Drugs for the Ear

Anatomy of the Ear  The external ear  Auricle or pinna  External auditory canal (EAC)  The middle ear  Malleus, incus, and stapes  The inner ear  Semicircular canals and the cochlea

Otitis Media  Inflammation of and fluid in the middle ear  Otalgia: ear pain  Children may tug or hold affected ear  May be bacterial, viral, or both  Usually starts as viral infection of the nasopharynx  Diagnosis (must have all three of the following)  Acute onset of signs and symptoms  Middle-ear effusion  Middle-ear inflammation

Standard Treatment of Otitis Media  Required pain medication  Acetaminophen, ibuprofen, codeine  Some should receive antibiotics when clearly indicated  80% of cases resolve spontaneously without antibiotics

Treatment of Otitis Media  Acute otitis media (AOM)  Amoxicillin  Antibiotic-resistant otitis media  High-dose amoxicillin-clavulanate  Prevention  Breast-feeding for at least 6 months  Avoiding child care centers when respiratory infections are prevalent  Vaccination for and treatment of influenza  Vaccination against Streptococcus pneumoniae

Recurrent Otitis Media  Acute otitis media that occurs 3 or more times within 6 months, or 4 or more times within 12 months  Short-term antibacterial therapy  Prophylactic antibacterial therapy  Prevention and treatment of influenza  Tympanostomy tubes

Otitis Media With Effusion  Often seen following AOM episode  Fluid in middle ear without local or systemic illness  May cause mild hearing loss but no pain  Antibiotics have minimal effect: do not use

Otitis Externa  Acute otitis externa (OE): “swimmer’s ear”  Bacterial infection of the EAC Abrasion and excessive moisture Abrasion and excessive moisture  Topical treatment 2% solution of acetic acid + alcohol as ear drops 2% solution of acetic acid + alcohol as ear drops Cipro HC (ciprofloxacin plus hydrocortisone), Ciprodex (ciprofloxacin plus dexamethasone), and Floxin Otic (ofloxacin alone) Cipro HC (ciprofloxacin plus hydrocortisone), Ciprodex (ciprofloxacin plus dexamethasone), and Floxin Otic (ofloxacin alone)  Oral treatment Adults: ciprofloxacin Adults: ciprofloxacin Children: cephalexin (Keflex) fluoroquinolones Children: cephalexin (Keflex) fluoroquinolones  Prevention

Otitis Externa Prevention  Do not put anything in the ear, including swabs  Dry the EAC (with towel and tipping of head) after swimming and showering  Do not remove earwax  Do not use earplugs, except when swimming

Necrotizing Otitis Externa  Rare but potentially fatal complication of acute OE  High-risk groups: older adult patients with diabetes and immunocompromised patients  Bacteria in EAC invade mastoid or temporal bone  Infection can spread to skull base, cranial nerves, and dura mater, causing meningitis and lateral sinus thrombosis  Treatment antipseudomonal  Ear drops and/or IV  Oral ciprofloxacin

Fungal Otitis Externa (Otomycosis)  10% of OE caused by fungi, not by bacteria  Two most common pathogens  80%–90% caused by Aspergillus  Candida  Intense pruritus and erythema with/without pain or hearing loss  Managed with thorough cleansing and acidifying drops  1% clotrimazole used if acidifying drops are not effective