The ear is made up of four parts: the external, outer, middle, and inner ears. The external ear is composed of the pinna (outer projecting part of the ear) and the external auditory meatus or opening of the ear canal. Synonyms for the pinna are auricle and ala. The term outer ear refers primarily to the external auditory canal. This is the space between the external auditory meatus and the tympanic membrane (eardrum). The middle ear is composed of the tympanic cavity, which is the space that begins with the tympanic membrane and ends with the oval window. Included in the middle ear are three bony structures of the mastoid bone—the malleus (“hammer”), incus (“anvil”), and stapes (“stirrup”)—as well as the auditory or eustachian tube. The inner ear includes the cochlea and semicircular canals. The ear and its associated structures are illustrated in Figure 58-1.

Disorders of the ear can be categorized according to the portion of the ear affected. External ear (pinna) disorders are generally the result of physical trauma to the ear and consist of lacerations or scrapes to the skin and localized infection of the hair follicles, which often causes the development of a boil. These disorders also tend to be self-limiting and heal with time. Other examples of external ear disorders are contact dermatitis, seborrhea, and psoriasis, as evidenced by itching, local redness, inflammation, weeping, or drainage. These conditions usually respond to the same topical medications used for any other local skin disorders, as discussed in Chapter 56. However, symptoms such as drainage, pain, and dizziness are sometimes also the first signs of a more serious underlying condition (e.g., head trauma, meningitis) and warrant prompt medical evaluation. Medications for disorders affecting the outer ear (ear canal) and middle ear are the focus of this chapter. Diseases of the inner ear involve highly specialized medical practices that are beyond the scope of this book.

The most common disorders affecting the outer and middle ear are bacterial and fungal infections, inflammation, and earwax accumulation. Such disorders are often self-limiting, and treatments are usually successful. If problems persist or are left untreated, however, more serious problems such as hearing loss may result. Infections affecting the ear canal are known as otitis externa, whereas those affecting the middle ear are known as otitis media (OM). OM is a common disease of infancy and early childhood. It is often preceded by an upper respiratory tract infection. It may also occur in adults, but it is then generally associated with trauma to the tympanic membrane. Foreign objects and infection or inflammation associated with water sports are the usual sources of such trauma. In adults, the condition is also more likely to manifest as otitis externa, involving the ear canal and/or external tympanic membrane. Common symptoms of both otitis media and otitis externa are pain, fever, malaise, pressure, a sensation of fullness in the ears, and impaired hearing. If the condition is left untreated, tinnitus (ringing in the ears), nausea, vertigo, mastoiditis, and even temporary or permanent hearing deficits may occur.

OM is the second most common infection in children, accounting for more than 20 million physician visits annually. Medical management of OM is debated among the medical community, primarily due to the increased incidence of antibiotic resistance. Because of these concerns, treatment of OM has significantly changed over the last decade. In 2004, the American Academy of Pediatrics published guidelines based on expert opinion and a thorough review of the literature. A growing number of physicians do not recommend antibiotic treatment in children with mild OM without a fever (or with minimal fever). More emphasis is now given to observation and close follow-up. Many parents have concerns regarding this option. If a decision is made to treat with an antibiotic, amoxicillin should be the first-line drug for most children. If the patient fails to respond within 48 to 72 hours, the patient must be reassessed. If no antibiotics were given initially, they should be started or the initial antibiotic may need to be changed. Antibiotics are discussed in Chapters 38 and 39.

Antibacterial and antifungal otic drugs are often combined with steroids to take advantage of the antiinflammatory, antipruritic, and antiallergic effects of the latter drugs. These drugs are used to treat outer and middle ear infections. Because they all work and are dosed very similarly, four products are profiled together here. Systemic antibiotics are also commonly prescribed for these conditions (e.g., amoxicillin; see Chapter 38), either alone or in addition to the otic drugs described in the following sections. Tables 58-1 and 58-2 list several commonly used products and their component amounts. These drugs are pregnancy category C.

Stay updated, free articles. Join our Telegram channel

Join