Med classes Ears- Quiz 1

Question 1

What is Otitis Externa? (OE)

Answer 1

-“SWIMMERS EAR”
- Acute, painful inflammation of the external auditory canal
-Occurs when there is a breakdown in
acidic environment and cerumen
(Cerumen is bacteriostatic/ protects epithelium against overhydration)
-Occurs from: abrasions, water, maceration, or loss of acidic environment in the ear canal
-Organisms can invade BOTH intact and damaged epithelium
-Hearing aids, ear plugs, ear phones, can predispose

Question 2

What meds are used for Otitis Externa?

Answer 2

-Antibiotic-Corticosporin combo:
1. Corticosporin
2. Pediotic
3. Ciprodex
4. Cipro HC

NOTE– nearly 35% of the population is allergic to neomycin

Question 3

What else can you give for OE?

Answer 3

1. Antibiotics alone:
   Gentamycin, Ofloxacin
2. Acid or Alcohol drops:
   Otic Domeboro, Burow’s Otic, VoSol, VoSol HC

Question 4

Corticosteroid Otic Meds
(MOA)

Answer 4

1. MOA:Hydrocortisone decreases inflammation (exact MOA unknown)

Question 5

Otic Aminoglycoside Abx
(MOA)

Answer 5

-Neomycin, Gentamycin
1.MOA: effective for Gram - AND +

Question 6

Otic Polymixin Abx
Effective for

Answer 6

-Polymyxin B
1. MOA: Effective for Gram -

Question 7

Antibitoic + Corticosteroid combo

Answer 7

-Pediotic, Corticosporin, -Coly-Mycin S otic, Ciloxin HC
1. Use: Infection + inflammation, FIRST LINE DRUG d/t duel properties
2. ADE: ototoxicity may occur with prolonged use

Question 8

Otic Fluoroquinolones

Answer 8

-Ciproflaxacin
1. MOA: effective for Gram -
(Known for good abx coverage but no steroid in it)
2. ADE: can cause taste alteration,
dizziness, vertigo, and paresthesias

Question 9

Acid Solutions

Answer 9

-Otic Domeboro, Burow’s Otic
1. MOA: Decrease inflammation and are antibacterial and antifungal

Question 10

What medication is CONTRAINDICATED if tympanic membrane is perforated?

Answer 10

-CORTICOSPORIN
-This is due to possibility ototoxicity because it contains neomycin

Question 11

What medication is OKAY if tympanic membrane is ruptured?

Answer 11

-CIPROFLAXACIN

Question 12

Acute Otitis Externa Pathogens

Answer 12

-Canal is swollen and full of discharge
-Usual pathogen= GRAM NEG ROD:
(Pseudomonas most common)
-Mycotic (fungal) OE less common
-Small abscess from staph aureus or strep pyogenes (from dirty fingers)

Question 13

What should you do first with Otits Externa?

Answer 13

-MAKE SURE TYMPANIC MEMBRANE IS INTACT
-If so, clean with warm NS or 3% Hydrogen peroxide
-DO NOT IRRIGATE EAR IF TM IS NOT INTACT

Question 14

What else can you use to treat OE?

Answer 14

1. Topical acid or alcohol solutions if TM is intact:
   -Otic Domeboro, Burow’s Otic, VoSol
   -1:1 vinegar/ rubbing alcohol solution
   -VoSol HC if a lot of inflammation

NOTE–if ear is too swollen use cotton pad with meds to put in the ear for 24-36 hours, recheck in 48 hours

Question 15

Chronic OE

Answer 15

-Can be inflammation or infection
(Psoriasis, Eczema, Seborrhea)
-If patient c/o chronic itching with dry skin elsewhere on the body— 2-3 gtts of baby or mineral oil in canal daily
-If patient has psoriasis in external canal—treat with steroid cream
-Seborrhea is treated with Selenium shampoo and topical steroids
-If EC is markedly inflamed—clean EC of debris and use steroid otic solution 2-3 times/day til swelling decreases

Question 16

Malignant OE
(TERRIFYING)
What is it?
How to treat it?

Answer 16

-Rare, but potentially lethal—caused by Pseudomonas aeruginosa
(occurs in older patients with DM)
-OE extends and invades surrounding
tissues, causing osteomyelitis of the base of the skull and meningitis [and multiple cranial nerve palsies]
-Treat with IV antibiotics—aminoglycoside & Carbenicillin for 4-6 weeks + surgical debridement

Question 17

How do you prevent Swimmers Ear (OE) ?

Answer 17

-Isopropyl ear gtts or 1-2 gtts or rubbing ETOH into the EC after swimming to dry it
-Combination of 1:1 alcohol/ white vinegar

Question 18

What otic solutions can be used for kids if tympanic membrane IS ruptured?

Answer 18

1. Ofloxin solution (kids >6 mo)
2. Ciprodex Suspension (kids > 6 mo)
3. Pediotic Solution (kids > 1 year)

NOTE– the rest of OE meds are contraindicated if TM ruptured

Question 19

Otic Analgesics

Answer 19

• Antipyrine and Benzocaine
• Used for pain relief until systemic antibiotics take effect
  -Use gtts 3-4 times per day or up to
  every 1-2 hours for pain as needed

Question 20

Ceruminolytics

Answer 20

-Mineral oil, Carbamide peroxide Excess wax can cause hearing loss, wax impaction, and environment for OE to develop
-Once wax is soft— irrigate ear with warm water or saline
-If canal excoriated— apply antibiotic or steroid gtt for 7-10 days to prevent the development of OE