Otic

Question 1

Otic Treatment

Answer 1

-Treat local conditions/disease in the outer ear
EX: Build up of cerumen, infections, inflammation, and pain
-Outer ear includes ear canal and visible parts of the ear
-Inner ear conditions are treated systemically (everything behind ear drum)

Question 2

3 Barriers

Answer 2

1. Tympanic membrane (ear drum)
2. Round window
3. Blood-labyrinth barrier

Question 3

Round Window Membrane (RWM)

Answer 3

• Separates middle and inner ear
• Function: passage of drug from middle to inner ear
• Permeable primarily to low MW molecules
• Drug lipophilicity and charge also affect ability to diffuse this barrier

Question 4

BLB

Answer 4

• Separates the systemic circulation (blood) from the inner ear
• Function: maintains micro-homeostasis of the inner ear fluid, biochemical barrier with efflux pump systems

Question 5

Similarities to Ophthalmics

Answer 5

• Dosed in small volumes (5-15 mL)
• Has sterile dropped if needed
• Sterile necessary

Question 6

Differences to Ophthalmics

Answer 6

-Generally contains preservatives (depends on vehicle)
-May or may not be isotonic
-Vehicles = hygroscopic (removes moisture that increases microbial growth
-Vehicles are viscous, maximizes contact times
EX: anhydrous glycerin or propylene glycol

Question 7

Viscosity

Answer 7

• Helps medication not run out of ear as quickly

- Therefore increases contact time in ear canal

Question 8

Can ophthalmics be used in the ear?

Answer 8

Yes! BUT not vice versa

Question 9

Ear Wax

Answer 9

• AKA cerumen
• Waxy oil made from glands in ear canal
• Dry to become sticky, semisolids that can cause pain, itching, and impaired hearing
• Problem in the southwest, arid countries, and those with genetic predispositions
• Keep soft to allow for ear to clean itself (mineral oi, veggie oil, humectants (glycerin)
• Want to prevent excess cerumen accumulation

Question 10

Cerumolytic Treatment

Answer 10

-Drops that act as surface surfactant
-Emulsify cerumen for removal
EX: Debrox drops - carbamide peroxide, released oxygen when in contact with wax, disrupts its integrity for removal

Question 11

Otitis Externa

Answer 11

• Inflammation in ear canal

- Usually from trapped water and increased bacterial growth

Question 12

Otitis Externa Treatment Options

Answer 12

1. Acidify ear canal and dry out

2. Inhibit bacterial growth

Question 13

Otitis Media

Answer 13

• Inflammation of middle ear
• Cause: dysfunction of Eustachian tubes commonly
• Generally treat with systemic antibiotics
• Can use analgesic drops for local pain

Question 14

Proper Ear Drop Use

Answer 14

1. Wash hands thoroughly
2. Warm bottle before use in HANDS
3. Suspension? SHAKE!
4. Tilt head to side or lay down
5. Hold earlobe (Up and back for adUlts, or Down and back for chilD)
6. Administer correct amount
7. Replace cap or dropper
8. After administration, try to wait at least 5 minutes
9. Wait 5-10 minute between ears
10. Use cottonball to decrease neck leakage

Question 15

Ear Drop Precautions

Answer 15

-Burst eardrum? Stinging!
-Antibiotics may be prescribed prophylactically for swimming, especially in lakes/rivers
-Consider antibiotics that don’t become acidic overtime to minimize stinging
EX: Cortisporin Otic Suspension pH sits at 4.8-5.1 ideally, generics sit at about 3-3.5, brand buffered to higher pH (doesn’t <4.1)