Treatments are available without prescription for earache (acute otitis media, AOM), ear wax, otitis externa, and otitis media with effusion (OME, glue ear).
Earache is often associated with an upper respiratory tract infection and, as long as the pain is not severe, can be treated with oral analgesics for up to 48 hours, before referring if the condition does not improve. There are no OTC analgesic ear drops available. Earache in very young children should be referred immediately, as the possibility of secondary bacterial infection of the Eustachian tube, requiring antibiotic treatment, is relatively high.
Cerumen (ear wax) is a complex oily fluid secreted by sebaceous and apocrine glands in the external auditory canal, which combines with exfoliated skin cells to form a protective waxy layer. This is normally moved outwards by movement of the jaw in speaking and chewing and removed by washing. In some individuals, however, excessive cohesive cerumen is produced. This forms a waxy plug that affects hearing and causes discomfort. Although syringing is usually necessary to remove ear wax, cerumenolytics can be used in advance to soften, loosen and partially dissolve the wax.
Several approaches to softening and removing ear wax are employed in cerumenolytic ear drops:
A Cochrane Review found that ear drops (of any sort) can help to remove ear wax, but that water and saline drops appear to be as good as more costly commercial products. However, the quality of the trials reviewed was generally low.1
The following technique is recommended for the most effective use of ear drops:
Otitis externa is inflammation of the external auditory canal. The acute form is usually caused by bacterial infection, but may also be fungal or viral. The chronic form is eczematous and may be atopic or a contact dermatitis. Dermatitis may become infected and the two types of otitis externa can exist together. OTC treatments available are:
In this condition fluid builds up in the middle ear and Eustachian tube, preventing the eardrum from vibrating properly and resulting in hearing loss. It mainly affects children and is often self-limiting, with 50 per cent of cases clearing spontaneously within three months. A medical device is available to relieve OME – an auto-inflator consisting of a nosepiece applicator attached to a small balloon. It works by generating positive pressure in the middle ear and Eustachian tube and allowing built-up fluid to drain. The nosepiece is inserted into each nostril in turn with the other nostril held shut, and the patient exhales through the nose to inflate the balloon. When the balloon is inflated the air is allowed to re-enter the nostril whilst swallowing. The device is prescribable on the NHS as well as being available for OTC sale.
A Cochrane Review concluded that the evidence for the use of autoinflation in the short term appears favourable. But given the small number of studies found and the lack of long-term follow-up, the long-term effects associated with the use of such devices cannot be determined.3