Ear Disorders - Pharmacology

The ear consists of three parts: the external, middle, and inner ear. The external ear consists of the pinna and the external auditory canal that transmits sound to the middle ear. The middle ear has an air-filled cavity that contains auditory ossicles, which are the malleus, incus, and stapes. The auditory ossicles forward the sound to the inner ear where the eardrum is located. Pressure on both sides of the eardrum is equalized by the eustachian tube that connects to the nasopharynx. The eardrum could rupture if pressure becomes unequal. The inner ear also contains a series of canals called the labyrinths that are made up of the vestibule, cochlea, and semicircular canals. The vestibule maintains equilibrium and balance and the cochlea is the principal hearing organ.

Common ear disorders are cerumen (ear wax) impaction, otitis external, otitis media (infections of the external and middle ear), and vestibular disorders of the inner ear.

CERUMEN IMPACTION

Cerumen (ear wax) is produced by glands in the outer portion of the ear canal. Cerumen moves down the canal to the external os (opening) where the cerumen is washed away. When this process fails, cerumen becomes impacted and must be loosened by using ceruminolytics such as a hydrogen peroxide solution (3% diluted to 1/2 strength with water). The ear canal is irrigated with ceruminolytics, which flushes cerumen deposits out of the ear canal. Patients who have chronic cerumen impaction are treated with drops of olive oil or mineral oil or by Cerumenex and Debrox. Cerumenex is available by prescription and Debrox is an over-the-counter medication.

OTITIS EXTERNA AND OTITIS MEDIA

Otitis externa and otitis media are infections of the external and middle ear, respectively. These disorders are treated with analgesics and antibiotics. Antibiotics are discussed in Chapter (Antimicrobials Fighting Infection) . Analgesics are discussed in Chapter (Narcotic Agonists) . Table (Common medications used to treat ear infections) contains commonly used antibiotics for ear infections. Most ear infections are caused by a virus and should not be treated with an antibiotic.

VESTIBULAR DISORDERS

The most frequently reported symptoms of vestibular disorders are dizzi-ness, unsteadiness or imbalance when walking, vertigo, and nausea. These symptoms may be quite mild, lasting minutes, or quite severe, resulting in total disability.

Because the vestibular system interacts with many other parts of the nervous system, symptoms may also be experienced as problems with vision, muscles, thinking, and memory. In addition, people with vestibular disorders may suffer headache and muscular aches in the neck and back, increased tendency to suffer from motion sickness, and increased sensitivity to noise and

Common medications used to treat ear infections.

TABLE : Common medications used to treat ear infections.

bright lights. Patients with vestibular disorders often report fatigue and loss of stamina and an inability to concentrate. Difficulty with reading and speech may occur during times of fatigue. When these symptoms are constant and disabling, they may be accompanied by irritability, loss of self-esteem, and/or depression. Meniere’s disease, labyrinthitis, and inner ear infections should cause vestibular disorders.

EAR PAIN

Ear pain usually resolves itself between 48 and 72 hours from the onset of the pain. However, analgesics such as acetaminophen or ibuprofen should be administered to relieve the pain in the interim.

EAR CONGESTION

Ear congestion can be caused by the improper drainage of the eustachian tube. This can be relieved by administering antihistamine-decongestant medications such as Actifed, Allerest, Dimetapp, Drixoral, Novafed, Ornade, and Triaminic, all of which are available over the counter.


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