Related guidance:
See NHS Somerset infection management guidance.
Otovent nasal balloon for otitis media with effusion Medtech innovation briefing (MIB59 March 2016)
Otitis externa (CKS February 2022)
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Otitis externa | First line: analgesia for pain relief, and apply localised heat such as a warm flannel. | ||
| Second line: Cure rates similar at 7 days for topical acetic acid or antibiotic +/- steroid. | |||
Acetic acid as  EarCalm® - suitable for self-care | 2% spray: £4.92 (5ml) | For people aged 12 years and older. Administer directly into each affected ear at least three times a day, morning, evening, and after swimming, showering, or bathing, for a maximum of 7 days. | |
| Betamethasone with Neomycin as Betnesol-N® | Drops: £2.39 (10ml) | 2 or 3 drops instilled into the ear three or four times daily for 7-14 days. Should not be treated when the eardrum is perforated because of the risk of ototoxicity. |
|
| Neomycin and dexamethasone and acetic Acid as Otomize® | 0.5 and 0.1 and 2% spray: £3.27 (5ml) | For adults and children 2 years of age and over. One metered dose to be administered directly into each affected ear three times daily for 7-14 days. The product should not be used in patients where a perforated tympanic membrane has been diagnosed or is suspected or where a tympanostomy tube (grommet) is in situ. |
|
| Ciprofloxacin and dexamethasone | 0.3 and 0.1% drops: £6.12 (5ml) | For adults and children over 12 months of age. Instil four drops in the affected ear(s) twice a day for 7 days. May be preferred in cases of tympanic perforation (off label). |
|
| Otitis media | NHS Somerset do not recommend topical antimicrobials for otitis media, please refer to guidance. | ||
| Phenazone and lidocaine as Otigo® | 40mg and10mg/g drops: £8.92 (15ml) | Otigo is intended for local symptomatic treatment and relief of pain in the following diseases of the middle ear without tympanic perforation: - acute, congestive otitis media; - otitis in influenza, the so called viral bullous otitis; - barotraumatic otitis. Contraindicated in infectious or traumatic perforation of the tympanic membrane (including myringotomy). |
|
| Removal of earwax | For all preparations used in removal of ear wax patients should be advised to lie with affected ear uppermost for 5 minutes after administration to ensure penetration of the ear canal. | ||
| Olive oil - suitable for self-care | Drops: £0.92 (15ml) | First line. | |
| Docusate sodium as Waxsol® - suitable for self-care | 0.5% drops: £1.95 (10ml) | ||
| Otovent® | Auto inflation device: £6.69 (1) | Otovent may be used in situations for children who cannot equalise air pressure in the middle ear, including those with glue ear. Effectiveness has not been assessed in adults. | |