139 - Topical Therapies of External Ear Disorders

Abstract

Topical therapies for external ear disorders are among the most commonly prescribed medications for pediatric and adult patients who present to an otolaryngology office. The local delivery of antibiotic and antiinflammatory medications to the external ear has several advantages over systemic therapies, including (1) ease of patient use, (2) increased concentration of drug levels in the affected region, (3) decreased systemic side effects and (4) lower cost. Topical agents are commonly used for bacterial, fungal, and dermatologic external ear disorders. Caution must be taken with regard to middle ear penetration and inner ear injury; however, select medications may be safely applied in the setting of tympanic membrane perforations and tympanostomy tubes. Although historically, local therapy has primarily been used for external ear disorders, newer gel-based therapy for otitis media has been developed for use via tympanostomy tubes and is currently being studied for transtympanic delivery. This chapter provides an evidence-based discussion of topical therapy for external ear disorders as well as emerging treatment for middle ear disorders. Specific disease categories discussed include bacterial otitis externa, fungal otitis externa, eczematoid otitis externa, viral infections of the external ear, cerumen impaction, chronic otitis externa, acute otitis media, and otitis media with effusion.