1. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 59 Otic Drugs

2. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Structure of the Ear

3. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Ear Disorders  Bacterial and fungal infections  Inflammatory disorders that cause pain  Earwax accumulation  External ear: physical trauma, dermatitis  Middle ear: otitis media

4. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Ear Disorders (cont’d)  Otitis media: middle ear infection  Most often afflicts children, following a respiratory tract infection  In adults usually results from foreign objects or water sports

5. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Ear Disorders (cont’d)  Otitis media: middle ear infection (cont'd)  Symptoms include pain, fever, malaise, pressure, sensation of fullness in the ears, hearing loss  If untreated, tinnitus, nausea, vertigo, mastoiditis may occur  Hearing deficits and hearing loss may result if prompt therapy not started

6. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Otic Drugs for External and Middle Ear Disorders  Antibiotics  Antifungals  Antiinflammatory drugs  Local analgesics  Local anesthetics  Steroids  Wax emulsifiers

7. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial and Antifungal Otic Drugs  Topical formulations applied to the external ear  Often combined with steroids for antiinflammatory, antipruritic, and antiallergic drug effects  Middle ear infections generally require systemically administered antibiotics

8. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial and Antifungal Otic Drugs (cont’d)  Antibiotics  neomycin and polymyxin B plus hydrocortisone combination (Cortisporin Otic)  Others containing ciprofloxacin  Antifungals  Cortic (combination of antifungal drugs and hydrocortisone)

9. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Wax Emulsifiers  carbamide peroxide  Combined with other drugs, such as glycerin, to work together to loosen and help remove cerumen  Debrox Drops, Murine Ear Drops, Auro Ear Drops

10. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Assess baseline hearing or auditory status  Evaluate patient’s symptoms  Assess drug and food allergies  Assess for contraindications  Perforated eardrum(s) may be a contraindication to these drugs

11. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  If necessary or if ordered, remove cerumen before instilling ear drops by irrigation  Cleanse outer ear thoroughly

12. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Ear drops should be warmed to approximately body temperature before instillation  Allow refrigerated solutions to warm to room temperature  Drops that are too cold may cause vomiting and dizziness

13. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  For adults, drops should be given while holding the pinna up and back  For children younger than 3 years, hold the pinna down and back when giving ear drops

14. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Allow the drops time to flow down into the ear canal  Patients should lie on the side opposite to the side of the affected ear for about 5 minutes after instillation of the drug

15. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  A small cotton ball may be gently inserted into the ear canal to keep the drug in, but do not force the cotton into the ear canal  Gently massage the tragus of the ear to encourage flow of medication