Chapter 58: Otic Drugs – Ear Infections & Inflammation

The pharmacology chapter detailing otic drugs provides an overview of ear anatomy—including the outer, middle, and inner structures—to contextualize disorders such as otitis externa (external canal infection) and otitis media (middle ear infection). Otitis media is described as the second most common infection in Canadian children, with roughly 75% experiencing an episode before school age. General symptoms shared by ear infections include pain, malaise, fever, a feeling of pressure or fullness, and impaired hearing, which, if untreated, could potentially progress to tinnitus, vertigo, or mastoiditis. Treatment relies primarily on otic drugs applied topically to the ear canal. These topical medications are categorized as antibacterials, antifungals, anti-inflammatory agents, local analgesics, and wax emulsifiers. Many anti-infective products are combined with corticosteroids, such as hydrocortisone or dexamethasone, to maximize anti-inflammatory, antipruritic, and anti-allergic effects. A critical consideration for drug selection is the integrity of the tympanic membrane: products containing neomycin, polymyxin B, or certain antifungals (like clioquinol with flumethasone pivalate) are contraindicated if the eardrum is perforated due to the risk of ototoxicity, though drugs like ciprofloxacin and dexamethasone combinations may be used. For managing impacted cerumen (earwax), carbamide peroxide is a commonly used emulsifier that functions by releasing oxygen, creating a foaming (effervescent) effect to mechanically loosen and release the wax for subsequent irrigation. When administering drops, the nurse must ensure the solution is at room temperature to avoid stimulating the vestibular system, which can cause vomiting and dizziness. Correct technique requires pulling the pinna up and back for adults, but down and back for children younger than 3 years of age. Patient instruction should emphasize that cotton swabs or ear candling procedures should be avoided, as these practices can push wax deeper into the canal and potentially cause infection or damage.