Drugs for Disorders of Ear

A.

The EAR is divided into the external, middle, and inner ear.

The External Ear consists of the pinna and the external

auditory canal. The external auditory canal transmits sound to the
tympanic membrane (eardrum), a transparent partition between
the external and middle ear. The eardrum in turn transmits sound
to the bones of the middle ear; it also serves a protective
function.

The Middle Ear, an air-filled cavity, contains three auditory

ossicles- the malleus, incus and stapes that transmit sound waves
to the inner ear. The tip of the malleus is attached to the
eardrum; its head is attached to the incus, which attached to the
stapes. The Eustachian tube provides a direct connection to the
nasopharynx and equalizes air pressure on both sides of the
eardrum to prevent it from rupturing. Swallowing, yawning, and
chewing gum help the eustachian tube relieve pressure changes
during airplane flights.

The Inner Ear is a series of labyrinths (canals) that consist

of a bony section and a membranous section. The vestibule,
cochlea, and semicircular canals make up the bony labyrinth. The
vestibular area is responsible for maintaining equilibrium and
balance. The cochlea is the principal hearing organ.

Professional evaluation of ear problems is essential, because

hearing loss can result from untreated disorders. External ear
disorders can be treated with over-the-counter products. Whereas
prescription drugs are required to treat middle ear disorders.

Drugs for disorders of the ear

Anti-infectives

 Common ear conditions that require antibacterial drugs

are acute otitis media (AOM) and acute acute otitis
externa (AOE), commonly known as swimmers ear.
Acute otitis media occurs more often in children, and
streptococcus pneumonia is the most common
pathogen, followed by haemophilus influenza and
Moraxella catarrhalis. Acute otitis media (AOM) may
also be caused by other microorganisms such as
viruses.
 Acute otitis media (AOM) is usually related to a
dysfunction of the Eustachian tube, especially after an
upper respiratory infection from a virus. The tympanic
membrane (TM) is usually bulging, and patients
complain of otalgia (ear pain).other symptoms may
include fever and irritability.
 Oral amoxicillin is usually the drug of choice when
antobiotics are indicated for AOM. The recommended
dosage for children 6 months and older is 80-90mg/kg
every 12hours for 7 to 10 days depending on the
severity of the condition and the age of patient. The
dosage for adults is 500 to 875 mg every 8 to 12 hours,
depending on the severity.
  Otitis externa (EO) is an infection of the external
auditory canal that occurs when excess moisture and
breaks in the epithelium allow some pathogen, usually
bacterial or fungal, to invade the tissues.
 The cerumen is lipid rich and hydrophobic (repels
water), and it protects the skin from water penetration.
However, the excessive cerumen can obstruct the canal
and can trap water. Trapped moisture in the canal
elevates the pH and removes the protective cerumen,
allowing pathogens a warm, dark, moist area in which
to grow. Like many areas of the body, the external
canal contains normal bacterial flora that protect the
ear; however, when protective mechanism fail, a
pathogenic flora results.
 Pseudomonas aeruginosa and staphylococcus aureus
are pathogens most often responsible. Fever, otalgia,
lymphadenopathy, and swelling can occur.

Antihistamines and Decongestants

For years, antihistamines and decongestant were

thought to reduce middle ear congestion and eustachian
tube dysfunction associated with otitis media with iffusion
(OME), a noninfectious collection of fluid in the middle
ear. The rationale was that these drugs would promote
drainage from the middle ear.

J.Side/adverse effect

The most common side effects of otic antimicrobials are burning

and stinging, but oto-toxocity can occur with aminoglycoside
antibiotics. Chloramphenicol may cause bone marrow suppression
and can result in decreased erythrocytes, leucocytes, and
platelets. Opportunistic overgrowth of nonsusceptible organisms
may occur with any of these drugs.

Ciprofloxacin Otic.
Drug class
Flouroquinolone antibiotics
Action
Inhibition of topoisomerase
(DNA gyrase) enzymes,
which inhibits relaxation of
supercoiled DNA and
promotes breakage of double
stranded DNA
Indication
For the treatment of
infections caused by
susceptible gram- negative
bacteria, including
pseudomonas aeruginosa,
staphylococcus aereus, acute
otitis media, acute otitis
externa.
Dosage:
0.3%
Available types:
Drops
Drug-lab-food Interactions
Ciprofloxacin interacts with
certain foods and several
other drugs leading to
undiserable increases or
decreases in the serum levels
or distribution of one or both
drugs.

Otic: treatment of acute otitis

externa
Pharmacokinetics Pharmacodynamics
Bioavailability-70% Onset- NA
Protein binding-30% Peak- NA
Metabolism-liver
Elimination half-life-3.5 hours
Excretion-kidney
Therapeutic effects/uses Contraindications
Side effects Adverse reaction
 Itching or pain after
using the ear drops
 Fussiness or irritability
 Headache; or
 Stuffy nose and sore
throat
Nursing Management
Time- 15 to 2hrs
 Taking tizanidine at the
same time
 Use by those who are
hypersensitive to any
member of the
quinolone class of
antimicrobial agents
Ciprofloxacin is also
considered to be
contraindicated in children
(expect for the indications
outlined above), in
pregnancy, to nursing
mothers, and in people
with epilepsy or other
seizure disorders.
 Nausea
 Vomiting
 Stomach pain
 Heartburn
 Diarrhea
 Feeling an urgent need
to urinate
 Headache
 Fainting
 Fever
 Joint pain
 Removing wax blockage
 Removing foreign body
 Treating ear infection by
medication
 Ear irritation
 Aural toileting
 Hearing aids