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Chapter 105

Chapter 105. Drugs for the Ear. Anatomy of the Ear. The external ear Auricle or pinna External auditory canal (EAC) The middle ear Malleus, incus, and stapes The inner ear Semicircular canals and the cochlea. Fig. 105-1. Anatomy of the ear.

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Chapter 105

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  1. Chapter 105 Drugs for the Ear

  2. Anatomy of the Ear • The external ear • Auricle or pinna • External auditory canal (EAC) • The middle ear • Malleus, incus, and stapes • The inner ear • Semicircular canals and the cochlea

  3. 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.

  4. 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

  5. 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

  6. Treatment of Otitis Media • Acute otitis media (AOM) • Amoxicillin • Antibiotic-resistant otitis media • 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

  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

  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

  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

  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.

  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

  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

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