The standard spray for outer ear infection — and the one most often used with the wrong technique.
Explained by a GMC-registered GP, not a leaflet
Honest about what we can and cannot prescribe remotely
Side effects given the same weight as benefits
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
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Registered with the Care Quality Commission
Otomize is a combination spray for the outer ear canal, containing three things that each do a different job:
The steroid is doing more of the work than most people assume. Much of the pain of otitis externa comes from a swollen canal under pressure, and reducing that swelling is what produces relief within a day or two.
It is not for middle ear infection. Otitis media sits behind an intact eardrum, and a spray in the canal cannot reach it.
Seven days, and not routinely longer. Prolonged use of an aminoglycoside like neomycin in the ear is avoided, and extended steroid use can encourage fungal overgrowth — which then looks like treatment failure and gets treated with more of the same.
Neomycin can damage hearing and balance if it reaches the middle or inner ear. That is why a perforated eardrum matters, and why courses are kept short.
How to suspect a perforation: a sudden discharge of fluid or pus with relief of pain, a history of a burst eardrum, or long-standing hearing loss on that side. If there is any real doubt, the ear needs looking at before this is used.
Avoided in pregnancy unless clearly necessary.
No significant systemic drug interactions — very little is absorbed from a correctly used ear spray.
No monitoring is required for a standard seven-day course.
What should be reviewed is whether it worked. An ear that is no better after seven days needs re-examining rather than a repeat prescription — the likeliest explanations are a fungal infection, a neomycin allergy, or a canal too swollen for the spray to penetrate, and each needs something different.
Yes, where the picture is a straightforward outer ear infection and there is no reason to suspect a perforated eardrum. A careful history covers most of that: previous perforations, grommets, sudden discharge with pain relief, or known hearing loss on that side.
The honest limitation is that we cannot look in your ear. That matters more here than for most remote prescribing, because the single contraindication that causes lasting harm — a perforation — is one only an otoscope can exclude with certainty. Where the history raises any doubt, we will ask you to be examined rather than prescribe.
What needs seeing in person: severe pain with swelling spreading onto the face or neck, fever, a canal so swollen it has closed, hearing loss, facial weakness, or anyone with diabetes or a suppressed immune system and a severe ear infection — necrotising otitis externa is a serious diagnosis and is not something to manage over video.
This page is information, not an offer to supply.
Otomize is prescription-only and relatively expensive for what it is — more than the England NHS prescription charge on a private script. NHS prescriptions are free in Wales.
A painful, swollen, discharging ear that has not settled with over-the-counter acetic acid, or one where the pain is significant enough that the steroid component is what you actually need.
Stop after seven days. This is not a treatment to continue until symptoms fully resolve — short courses are deliberate.
Do not simply repeat it. Three things explain most failures, and each needs a different answer:
Pain usually improves within 24 to 48 hours, largely because of the steroid reducing the swelling. Full resolution takes the week.
No improvement at all after 48 hours is worth reporting rather than waiting out the course.
The acetic acid. It is unpleasant but expected, and it settles after the first couple of doses. Warming the bottle in your hand first helps, and prevents the dizziness that cold spray in the ear can cause.
No — this is the one that matters. Neomycin reaching the middle ear can damage hearing permanently. If you have ever had a burst eardrum, have grommets, or had a sudden discharge that relieved severe pain, say so before using it.
Not during treatment, and keep the ear dry. Water is what caused it in a great many cases. A shower cap or a smear of petroleum jelly on cotton wool keeps water out while washing.
Usually because the ear keeps getting wet, or because cotton buds are still being used. Cotton buds strip the protective wax and scratch the canal, which is precisely how infection gets in. Nothing smaller than your elbow goes in your ear — the advice is old and it is correct.
No, and it is worth acting on. Increasing itch on treatment suggests either a neomycin allergy or a fungal overgrowth, and both need a different medicine rather than more of this one.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
September 5, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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