Download S11 Para Otic Products Part2[1]

Otic Products
(2)
Treatment of Ear disorders
General Guidelines:
• Infection of the auricle or external ear canal
is a skin infection and should be treated as
such
• Surgical interventions maybe necessary for
deep cuts, bruises or abrasions of the ear
• Severe infections usually require both
systemic & local antibiotics
Why necessary to treat
otitis externa?
Otitis externa should always be treated promptly,
• to prevent spread to mastoid bone or middle ear
cavity
• Severe cases may result in permanent hearing
loss
•
In mild cases of otitis externa topical
treatment is all that is necessary
Treatment of otitis externa
1. Topical antibiotics & hydrocortisone
drops/cream applied to ear canal
2. If cellulitis & lymphadenopathy are
present use oral antibiotics
3. 5% Aluminum acetate solution (Burow’s
solution)
4. Soaking ear with saline, or Burow’s solution
is useful in treatment of crusting & edema in
auricle & surrounding tissue
Treatment of otitis externa
5. Irrigation with soft rubber bulb ear syringe
maybe uncomfortable but should never be
painful (if pain occurs stop, if pain is severe
& knife-like, there may be tympanic
membrane perforation & vertigo may occur)
• The use of forced water spray should be
reserved for health professional trained in
aural hygiene
Ear bulb syringe
Water-Pik spray
Otitis externa
Contact dermatitis
.
Otitis Externa
• An aminoglycoside combined with a second
antibiotic and a topical steroid such as
neomycin-polymyxin B-hydrocortisone
used to be the most commonly prescribed
topical antibiotic.
• Neomycin-dexamethsone-acetic acid
• Caution must be used to recognize a
hypersensitivity reaction and ototoxicity to
the neomycin component.
• One literature review concluded that the use
of ciprofloxacin 0.3%/dexamethasone 0.1%
otic suspension for otitis externa is safe and
effective and that dexamethasone improves
treatment success
• Mild fungal infections can usually be
treated with an acetic acid solution, whereas
more severe cases may require a topical
antifungal such as 1% clotrimazole.
Acetic Acid
• Used in the form of household vinegar (5%)
• Has been used successfully for many years to
treat mild forms of otitis externa &
recommended for swimmer’s ear
• Advantages: 1. Has bactericidal & fungicidal
properties (Candida, Aspergillus &
Pseudomonas); 2.Well tolerated &
nonsensitizing and does not induce resistant
organisms
Acetic Acid
• Four drops of dilute acetic acid (2-3%) placed
into the ear canal four times daily will lower
the pH < 3. (NB. The optimal pH for bacterial
growth 7.2-7.6)
• Solutions of <1% lack bactericidal properties
• Disadvantages: has an unpleasant vinegarlike odor, and can be very painful if applied to
the middle ear
Application Technique:
• Tilt head downward, affected ear up
• If there is no possibility that there is a hole in the
eardrum, carefully squeeze a medicine dropper
full of the solution into the ear canal
• With one hand, move the ear back & forth to
move the solution all the way into the ear
• Tilt the head to the other affected side, to let the
solution out, gently tapping the unaffected side
• Repeat the procedure in the opposite ear
Aluminum Acetate solution
(Burow’s Solution)
•
•
•
Given as anti-inflammatory, antipruritic,
astringent & limited antibacterial
Widely used to treat external otitis or local
itching of external ear caused by dermatitis or
otomycosis, edema & crusting associated with
acute moist ear canals
A wet compress is used with a gauze dressing
on the auricle. Drops may be instilled into the
canal, 4-6 drops every 4-6 hrs until symptoms
subsides
Aluminum Acetate solution
(Burow’s Solution)
1. Has astringent properties: 1. dry the affected
area by reducing the secretory function of the
skin glands and, 2. toughen skin, help prevent
re-infection
2. Its major value: acidity which restores the
normal antibacterial pH of the ear canal
• Well tolerated, nonsensitizing. Rare adverse
effects
Cerumen-Softening agents
• Cerumen-softening & cerumenolytic agents
only soften & loosen the cerumen.
