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12.1 Ear

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety

 

 

Anti-inflammatory preparations

Betamethasone

  • Eye/Ear/Nose drops: Betamethasone sodium phosphate 0.1%        

Prednisolone

  • Ear/Eye drops: Prednisolone Sodium phosphate 0.5%

Notes:

  • Prolonged use of topical corticosteroids should be avoided.

 

 

 

Anti-infective preparations       

Clotrimazole

  • Solution 1% 

Gentamicin (Amber 2)

  • Ear drop 0.3%        

 

 

Anti-infective plus anti-inflammatory combination preparations 

Betnesol-N®

  • Ear/Eye/Nose drops: Betamethasone sodium phosphate 0.1%, neomycin sulphate 0.5% 

 

Flumetasone pivalate 0.02% / Clioquinol 1%

  • Ear drops: flumetasone pivalate 0.02%, clioquinol 1%

 

Otomize® (Amber 2)

  • Ear Spray: dexamethasone 0.1%, neomycin sulphate 3250 units/ml, glacial acetic acid 2% 

 

Otosporin® (Amber 2)

  • Ear drops containing hydrocortisone 1%, Neomycin 3400u, Polymyxin B 10,000u/mL,  10mL 

 

Sofradex®

  • Ear drops: Dexamethasone 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%     
  • Considered to be a "Drug of Limited Clinical Value"  

  

 

Other preparations

Acetic acid

  • Ear spray 2% 

 

Aluminium acetate

  • Ear drops 8%
  • For ear drops 8%—dilute 8 parts aluminium acetate ear drops (13%) with 5 parts purified water. Must be freshly prepared

 

 

 

Removal of earwax

 

Olive Oil 

  • Ear drops       

Notes: 

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use
  • Olive oil eardrops are considered as the standard first line product for the removal of earwax. It is extremely cheap and skin reactions to it are almost unheard of.

 

 

Sodium bicarbonate

  • Ear drops 5%

Notes:

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use
  • Sodium bicarbonate occasionally causes irritation.
  • Some proprietary preparations contain organic solvents which may cause irritation e.g. Cerumol®, and are not recommended.
  • All preparations for removal of earwax listed in the BNF are available over the counter at a cost less than the current prescription charge

 

 

 

Return to Chapter: 12. Ear, Nose and Oropharynx

Last updated by: Dupe Fagbenro on 22-10-2018 15:27