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Jiří Slíva, M.D. Drugs acting on the ear: Otitis externa - inflammatory reaction of the meatal skin => cleansing, dry mopping, suction =>introducing of a ribbon gauze dressing soaked with corticosteroids or with an adstringent aluminium acetate solution =>presence of an infection - topical application of antiinfective drugs - neomycin, quinolons - administration usually not longer than 1 week because of a risk of fungal infection - chloramphenicol - aminoglycosides - contraindicated by eardrum perforation - acetic acid 2% - antifungal and antibacterial effect in the external ear canal - systemic application- analgesics, antibiotics - flucloxacillin- drug of choice, ciprofloxacin (Ps. aerug.) =>eczema - topical corticosteroid creams, prolong. using prohibited =>herpes zoster oticus - aciclovir Drugs acting on the ear: Otitis media - the commonest cause of severe pain in small children - mostly viral ethiology - coryza => analgesics - paracetamol - bacterial ethiology => systemic antibacterial therapy + analgesics, local therapy seems to be ineffective => in recurrent otitis - antibacterial prophylaxis trimethoprim or erythromycin - during the winter months - “glue ear” x chronic otitis media (Pseudomonas aerug., Proteus spp.)=> cleansing with aural suction, local debridement of the meatal and middle ear contents + topical treatment with ribbon gauze dressing with antibiotics - ciprofloxacin, ofloxacin ear drops in patients with perforated drum.Aminoglycosides and polymyxines (ototoxicity) are not here strictly prohibited (the pus seems to be much worse than these compounds) Drugs acting on the ear: Removal of ear wax WAX - normal bodily secretion provides a protective film -reasons of the removal -deafness - interferention with a proper view of the ear drum - ways of the removal - syringing with water temperatured to body temperature - sodium bicarbonate ear drops - olive oil - almond oil - docusate sodium Drugs acting on the vestibular system: Ménière's disease Symptoms: - vertigo - pressure - a feeling of „fullness“ in the ear - hearing loss - tinnitus THERAPY 1 Self help techniques reduce the amount of salt in their diet avoid stress use a walking stick, shopping trolley or umbrella for balance avoid alcohol and caffeine avoid over exertion walk along the centre of the pavement or railway platform, rather than close to the edge Drugs acting on the vestibular system: Ménière's disease THERAPY 2 Pharmacological anticholinergics - atropine, scopolamine antihistamines - diphenhydramine, meclisine Ca blockers – flunarizine, cinarizine benzodiazepins - diazepam - very severe vertigo vasodilatators carbamazepine, Ginkgo, vitamine A, E, B 3 Surgical Drugs acting on the nose: Drugs used in nasal allergy - mild cases - nasal corticosteroids, oral antihistamines, systemic nasal decongestants, cromoglycate, topical antihistamines (azelastine, levocabastine) - in seasonal rhinitis treatment should begin 2-3 weeks before season commences and may have to be continued for several months - severe cases - systemic corticosteroids for short period Sinusitis Conservative treatment • Quietness • Antibiotics – drug of choice is amoxiciline and Biseptol [sulphamethoxazole and trimetoprim], next broad-spectrum antibiotics - pnc (i.e. amox. + clavulanic acid), cephalosporines /cefuroxim, cefixim/, clarithromycin, doxycycline. Average duration of treatment: 10 days. Antimycotics - Aspergilus. • Support treatment: mucosal decongestion in area of ostiomeatal unit => alpha-1 mimetics – naphazoline, oxymethazoline, xylomethazoline etc. in form of drops or indirect sympathomimetics – ephedrine, pseudoephedrine. Topical use no longer than 7 days. Fomentation with solux usually in stadium of healing. Drugs acting on the nose: Topical nasal decongestants - the nose and nasal sinuses produce a litre of mucus in 24 hours; much of this way silently into the stomach via nasopharynx -sodium chloride 0.9% - relief the symptoms by liquefy of mucous secretions -corticosteroids - produce shrinkage of nasal polyps -sympathomimetics - ephedrine (seems to be most safe), oxymetazoline, xylometazoline, naphazoline (risk of rebound phenomenona) - all these drugs may cause a hypertensive crisis if used with a monoamine-oxidase inhibitor -ipratropium bromide - non-allergic rhinorrhoea - the use of compounds containing volatile substances (menthol, eucalyptus) may encourage their use Drugs acting on the nose: Nasal infections - probably 40% of the population have present coagulase-positive staphylococci in the noses - chlorhexidine, neomycin - cream, very often re-colonisation occurs - mupirocin - resistant bacterial strains Epistaxis -bismuth iodoform paraffin paste - for packing cavities after surgery Epistaxis First medical aid - sitting position - head bent forward - cold lining on nape and front - blowint the nose - nose compression - anemising solutions on cotton, sponge… - blood control examination – oral antihypertensives captoprile - tbl. 12.5 mg with rapid onset of action: up to 15-30 minutes - sedatives or anxiolytics p.o. or i.m. - antishock therapy /fluids, analgesics,…/ in order to support basic vital functions