Ear Drops Research Articles

Topical ear treatment - options, indications and limitations of current therapy.

Topical otic products form an integral part of the overall management of otitis externa. With an ever increasing array of ear drops and cleaners to choose from, appropriate selection of therapy can be difficult. The investigation of all cases of otitis externa should consider primary and secondary causes and predisposing and perpetuating factors. This article considers topical therapy under these same broad headings and discusses, through literature review, the various properties of the components of the ear cleaning solutions and drops.

Therapeutic effect of Castellani's paint in patients with an itchy ear canal.

To examine the effects of Castellani's paint on symptomatic relief and skin flora in patients with an itchy external ear canal. Subjective pruritus scores, and erythema and desquamation scores, were noted in 61 patients with an itchy external ear canal. External ear canal skin swabs were taken for bacterial and fungal cultures. Patients were then randomly divided into three groups: either Castellani's paint (group one) or steroid ear drops (group two) were instilled, or non-impacted cerumen was removed (group three). Patients were re-assessed at one month after the initial visit. After treatment, subjective pruritus scores were significantly lower in all groups, erythema scores were significantly decreased in group one, and desquamation scores were significantly reduced in groups one and two, when compared with pre-treatment scores. Reproduction density of bacteria including normal flora was decreased in group one. However, the types of bacteria that constitute the normal flora of the external ear canal were unchanged. Castellani's paint can be administered safely, effectively and easily, without affecting the type of external ear canal skin bacteria, in patients with an itchy external ear canal.

Association of use of ear drops and sensori neural hearing loss: Cross sectional study

As we can cure the conductive deafness by surgery, the sensori neural deafness is still a challenge to us. Children having mixed loss of hearing invariably suffer from the point of view of education and development of language and therefore it becomes essential to study such cases so that we can prevent the sensori neural deafness in chronic suppurative otitis media. One hundred patients of chronic suppurative otitis media with sensori neural hearing loss, either alone or more commonly, with mixed loss were studied in this series. The patients were carefully selected after proper history and careful examination to exclude the above mentioned criteria to rule out the other possible causes of sensori neural loss. Though cases with use of ototoxic systemic drugs were rejected, cases with use of topical ear drops were included as their use was found to be common in chronic otitis media. The different ear drops used by patients showed large variety of nature of contents and varying period of use. Many patients could not inform the name of the drops they had used in past. In our study, use of topical antibiotic ear drops for long duration as a cause of sensori neural hearing loss was not statistically significant.

Ear drops for the removal of ear wax

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of ear drops (or sprays) to remove or aid removal of ear wax in adults (aged 18 years and over) and children (aged under 18 years).

Mastoidectomy reconstruction with Sofradex®/bone pâté: is there a hearing effect?

Mastoidectomy reconstruction with Sofradex^®/bone pâté: is there a hearing effect?

Homeopathic treatment of respiratory illnesses in children: results from two randomized trials

These studies were done to determine if homeopathic preparations are useful in the treatment of URI's in children, especially when there are no conventional treatments available and/or antibiotics are to be avoided. In the first study, children 6 months – 11 years old, diagnosed with AOM and managed with a delayed antibiotic approach, were randomized to standard therapy alone or standard therapy plus a homeopathic ear drop preparation. The primary outcome was whether or not an antibiotic prescription given at the index visit was filled; any antibiotic use was a secondary outcome. During the 12–15 day follow-up period, significantly fewer parents of children randomized to the homeopathic ear drops group filled the antibiotic prescription compared to those of children receiving standard therapy alone (26.9% and 41.2%, respectively, P = .032). In the second study, children ages 2–5 years old diagnosed with upper respiratory infection were randomized to receive a homeopathic combination product for cold and cough or a placebo. Parents were instructed to give a dose of study medication as needed for relief of URI symptoms up to 6 times per day for three days. Parents recorded changes in symptoms 1 hour after each dose, as well as changes in overall severity of URI symptoms in twice daily diaries. There was no difference in symptoms one hour after the dose between those receiving the homeopathic preparation compared to placebo. However, the homeopathic group reported a statistically significant improvement in 3 of the 4 URI symptoms at 12 and 24 hours after enrolment as well in a composite cold score. These studies should encourage health care providers to utilize homeopathy as an alternative to conventional therapies in the treatment of URI's in children.

Benzyldimethyl[3-(miristoylamino)-propyl]ammonium chloride stabilized silver nanoparticles (Argumistin™) in medicine: results of clinical trials for treatment of infectious diseases of dogs and perspectives for humans

AbstractIncreased interest in nanosilver during the last 10 years is mainly explained by the emergence and spread of pathogenic microorganisms with multiple drug resistance, including resistance to last-generation antibiotics. In this article, we for the first time, give a description of large-scale clinical trials of a new nanosilver based antibacterial drug [containing two active components: silver nanoparticles (AgNPs) (10–50 ppm) and benzyldimethyl[3-(miristoylamino)-propyl]ammonium chloride (100 ppm)] registered in Russia in 2015 as a veterinary drug under the brand name Argumistin™. This drug has been approved for application in a diluted dosage form – as eye drops, intranasal drops and orally; it has also been approved for application in a more concentrated dosage form (up to 50 ppm of nanosilver) as ear drops and as an antiseptic during demodicosis and gum disease treatment, open wound treatment, etc. We have registered the high therapeutic effectiveness of Argumistin™ during treatment of infectious conjunctivitis, gingivitis, parodontosis and enteritis of dogs. Application of this antibacterial drug gives considerable (up to 70% in case of periodontal diseases) reduction in the treatment period and prevention of complications. The results of clinical trials in the treatment of infectious diseases of dogs makes Argumistin™ a promising candidate for an effective antibacterial drug for human medicine.

