Can Eye Drop Medications be Used in the Ear?

Can EYE drop medications be used in the EAR for ear problems like ear infections?

For the most part, absolutely.

For pretty much any EAR drop preparation, there is an equivalent EYE drop preparation which can be used safely in the ear.

Why does this matter?

It's because it may be cheaper for the patient if the EYE drop medication is prescribed rather than the EAR drop medication. Often, it is not unusual for a brand name ear drop medication to be available in generic eye drop form.

NOW... EAR drop medications should NOT be used in the EYE because preservatives used in eye drop preparations are much gentler than those used in ear drops due to the eyeball being much more sensitive compared to the ear. As such, it may burn if ear drops are used in the eye... but not vice-versa.

• Floxin (Ear) equivalent to Ocuflox (Eye)
• Ciprodex (Ear) equivalent to Ciloxan (Eye) without the steroid dexamethasone
• Cipro HC (Ear) equivalent to Ciloxan (Eye) without the steroid hydrocortisone
• Cortisporin (neomycin-polymyxin-hydrocortisone) is available in both eye and ear preparations
• Tobradex (Eye) can be used in the ear and is imprecisely similar to Cortisporin (Eye/Ear).

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Best Drops for Earwax Removal

It's about time, but some researchers actually put to the test to try and determine what is the best solution to dissolve/remove earwax.

The verdict was... WATER!

Better than mineral oil, liquid colace, and over-the-counter cerumenolytics (ie cerumol). Hydrogen peroxide was not evaluated.

How was this result determined?

Using guinea pigs, the researchers first tested whether each of these substances were safe should a hole in the eardrum be present allowing for the solution to enter the middle ear space. Colace was found to be the most ototoxic (meaning, potential for permanent hearing loss if a ear tube or a hole in the eardrum is present). Mineral oil and saltwater (normal saline) was found not to be toxic.

Next, they determined which substance provided the greatest degree of cerumen dissolving ability. Each substance was added to a cylinder filled with earwax for 5 minutes. They than determined how much weight was required for a 25G needle to fully penetrate through the earwax.

Water was found to provide far superior earwax dissolving ability compared to all other substances tested. Not surprising given water is considered the best universal solvent used to clean everything from dishes to cars to buildings.

What is the take-home message?

Given saltwater/water is completely safe for hearing even if there is a hole in the eardrum along with superior earwax dissolving ability, it seems to be a no-brainer to instruct patients with lots of earwax to use salt-water to get rid of earwax.

Reference:
Ototoxicity of intratympanic docusate sodium and mineral oil in the Guinea pig. Otolaryngol Head Neck Surg. 2012 Mar;146(3):455-60. Epub 2011 Nov 18.

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Skin Patch Immunotherapy for Allergy Cure

Over the years, there have been a variety of systems via which physicians and researchers have attempted to cure patients of their inhalant allergies.

These include (click here for a description of each):

• Allergy shots
• Under the tongue allergy drops (SLIT)
• Intra-Lymphatic Injections (ILIT)
• Allergy Tablets
• Epicutaneous Immunotherapy (EPIT)
• Intra-Nasal Spray
• Bronchial Inhalers

Well... we can now add skin patches to the list.

European researchers conducted a placebo-controlled, double-blinded trial involving 132 patients with grass pollen allergies. The patients were randomly divided into one of four groups: placebo, low-dose, medium-dose or high-dose patches. Patients applied six weekly patches prepared with grass allergens prior to and during the 2008 grass season and ALL reported improvement in their symptoms (30% in 2008) though one year later, there was a dose-dependent improvement with essentially no improvement in low-dose and placebo groups.

Unfortunately, higher-dose patches had higher rates of adverse events including pruritus, erythema, wheal, or eczema leading to an overall drop-out rate of 8.3% from the study.

This all may sound good and promising, but two of the study's authors hold patents on patch-based immunotherapy which may lead to study bias.

My take? More study is needed...

Reference:
Epicutaneous allergen-specific immunotherapy ameliorates grass pollen–induced rhinoconjunctivitis: A double-blind, placebo-controlled dose escalation study. The Journal of Allergy and Clinical Immunology Volume 129, Issue 1 , Pages 128-135, January 2012

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