About your condition and treatment
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.
For how long has the consumer of this medicing experienced these symptoms?
Please select your option
Has the target user tried a different medicine to address the symptoms before?
If yes, what medicine was consumed and how effective was it?
What is your biological gender?
Please select your option
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
Can you relate to any of the following?
You have an underlying medical condition
Does your problem only affect one ear?
Which signs and symptoms are you currently experiencing?
You can select more than one option
Does pulling the middle of your earlobe toward the back of your head aggravates the pain?
Are you using Otomize to treat a recurrence of a swimmer's ear infection that was previously diagnosed?
Do you have a history of experiencing:
Ear infections that last a long time.
Do you recognize yourself in any of the following scenarios:
You've had cholesteatoma (an abnormal growth of skin in the middle ear beneath the eardrum) from birth or as a result of repeated ear infections.
Are you presently experiencing:
A grommet was installed.
Do you know of any ingredients in Otomize that you are allergic to or sensitive to?
Did you know that:
A healthcare practitioner should assess any acute injuries.
What symptoms do you intend to treat using this medicine?
Please provide more information
Are you the actual consumer of this medicine?
If not, please describe in detail who the intended consumer is and how old he/she is.
Do you currently have an infection of the outer ear?
Women only: Are you pregnant, planning pregnancy, or is there any possibility that you could be pregnant?
Women only: Are you breast feeding?
Do you have a perforated ear drum or grommet fitted in the affected ear?
Have you had a serious reaction or intolerable side effects to neomycin sulfate, dexamethasone, glacial acetic acid or any medications before?
If yes, please describe the product and the reaction
Are you immunosuppressed due to disease or treatment?
Do you have any liver or kidney problems?
If yes, please provide details
Are you suffering from severe pain or discomfort?
Do you have any allergies?
If yes, please provide details
Do you have an infection anywhere other than in the ear?
Do you have any open wounds or damaged skin in the affected ear?
Have you experienced a considerable amount of discharge from your ear or swelling of the ear canal?
Have you had persistent infection for the last 3 months?
Please list all your current prescription medication including any medication you buy over the counter...
Please provide details of any recent or past medical history of note
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