• These agents do not readily remove cerumen
• Patients then can remove minor amounts of
excessive ear wax by rinsing the ear canal
with an ear syringe
• Hardened or impacted earwax removed by
doctor, or if pain is present refer to doctor
Carbamide Peroxide
(urea hydrogen peroxide, 6.5% in glycerine)
• The effervescence caused by oxygen release
mechanically assists in disintegrating wax
accumulations in the ear
• Carbamide (urea) helps to increase penetration of
solution into the plug
• Removal of the softened cerumen may be assisted by
warm water irrigation using a soft rubber ear syringe
• Recognized by FDA as safe & effective for occasional
OTC use
Carbamide Peroxide
(urea hydrogen peroxide)
• FDA recommends use twice daily for up to
4 days if needed
• 5 drops of the solution should be instilled
into the affected ear & allowed to remain at
least 15 minutes, either by tilting the head
up or by inserting small amount of cotton
into the canal opening then irrigate with
warm water using a soft rubber ear syringe
Carbamide Peroxide
(urea hydrogen peroxide)
•
If condition not improved after 4 days
consult a doctor
1. Procedure not recommended for children
under 12 years of age
2. Should not be used if there is ear drainage,
pain or dizziness or injury or perforation
of the eardrum
Carbamide Peroxide
(urea hydrogen peroxide)
3. Should not be used if surgery has been
performed in the past 6 weeks
4. Carbamide peroxide should be
discontinued whenever irritation or rash
appears
5. Not recommended for treating pain of
inflamed tissue, swimmer’s ear or itching
of the ear canal
Other cerumen-softening
products
• Occasional instillation of olive oil, turpentine
oil, glycerin, diluted hydrogen peroxide (1:1 of
3% solution) or propylene glycol, sodium
bicarbonate or docusate sodium may soften the
cerumen and promote the normal process of
removal
• These products should be used only under
medical supervision if the tympanic membrane
is perforated or is not known to be intact;
Other cerumen-softening
products
• To prevent cerumen build-up: rinse ear
canal every few days with a mixture of 2030% alcohol & water or aluminum acetate
solution;
• Over-irrigation of the ear is not
recommended as maceration of the skin
may happen and may lead to infection
Glycerin
• Used as a solvent, emollient or humeactant
• It is safe & nonsensitizing when applied to open
wounds or abraded skin
Olive oil (Sweet Oil)
• Used as an emollient & topical lubricant
• Alleviates itching & burning, softens earwax
and smothers insects
Propylene Glycol
• A solvent that has preservative and
humeactant properties
• Because it is viscous, increases contact with
the skin
• Adding acetic-acid to it increases solution’s
acidity, enhancing its anti-infective properties
• If used for a long period of time, may cause
allergic dermatitis in susceptible individuals
Choline Salicylate
• Local analgesic, has a counterirritant effect
• Used for earache
• Hydrolysed by cutaneous esterases to salicylic
acid that has anti-inflammatory effect
• Softens ear wax as it is usually in combination
with glycerol
Ear Drop Administration
• Pharmacist must make sure that patient
understands the proper techniques of drug
administration & use:
• Eardrops maybe applied as often as 4 times
daily
Patient Counseling
• The involved ear should be tilted up for at
least 2 minutes following placement of 2-4
eardrops to permit effective contact
• Apply a piece of cotton or gauze to the area
• A cotton wick may be inserted gently into
ear canal to help medication maintain
contact with the affected area in ear canal
Patient Counseling
• Patients should also fully understand the
proper use of medicine dropper for
administering ear drops & of ear syringes for
irrigating the ear
• Eardrops should be warmed to body
temperature by: (1) or (2) but not the
microwave! WHY NOT?
Patient Counseling
• Cotton wicks, however, usually require
insertion using appropriate instruments &
should be used only by trained personnel
• Gently pulling the auricle backward may
allow medication to reach a greater depth into
ear canal
• Patients should be advised that symptoms
should subside 1-2 days following selftreatment. If symptoms persist or worsen,
consult doctor
Water Clogged Ears
• Some patients are prone to this due to the
shape of their ear canal, or excessive
cerumen
• Excessive moisture in the ear, due to hot
humid climate, swimming, bathing, etc.
• Isopropyl alcohol 95% in anhydrous
glycerine.
• Acetic acid in in isopropyl alcohol (50:50)