Download Chapter 16 Cholinesterase Inhibitors

Drugs for the Ear
Anatomy of the Ear
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The external ear
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The middle ear
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Auricle or pinna
External auditory canal (EAC)
Malleus, incus, and stapes
The inner ear
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Semicircular canals and the cochlea
Otitis Media
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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)
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Acute onset of signs and symptoms
Middle-ear effusion
Middle-ear inflammation
Standard Treatment
of Otitis Media
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Required pain medication
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Acetaminophen, ibuprofen, codeine
Some should receive antibiotics when clearly
indicated
80% of cases resolve spontaneously without
antibiotics
Treatment of Otitis Media
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Acute otitis media (AOM)
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Antibiotic-resistant otitis media
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Amoxicillin
High-dose amoxicillin-clavulanate
Prevention
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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
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Acute otitis media that occurs 3 or more times
within 6 months, or 4 or more times within 12
months
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Short-term antibacterial therapy
Prophylactic antibacterial therapy
Prevention and treatment of influenza
Tympanostomy tubes
Otitis Media With Effusion
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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
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Acute otitis externa (OE): “swimmer’s ear”
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Bacterial infection of the EAC
• Abrasion and excessive moisture
Topical treatment
• 2% solution of acetic acid + alcohol as ear drops
• Cipro HC (ciprofloxacin plus hydrocortisone), Ciprodex
(ciprofloxacin plus dexamethasone), and Floxin Otic
(ofloxacin alone)
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Oral treatment
• Adults: ciprofloxacin
• Children: cephalexin (Keflex) fluoroquinolones
Prevention
Otitis Externa Prevention
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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
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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
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Infection can spread to skull base, cranial nerves, and dura
mater, causing meningitis and lateral sinus thrombosis
Treatment antipseudomonal
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Ear drops and/or IV
Oral ciprofloxacin
Fungal Otitis Externa (Otomycosis)
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10% of OE caused by fungi, not by bacteria
Two most common pathogens
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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