Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
BNF Chapter 12: Ear, nose, and oropharynx
12.1 Drugs acting on the ear
Otitis Externa
also see Chapter 5

First line:
Acetic acid
as EarCalm®
2% spray: £4.10 (5ml)See infection management guidance for appropriate clinical indications Available OTC.

Cure rates similar at 7 days for topical acetic acid or antibiotic +/- steroid.
Second line:Betamethasone with Neomycin
as Betnesol-N®
Drops: £2.39 (10ml)
Otitis mediaTopical antimicrobial products are not recommended for otitis mediaSee infection management guidance for appropriate clinical indications
as Otigo®
40mg/10mg/g ear drops: £8.92 (15ml with dropper applicator)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 waxFor 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.
Green crossOlive Oil - suitable for self-careSimple oils such as olive (or almond) oil should be used first line.
Available OTC
Green crossDocusate Sodium
as Waxsol®
- suitable for self-care
0.5% drops: £1.95 (10ml)Available OTC
Otovent® auto inflation device£6.69 (1 device)Recommended by NICE MIB59 as demonstrates improved outcomes for children with middle ear / glue ear problems. Little evidence to support use in adults. (PAMM April 2016)