What type of lidocaine (local anesthetic) can be used for otic (ear) purposes?

From the Guidelines

For otic purposes, 2% lidocaine solution can be used as ear drops, typically 2-3 drops in the affected ear as needed for pain relief, but only if the eardrum is intact. This is based on the guidelines for the use of local anesthesia in office-based dermatologic surgery 1. It's essential to note that lidocaine drops should not be used if you have a perforated eardrum, ear tubes, or drainage from the ear. Prescription lidocaine otic solutions like Auralgan (containing lidocaine and other ingredients) are specifically formulated for ear use. Over-the-counter alternatives include benzocaine-containing products like Aurodex. Lidocaine works by temporarily blocking nerve signals in the ear tissue, providing relief from pain. The numbing effect typically lasts 30-60 minutes. Before using any lidocaine product in your ear, it's crucial to consult with a healthcare provider to determine the cause of your ear pain and ensure that lidocaine is appropriate for your specific situation.

Some key points to consider when using lidocaine for otic purposes include:

• The maximum recommended dose of lidocaine with epinephrine is 7.0 mg/kg, and without epinephrine is 4.4 mg/kg 1.
• The duration of action of lidocaine is dependent on concentration, total dose, and site of administration, as well as the use of epinephrine and the patient's age 1.
• The addition of epinephrine to local infiltration anesthesia is safe and recommended for use on the ear, nose, hand, feet, and digits 1.
• Hyaluronidase may be used as an additive to local infiltration anesthesia to ease diffusion and reduce contour distortion, but there are insufficient data to support a recommendation for its routine use in dermatologic surgery 1.

It's essential to follow the guidelines and recommendations for the use of local anesthesia in office-based dermatologic surgery to ensure safe and effective use of lidocaine for otic purposes. Always consult with a healthcare provider before using any lidocaine product in your ear.

From the Research

Types of Lidocaine for Otic Purposes

• Lidocaine spray, also known as Xylocaine, can be used as a topical anesthetic for minor ear procedures, such as grommet insertion or intratympanic steroid injection 2
• The use of lidocaine spray has been shown to be effective in reducing pain during these procedures, with a median level of pain measured at 2 out of 10 on an 11-point visual analogue scale 2
• Lidocaine spray is simple to administer, rapid-acting, and well tolerated by patients, making it a suitable option for anesthesia of the tympanic membrane during minor ear procedures in the out-patient setting 2

Characteristics of Lidocaine

• Lidocaine is a commonly used local anesthetic that can cause systemic toxicities when plasma concentration is raised 3
• A hydroxyl derivative of lidocaine, called lido-OH, has been shown to produce a similar local anesthesia profile as lidocaine with reduced systemic toxicities 3
• The concentration of lidocaine, the formulation of the drug, and the individual patient can all have significant effects on serum levels of lidocaine 4

Comparison of Lidocaine Preparations

• Different lidocaine-containing topical anesthetics can have varying levels of absorption and effectiveness 4
• A study comparing five commonly-available lidocaine preparations found that the OTC preparations had the highest serum lidocaine and MEGX levels, with Topicaine having the greatest serum levels of individual lidocaine absorption 4