Can I use lidocaine (local anesthetic) drops with an ear tube (tympanostomy tube)?

Can You Use Lidocaine Drops with Ear Tubes?

No, you should not use lidocaine drops when tympanostomy tubes are present in the ear. The FDA explicitly contraindicates lidocaine otic drops in patients with tubes in the ear 1.

FDA Contraindication

• The FDA drug label for lidocaine (otic) specifically states: "do not use...if you have an injury or perforation (hole) of the eardrum or tubes in the ear" 1.
• This is an absolute contraindication that supersedes any potential analgesic benefit 1.

Recommended Treatment for Ear Pain with Tubes

For Ear Infections with Tubes (Tympanostomy Tube Otorrhea)

• Use topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) as first-line treatment for uncomplicated acute ear infections with tubes 2.
• These quinolone drops are specifically approved for use with tympanostomy tubes and achieve clinical cure rates of 77-96% 2.
• Administer twice daily for up to 10 days 2.

For Pain Management

• Use oral acetaminophen or ibuprofen to manage fever and discomfort in children with ear infections and tympanostomy tubes 2.
• Oral analgesics provide effective pain relief without the contraindication associated with lidocaine drops 2.

Important Clinical Context

• The contraindication exists because lidocaine drops can enter the middle ear space through the tube, potentially causing ototoxicity or systemic absorption 1.
• Only topical antibiotics specifically approved for use with tympanostomy tubes should be used to avoid ototoxicity 3.
• Aminoglycoside-containing eardrops (often used for otitis externa) should also be avoided with tubes due to ototoxicity risk 3.

Common Pitfall to Avoid

• Do not confuse the use of lidocaine drops for acute otitis media (without tubes) with their use in patients who have tympanostomy tubes 1, 4.
• While lidocaine drops may be studied for pain relief in intact eardrums with acute otitis media, this does not apply to patients with tubes 4.