Otic Medications

ANTIINFECTIVE EAR MEDICATIONS

·         Kills or inhibits the growth of susceptible bacteria

·         Indication:

o    To dry the ear and kill susceptible bacteria

o    Acetic acid may be used to dry the ear.

Example:

acetic acid and aluminum acetate (Otic Domebro®)

amoxicillin (Amoxil®)

ampicillin trihydrate (Polycillin®)

cefaclor (Ceclor®)

chloramphenicol (Chloromycetin® otic)

clarithromycin (Biaxin®)

clindamycin hydrochloride (Cleocin®)

erythromycn (Ilotycin®, E-Mycin®)

gentamicin sulfate otic solution (Garamyin®)

loracarbef (Lorabid®)

penicillin V potassium (Pen-V®)

polymyxin B sulfate (Aerosporin®)

tetracycline hydrochloride (Achromycin®)

trimehoprim and sulfamethoxasole (Bactrim®, Cotri®, and Septra®)

Side Effects:

·         Mild diarrhea

·         Headache

·         Superinfection in patients with overgrowth of nonsusceptible organisms

ANTIHISTAMINES AND DECONGESTANTS

·         Stimulate adrenergic receptors of respiratory mucosa, producing vasoconstriction and reducing respiratory tissue hyperemia to open Eustachian tube

·         Indication:

o    Adjunctive therapy for otitis media; to reduce respiratory congestion or open obstructed Eustachian tube

Example:

brompheniramine (Bromphen®,Dimetane®)

cetirizine (Zyrtec®)

chlorpheniramine (Chlor-Trimeton®, Teldrin®)

clemastine (Tavist®)

naphazoline hydrochloride (Allerest®, Albalon®)

tripolidine and pseudoephedrine (Actifed®)

Side Effects:

·         Drowsiness ·         Blurred vision

·         Dry mucus membranes

LOCAL ANESTHETICS

·         Block nerve conduction at or near application site to control pain associated with ear infections.

·         Indication:

o    To treat pain associated with ear infection

Example:

antipyrene and benzocaine combination (Auralgan® otic solution)

benzocaine (Tympagesic®)

Side Effects:

·         Irritation

·         Allergic reactions

·         May mask the symptoms of middle ear infection

CERUMINOLYTICS

·         Emulsify and loosen cerumen deposits

·         Indication:

o    To remove excess cerumen

Example:

carbamide peroxide (Debrox®)

boric Acid (Ear Dry®)

trolamine polypeptide oleate-condensate (Cerumenex®)

Side Effects:

·         Irritation, redness or swelling of the ear canal

General Contraindications and Precautions for Otic Medications:

o    Hypersensitivity reactions

§  Redness

§  Burning

§  Itching

§  Stinging

§  Vesicular or maculopapular dermatitis

§  Swelling and mild irritation

o    Perforated eardrums

General Nursing Interventions:

ü  Assess the patient for hearing loss, pain and ear drainage.

ü  Use the correct method to instill medications:

Ear drops:

o    Use clean technique; if tympanic membrane is damaged, use sterile technique.

o    Assist patient to side-lying position, ear being medicated uppermost.

o    Clean the pinna of the ear and the opening of the external ear canal with solution and cotton-tipped applicators as needed.

o    Warm the medication container with your hand or in warm water for comfort; partially fill the ear dropper with medication.

o    Straighten the auditory canal by:

§  For the child younger than age 3: pull the pinna/auricle down and back

§  For the adult and older child: pull the pinna up and back

o    Hold the bottle or dropper ½ inch above the ear canal and instill the correct number of drops along the side of the ear canal.

o    Apply gentle pressure with fingers to the tragus of the ear (to enhance the flow of medication to the ear canal).

o    Have the patient maintain side-lying position for 2-5 minutes for even dispersion.

o    Before the patient arises, loosely place a cotton ball at the meatus and leave in place for 30 mins. to prevent mediation loss.

Otic irrigation:

o    Assist the patient to a sitting or lying position with the head tilted toward the affected ear ; place water-proof pad and drainage receptacle under the affected ear.

o    Check that the temperature of the irrigant is 98ºF.

o    Determine that the tympanic membrane is intact before beginning the otic irrigation.

o    Straighten the ear canal and gently insert the syringe tip into the auditory meatus; direct the solution slowly and steadily along the wall of the canal (*to avoid damaging the tympanic membrane).

o    Use no more than 50 to 70 ml at one time.

o    Dry the outside of the ear with cotton balls after the solution drains. Place a dry cotton ball in the auditory meatus lightly to absorb remaining excess fluid.

o    Assist the patient to a side-lying position on the affected side for further drainage.

o    Assess for discomfort.

Administration of Ceruminolytics:

o    Moisten a cotton ball with medication before insertion. Do not use a swab because it might cause trauma to the inner ear.

o    Avoid touching ear with dropper.

o    Flush ear gently with warm water, using a soft rubber bulb ear syringe within 30 mins. after instillation to remove cerumen.

o    Keep container tightly closed and away from moisture.

ü  Assess the patient for hypersensitivity reactions.