Prednisone Ear Drops: Availability and Clinical Use
Prednisone ear drops are not commercially available as a standalone formulation; prednisolone (not prednisone) is the corticosteroid used in topical otic preparations, and it is always combined with antimicrobials—never used alone for ear infections. 1, 2
What Is Actually Available
Prednisolone-containing combination drops are FDA-approved and widely used for treating ear inflammation, specifically in products that combine prednisolone acetate with antibiotics (such as polymyxin B and/or miconazole) 2
Hydrocortisone-containing preparations are the most commonly recommended corticosteroid component in combination antibiotic-corticosteroid drops for acute otitis externa, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
Prednisone itself is not formulated as ear drops because it requires hepatic conversion to prednisolone to become active, making prednisolone the preferred topical corticosteroid 2
When Corticosteroid Ear Drops Are Indicated
For Acute Otitis Externa (Swimmer's Ear):
The American Academy of Otolaryngology-Head and Neck Surgery establishes that topical antimicrobial therapy with steroids is first-line treatment for acute otitis externa 1
Combination antibiotic/steroid drops achieve clinical cure in approximately 74% of patients within 7 days, with symptoms typically improving within 48-72 hours 1
Administer 3-5 drops twice daily with the patient lying on their side with the affected ear up for 3-5 minutes, continuing for a minimum of 7 days 1
For Ventilation Tube-Associated Ear Discharge:
Ear drops containing a combination of antibiotics and corticosteroids are the most clinically effective and cost-effective management strategy for children developing acute ear discharge through tympanostomy tubes 3
Evidence shows that antibiotic-corticosteroid combinations are superior to antibiotics alone for this indication 3
For Intratympanic Injection (Not Drops):
Dexamethasone or methylprednisolone can be injected intratympanically for sudden sensorineural hearing loss, using concentrations of 24 mg/mL, 16 mg/mL, or 10 mg/mL for dexamethasone, or 40 mg/mL or 30 mg/mL for methylprednisolone 3
This requires anterosuperior myringotomy after topical anesthetic and is not the same as using ear drops 3
Critical Pitfall to Avoid
Never use prednisolone-only drops without antimicrobial coverage for acute bacterial otitis externa, as 98% of cases are bacterial 1. The anti-inflammatory effect of corticosteroids must be paired with antimicrobial activity to treat the underlying infection while reducing inflammation, swelling, and pain 1, 4.
Role of Oral Corticosteroids
Oral prednisone (not ear drops) at 1 mg/kg/day (usual maximum 60 mg daily) for 10-14 days is used for sudden sensorineural hearing loss, ideally within the first 14 days of onset 3
Oral prednisolone as adjuvant therapy can reduce the duration of otorrhea in acute otitis media with discharge through tympanostomy tubes from 3 days to 1 day when combined with antibiotics 5
A short course of oral corticosteroids is being studied for persistent otitis media with effusion in children, but this remains investigational 3