Otitis externa (an infection of the external parts of the ear) is common, occurring in about 1 out of every 10 people in their lives. Even though many ear infections can be easily treated with topical formulations, systemic medications are often used. There are numerous topical medications available for treating ear infections but many have downsides. Unique combinations of antibiotic and antifungal ingredients can be made by a compounding pharmacy in the form of powders that have benefits over many of the commercially available products.

What is Otitis Externa?

Otitis externa isan inflammatory process of the external auditory canal that results from infection – usually Pseudomonas aeruginosa and Staphylococcus aureus. In most cases the infection and symptoms are localized to the external parts of the ear. This makes topical treatment ideal as it can avoid the use of systemic medications that may have more side effects.

There are a few main causes of otitis externa which include:

• Moisture entering the ear from swimming, perspiration, and high humidity (otitis externa is sometimes called Swimmer’s Ear)
• The removal of the ear’s protective wax (cerumen)
• Insertion of objects like cotton swabs, fingernails, hearing aids, and ear plugs
• Chronic dermatologic disease like eczema, psoriasis, and acne

Symptoms of minor cases include discomfort, itching, and a feeling of fullness in the ear. More severe cases may cause pain, canal obstruction, and involvement of the surrounding skin.

Because of the way the ear is structured, it is especially susceptible to infection. The ear provides the perfect environment for bacteria to grow. While treatments for otitis externa are very effective, it is always better to try to prevent the infection in the first place. Swimmers will often wear swimmers caps to protect their ears. Also avoidance of doing anything that could damage the ear like using cotton swabs deeply in the ear canal can prevent injury and infection.

Commercially Available Treatments

There are numerous commercially available treatments for otitis externa but many either have adverse effects or only partially treat the infection. Antibiotics and antifungals are the standard treatment options. Neomycin drops may be effective but they often cause contact dermatitis. Acetic acid can also help when used in conjunction with anti-infectives but it often causes irritation. Pain relief medications like ibuprofen can reduce the pain of an ear infection but will not treat the infection. While numerous prescription and over-the-counter treatments are available, they all have some downsides. Many doctors are now turning to a compounded treatment that uses topical powder to manage otitis externa.

Topical Treatment with Otic Powders

Otic drops are commonly found in pharmacies but powders are much less common. A topical powder has a few benefits over other dosage forms. Powders are able to adhere to moist surfaces and have a longer dwelling time than liquid preparations. The powder stays on the infected surfaces longer to provide more opportunity for the ingredients to treat the infection. If a systemic treatment can be avoided it is ideal – as systemic treatments generally have more side effects and contraindications. A topical avoids most of the side effects of an orally administered medication by being applied only to the area of concern.

CSF Powder

CSF powder is a compounded topical treatment for ear infections that includes chloramphenicol 46.7%, sulfamethoxazole 46.7%, and amphotericin 5.6%. Hydrocortisone may also be added to this formulation to help reduce inflammation (called CSF-HC). This formulation contains two antibiotics – chloramphenicol and sulfamethoxazole – and the antifungal amphotericin. This combination of ingredients provides a more comprehensive treatment for all possible bacterial and fungal infections.

The powder can be dispensed in either a disposable accordion insufflator or in capsules that are used with a Sheehy-House insufflator.  The powder dispensed in an insufflator lasts around 100 puffs, and each capsules of powder lasts around 10-15 puffs. Treatment with CSF is generally rapid and symptom relief should be seen not long after starting therapy.  In various forms, otic powders can provide relief in about 75-85% of patients in just a few days.

Relief from Otitis Externa

Since treatments for otitis externa can be so effective with few side effects, there is no reason to delay being treated. In addition to antibiotic and antifungal treatment, it is essential to practice moisture prevention and cleansing of the canal. This will prevent re-infection and help the ear heal.