From the Guidelines
Cleaning with hydrogen peroxide is not recommended for acute otitis externa, as it can worsen the condition and potentially cause further irritation. According to the clinical practice guideline for acute otitis externa 1, the ear canal should be cleared of inflammatory debris, obstructing cerumen, or any foreign object, but this should be done gently and with caution. The guideline suggests that aural toilet may be performed by the clinician with a gentle lavage using body-temperature water or saline solution, but notes that there are no randomized studies to support the use of aural toilet in AOE.
Some key points to consider when managing acute otitis externa include:
- Avoiding the use of hydrogen peroxide, which can irritate the already inflamed ear canal tissue and disrupt the natural protective environment of the ear 1
- Keeping the ear dry and using prescribed antibiotic ear drops, such as ciprofloxacin/dexamethasone or ofloxacin, typically 3-4 drops in the affected ear twice daily for 7-10 days
- Avoiding inserting anything into the ear canal, including cotton swabs or earbuds, as these can push debris deeper and damage the ear canal
- Considering professional cleaning by a healthcare provider if there's significant debris blocking the ear canal, using atraumatic cleaning with aural suctioning under microscopic guidance, especially in patients with risk factors such as diabetes or immunocompromised state 1
It's also important to note that the condition is usually caused by moisture trapped in the ear creating an environment for bacterial or fungal growth, often exacerbated by scratching or inserting objects into the ear. Pain relief can be achieved with over-the-counter medications like acetaminophen or ibuprofen while the antibiotic drops take effect. Overall, the goal of treatment is to reduce morbidity, mortality, and improve quality of life by effectively managing the condition and preventing further complications.
From the FDA Drug Label
Carefully remove all cerumen and debris to allow Acetic Acid Otic Solution to contact infected surfaces directly.
- Cleaning is necessary to allow the medication to contact the infected surfaces directly.
- The use of hydrogen peroxide is not mentioned in the provided drug label, and therefore, it is unclear if it can cause acute otitis externa or if it is recommended for cleaning. The FDA drug label does not answer the question about the use of peroxide cleaning. 2
From the Research
Cleaning with Acute Otitis Externa
- Cleaning the ear canal is not necessarily recommended for acute otitis externa, as it may cause further irritation or injury to the ear canal 3, 4.
- In fact, the studies suggest that avoiding injury to the ear canal and keeping it free of water are key factors in preventing acute otitis externa 3.
- However, if cleaning is necessary, it should be done gently and with caution to avoid further irritating the ear canal.
Peroxide Cleaning and Acute Otitis Externa
- There is no direct evidence to suggest that peroxide cleaning can cause acute otitis externa 3, 4, 5, 6, 7.
- However, using peroxide or other harsh cleaning agents can potentially irritate the ear canal and increase the risk of infection 4.
- It is recommended to avoid using peroxide or other harsh cleaning agents in the ear canal, and instead use gentle cleaning methods and topical treatments as recommended by a healthcare professional 3, 4, 5.