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Topical Corticosteroid — Otitis Externa Pregnancy: Topical use considered safe — minimal systemic absorption; avoid prolonged use

Hydrocortisone Ear Drops

Brand names: Gentisone HC (with gentamicin), Otosporin (with neomycin + polymyxin B), EarCalm (acetic acid — not steroid)

Adult dose

Dose: 3–4 drops
Route: Otic
Frequency: Three to four times daily
Max: 4 drops per ear four times daily
Topical hydrocortisone (usually in combination with antibiotic) for inflammatory otitis externa with bacterial infection. Gentisone HC (gentamicin 0.3% + hydrocortisone 1%) and Otosporin (neomycin + polymyxin B + hydrocortisone) are the common combination preparations. Reduces inflammation and oedema in the ear canal.

Paediatric dose

Dose: 3 drops drops/kg
Route: Otic
Frequency: Three times daily
Max: 3 drops per ear three times daily
BNFc: Gentisone HC and Otosporin — licensed in children. AVOID if tympanic membrane perforated (aminoglycoside component is ototoxic).

Dose adjustments

Renal

No dose adjustment required (topical)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: Gentisone HC and Otosporin — licensed in children. AVOID if tympanic membrane perforated (aminoglycoside component is ototoxic).

Clinical pearls

  • Combination antibiotic+steroid drops reduce both infection and canal oedema — particularly useful in severe inflammatory otitis externa
  • Neomycin (in Otosporin) has a higher sensitisation rate than gentamicin — consider Gentisone HC if patient has had previous neomycin exposure
  • CONTRAINDICATED with perforated TM when combination contains aminoglycoside — switch to ciprofloxacin ear drops (safe with perforation)
  • Otomycosis (fungal OE): avoid steroid-containing ear drops — steroids promote fungal growth; use clotrimazole ear drops instead
  • Aural toilet (microsuction) before ear drops significantly improves efficacy — removes debris allowing drops to reach infected skin

Contraindications

  • Perforated tympanic membrane (combination products containing aminoglycosides — ototoxicity)
  • Fungal otitis externa (otomycosis — steroids worsen fungal infections)
  • Viral infection

Side effects

  • Local irritation
  • Sensitisation to neomycin component (Otosporin) — contact allergy
  • Superinfection (prolonged use)

Interactions

  • Negligible at topical otic doses

Monitoring

  • Symptom response at 5–7 days
  • TM integrity before prescribing combination drops

Reference: BNFc; BNF 90; BNFc; NICE CKS Otitis Externa; ENT-UK Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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