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Chapter 105 Drugs for the Ear Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Anatomy of the Ear The external ear The middle ear Auricle or pinna External auditory canal (EAC) Malleus, incus, and stapes The inner ear Semicircular canals and the cochlea Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 2 Fig. 105-1. Anatomy of the ear. The purple arrows indicate flow of the mucociliary system, which can transport bacteria out of the middle ear. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 3 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 following) Acute onset of signs and symptoms Middle ear effusion Middle ear inflammation Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 4 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 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 5 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 6 Treatment of Otitis Media Acute otitis media (AOM) Antibiotic-resistant otitis media Amoxicillin High-dose amoxicillin-clavulanate Prevention Breast-feeding for at least 6 months Avoiding child care centers when respiratory infections are prevalent Treatment of influenza Vaccination against Streptococcus pneumoniae Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 7 Recurrent Otitis Media Acute otitis media that occurs three or more times within 6 months or four or more times within 12 months Short-term antibacterial therapy Prophylactic antibacterial therapy Prevention and treatment of influenza Tympanostomy tubes Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 8 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 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 9 Otitis Externa Acute otitis externa (OE) – “swimmer’s ear” Bacterial infection of the EAC • Abrasion and excessive moisture Topical treatment • 2% solution of acetic acid + alcohol as ear drops Oral treatment • Adults – ciprofloxacin • Children – cephalexin (Keflex) fluoroquinolones Prevention Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 10 Otitis Externa Prevention Don’t put anything in the ear, including swabs. Dry the EAC after swimming and showering (with towel and tipping of head). Don’t remove earwax. Don’t use earplugs, except when swimming. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 11 Necrotizing Otitis Externa Rare but potentially fatal complication of acute OE High-risk groups – elderly 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 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 12 Fungal Otitis Externa (Otomycosis) 10% of OE caused by fungi, not 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 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 13
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