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:

Assess the patient for hearing loss, pain and ear drainage. 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 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 98F. 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.

Assess the patient for hypersensitivity reactions.