Overview
This lecture covers drug therapy for ear disorders, focusing on the causes, symptoms, and treatment of otitis externa and otitis media, and outlines nursing considerations for patient care.
Types and Causes of Ear Disorders
- Otitis externa ("swimmer's ear") is inflammation of the external ear, often caused by moisture, trauma, or allergic reactions.
- Necrotising otitis externa is a severe, invasive infection of the external auditory canal and skull, potentially fatal if untreated.
- Otitis media is inflammation of the middle ear, more common in children, often due to upper respiratory infections, allergies, or eardrum perforation.
Clinical Manifestations
- Otitis externa: pain, discharge (watery or pus), possible hearing loss.
- Otitis media: pain and diminished hearing.
- Necrotising otitis externa: involves deep tissue and can be life-threatening.
Drug Therapy
- Otitis externa: treated primarily with topical agents (ear drops), including neomycin/polymyxin B/hydrocortisone.
- Severe or widespread infections may require systemic (oral or IV) antibiotics.
- Otitis media: treated with systemic drugs, mostly oral amoxicillin; cephalosporins for penicillin-allergic patients.
- Necrotising otitis externa: treated with systemic fluoroquinolones, with ciprofloxacin as the drug of choice.
Supportive Medications and Considerations
- Pain and fever often managed with analgesics such as acetaminophen or ibuprofen (avoid aspirin in children due to Reye's syndrome).
- Avoid NSAIDs (like ibuprofen or aspirin) in patients with GI issues or hypersensitivity.
- Acetaminophen should be used cautiously in patients with liver problems.
Patient and Nursing Education
- Complete the full course of antibiotics unless a severe reaction occurs.
- Take antibiotics with a full glass of water.
- Do not insert objects (e.g., Q-tips) into the ear; use earplugs when swimming and dry ears thoroughly after water exposure.
- Report severe side effects (e.g., rash, severe itching, hearing loss, tendon pain) to a healthcare provider immediately.
- Ciprofloxacin should not be taken with dairy, calcium-fortified juices, antacids, zinc, or iron within two hours; feeding tube feedings should be paused around administration.
- Monitor for adverse effects: GI upset, dizziness, headache, photosensitivity, and signs of allergic reaction.
Key Terms & Definitions
- Otitis externa — inflammation of the external ear canal (swimmer's ear).
- Necrotising otitis externa — invasive infection of external ear canal and skull (malignant otitis externa).
- Otitis media — inflammation of the middle ear.
- Otalgia — ear pain.
- Otorrhea — ear discharge.
- Ototoxicity — drug-induced damage to the ear/hearing.
Action Items / Next Steps
- Review drug cards for ciprofloxacin, amoxicillin, and neomycin/polymyxin B/hydrocortisone combination drops.
- Read Box 60.2 ("Patient Teaching Guidelines for Ciprofloxacin") in your textbook.
- Be prepared to implement patient teaching and nursing process steps for otitis externa and otitis media.