-4 injections over 2 weeks 2, 3
• Higher concentrations (24 mg/mL) show better outcomes than lower concentrations (10 mg/mL) 2

2. Ménière's Disease

• Intratympanic steroid therapy can provide vertigo control in 31-90% of patients
• Less risk of treatment-associated hearing loss compared to gentamicin (0-8% vs 12.5-15.4%) 2

3. Ear Infections

• Combination with antibiotics (e.g., ciprofloxacin/dexamethasone 0.3%/0.1%) for:
  • Acute otitis externa
  • Otorrhea in patients with tympanostomy tubes 1, 4

Administration Techniques

For intratympanic administration:

1. Patient positioned with affected ear up
2. Injection through anterosuperior myringotomy after topical anesthetic
3. Patient remains in position for 15-30 minutes after injection
4. For multiple injections, a pressure-equalizing tube may be inserted 2, 3

For otic drops (e.g., ciprofloxacin/dexamethasone):

1. Warm bottle by rolling between hands for 1-2 minutes
2. Shake well before use
3. Administer 4 drops into affected ear(s)
4. Patient should remain with affected ear facing upward for 1 minute 1

Benefits of Dexamethasone in Otic Preparations

1. Anti-inflammatory effects - Reduces swelling, pain, and inflammation in ear conditions 5
2. Improved outcomes - Addition of dexamethasone to antibiotic ear drops:
   • Decreases granulation tissue
   • Improves clinical cure rates
   • Achieves greater bacterial eradication compared to antibiotics alone 6
3. Faster symptom resolution - Studies show quicker cessation of otorrhea with ciprofloxacin/dexamethasone compared to oral antibiotics 7

Precautions and Considerations

• For otic use only - not for injection or ophthalmic use 1
• Avoid contamination of the tip with material from the ear or fingers 1
• Store at room temperature (20-25°C/68-77°F) 1
• Protect from light and avoid freezing 1
• Discard unused portion after therapy is completed 1

Potential Side Effects

• Ear discomfort or pain
• Ear itching (pruritus)
• Transient dizziness
• Infection
• Persistent tympanic membrane perforation
• Possible vasovagal or syncopal episode during injection 2, 1

For patients who cannot receive systemic corticosteroids due to conditions like diabetes, hypertension, glaucoma, tuberculosis, or peptic ulcer disease, intratympanic dexamethasone provides an effective alternative treatment option with minimal systemic effects 2, 3.