What are the uses of steroid (corticosteroid) ear drops?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 14, 2025 • View editorial policy

From the Guidelines

Steroid ear drops are a highly effective treatment for acute otitis externa and should be used for at least 7 days, even if symptoms improve sooner, to prevent relapse of infection. The most frequently prescribed steroid ear drops include dexamethasone, hydrocortisone, and fluticasone, often combined with antibiotics like ciprofloxacin or neomycin for infections 1. For typical otitis externa (swimmer's ear), apply 3-4 drops to the affected ear 3-4 times daily for 7-10 days. For more severe inflammation, treatment may extend to 14 days. Before application, clean the ear canal gently and lie with the affected ear upward for 2-3 minutes after instilling drops to ensure proper distribution. Pull the outer ear gently upward and backward (for adults) or downward and backward (for children) to straighten the ear canal.

Key Considerations

  • Steroid drops work by reducing inflammation, swelling, and itching by suppressing the local immune response.
  • They're particularly effective for conditions like allergic reactions, eczema of the ear canal, and certain types of otitis media.
  • Side effects are minimal but may include local irritation or, rarely, fungal infections with prolonged use.
  • Avoid using if the eardrum is perforated unless specifically prescribed for this condition.

Important Precautions

  • Inform your doctor if you had any prior ear surgery, if there is an opening (hole or perforation) of the eardrum, or if an ear tube is in place 1.
  • Let your doctor know if you have recently used other ear products or medications or if you have had a reaction in the past to a particular eardrop or antibiotic.
  • If you have, or are suspected to have, diabetes, this could alter management 1.

Pain Management

  • Pain medicine is especially important to use for relief in the first few days, until the eardrops begin working 2.
  • Discuss with your doctor which pain medicines are best for you.
  • Pain-relieving (anesthetic) eardrops are not recommended because they are not intended for use during an active ear canal infection and can mask symptoms of a delayed response to therapy 2.

From the FDA Drug Label

Ciprofloxacin and dexamethasone otic suspension is indicated for the treatment of infections caused by susceptible isolates of the designated microorganisms in the specific condition listed below: Acute Otitis Externa (AOE) in pediatric (age 6 months and older), adult and elderly patients due to Staphylococcus aureus and Pseudomonas aeruginosa. The recommended dosage regimen is as follows: Four drops [equivalent to 0. 14 mL of ciprofloxacin and dexamethasone otic suspension, (consisting of 0.42 mg ciprofloxacin and 0. 14 mg dexamethasone)] instilled into the affected ear twice daily for seven days.

The steroid ear drops contain dexamethasone, a corticosteroid, and are used to treat Acute Otitis Externa (AOE) in patients 6 months and older. The recommended dosage is four drops instilled into the affected ear twice daily for seven days 3, 4, 5.

  • Key points:
    • Indication: Acute Otitis Externa (AOE)
    • Dosage: Four drops twice daily for seven days
    • Age range: 6 months and older
    • Active ingredients: Ciprofloxacin and dexamethasone

From the Research

Steroid Ear Drops

  • Steroid ear drops are used to treat otitis externa, an inflammation of the outer ear and ear canal [ 6, 7, 8, 9 ].
  • The efficacy and safety of topical ciprofloxacin/dexamethasone versus neomycin/polymyxin B/hydrocortisone for otitis externa has been compared in a randomized, observer-masked, parallel-group, multicenter study [ 6 ].
  • The results showed that ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension administered twice daily is clinically and microbiologically superior to neomycin 0.35%/polymyxin B 10,000 IU/mL/hydrocortisone 1.0% otic suspension administered 3 times daily in the treatment of mild to severe AOE [ 6 ].

Comparison of Treatments

  • A randomized controlled trial compared the clinical efficacy of ear drops containing acetic acid, corticosteroid and acetic acid, and steroid and antibiotic in acute otitis externa in primary care [ 7 ].
  • The results showed that ear drops containing corticosteroids are more effective than acetic acid ear drops in the treatment of acute otitis externa in primary care [ 7 ].
  • Another study compared ciprofloxacin/dexamethasone with neomycin/polymyxin/hydrocortisone for otitis externa pain and found that ciprofloxacin 0.3%/dexamethasone 0.1% provided greater pain relief than neomycin 0.35%/polymyxin B 10,000 IU/mL/hydrocortisone 1.0% [ 9 ].

Mechanism of Action

  • The mechanism of action of steroid ear drops involves reducing inflammation and edema in the ear canal [ 6, 9 ].
  • A study on lipopolysaccharide-induced experimental otitis media found that topical ciprofloxacin/dexamethasone reduced middle ear effusion and mucosal thickness compared to control [ 10 ].

References

1
Guideline

clinical practice guideline: acute otitis externa executive summary.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2014

2
Guideline

clinical practice guideline: acute otitis externa.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2014

10
Research

Effect of ciprofloxacin/dexamethasone versus ciprofloxacin/hydrocortisone on lipopolysaccharide-induced experimental otitis media.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2011

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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