Comparison of Boric Acid and Combination Drug of Polymyxin, Neomycin and Hydrocortisone (polymyxin NH) in the Treatment of Acute Otitis Externa.

Acute otitis externa is an inflammation of the external auditory canal known as "swimmer's ear". Direct costs including medical treatment, painkillers, antibiotics, steroids or both and indirect costs are also remarkable. The aim of this study was to compare the effect of boric acid and polymyxin, neomycin and hydrocortisone composition in the treatment of acute otitis externa. This randomized clinical trial was carried out on 80 patients aged more than 17-year-old who were referred to Kashani hospital clinic with a diagnosis of acute otitis externa by otolaryngologist. The patients were randomly allocated to two groups (A: Boric acid and B: polymyxin NH ear drops) and Painkiller was prescribed and administered orally for all patients and in the presence of fever, cellulitis around the ears and neck adenopathy, broad-spectrum systemic antibiotics were used besides topical treatment. Symptoms of patients who were evaluated by a physician includes pain, discharge from the ear, swelling of the ear canal, auricle swelling, tenderness, and ear itching. In addition, pain was evaluated in patients and was recorded by Macgill Pain Questionnaire, in the first, third, seventh and tenth days. Results showed that itching on third day (p=0.007) and swelling of the ear canal in the examination of the third day (p=0.006) and the seventh day (p=0.001) in the polymyxin NH group was more than those of boric acid group. Overall mean pain based on McGill questionnaire was 11.10±1.49 in boric acid group in the examination on the first day and was 4.05±0.22 in the examination on the tenth day and in the polymyxin NH group, it was 10.9±0.99 on the first day and 4.20±0.40 on the tenth day. In both groups, pain relief was the same and there was no significant difference between two groups (p=0.075). The findings of this study showed slight differences in the effectiveness of the boric acid drug and combination of polymyxin, neomycin and hydrocortisone in the treatment of patients with acute otitis externa that is of clinical significance.

Is This a Drug?" Answers From Medical Students in a Tertiary Care Teaching Hospital in Eastern India.

World Health Organization (WHO) defines what is drug and what is not. Second year MBBS students learn the principles of Pharmacology that they use in their later clinical practice life. The aim of the survey was to determine how medical students classify a range of preparations they might encounter in their professional lives and whether a brand name or a commercial preparation of a drug would influence their decision in the categorization of the preparation as a 'drug' or 'not a drug'. To assess the knowledge of medical students, if a substance or product is a drug. We surveyed 2 concurrent years of medical students to classify 60 candidate medicinal preparations into "drug" and "not-drug" from a validated questionnaire. The candidate preparations were named either in generic or in their commercially available forms and they were all essential drugs as per WHO definition. The two groups of students, A and B, included 192 and 215 students respectively. Demographically there was little difference in the two groups. Agents like Aspirin, Paracetamol, Amphetamine, Salbutamol, Atropine, Dextromethorphan, Codeine, Diazepam, Ciprofloxacin ear drops, Levonorgestrol, Neosporin eye ointment, Furosemide, Metronidazole, Penicillin, Sorbitrate, Lignocaine, Methotrexate, Penicillin, Zolpidem and Thalidomide received almost unanimous votes as drugs. Arsenic trioxide, Fentanyl and petroleum jelly were considered to be "non-drugs" by most participants. The two groups did not differ significantly in their responses. Some major lacunae were noted in the knowledge of the participating students despite book teaching on the definition of a drug. Drugs used for prophylaxis and those used in physiological conditions or topically, were often missed. These gaps need to be filled by more emphasis on definition of a drug and its clinical applicability based on example and case based studies.

Analysis and expansion ways of the extemporaneous preparations assortment in the republic of Tajikistan

For last twenty years in Post-Soviet states a gradual reduction in the amount of prepared extemporaneous formulations has been observed, many economic entities are reluctant to engage in this type of activity due to a number of regulatory and economic reasons. At the same time in Republic of Tajikistan there is a need to provide, specific for individual patients, medications readily not available in the market.Aim: The purpose of this paper is to analyze prescriptions in compounding pharmacies of the Republic of Tajikistan and search for ways to expand the range of extemporaneous preparations.Methods: The generally accepted analysis of literature sources, range of extemporaneous preparations, methods of synthesis and compilation were employed.Results: The analysis of the compounding preparation formulations was carried out in Tajikistan based on data obtained from the State Inspectorate of the Republic of Tajikistan for 2012. The assortment of extemporaneous preparations is made up of eye and ear drops, nose drops, powders, ointments, solutions for outdoor and indoor use, and drugs for parenteral use.Conclusions: Results of the analysis of pharmacy compounded preparations in Tajikistan confirm the need to revise and update formulations; develop new formulations and introduce modern and more effective active pharmaceutical ingredients. There are prospects for development of extemporaneous prescriptions in palliative care, hormone replacement therapy, medical assistance to athletes, for use in pediatry, geriatry, veterinary, dentistry, dermatology

Direct application of bFGF without edge trimming on human subacute tympanic membrane perforation

ObjectiveTo investigate the feasibility of direct application of basic fibroblast growth factor (bFGF) without edge trimming on human subacute traumatic tympanic membrane perforation (TMP). MethodsA total of 29 patients with traumatic TMPs beyond 1month after trauma were enrolled. Patients were placed into two groups: an observation group (n=17) and a bFGF-treated group (n=12). The bFGF-treated group was treated by direct application of bFGF, in which the margin of the perforation was not trimmed. All patients were followed at least once per week until the perforation was completely closed or for up to 6months. The closure rate and closure time were estimated. ResultsAt 6months, 11/12 (91.7%) perforations achieved complete closure after bFGF treatment. The mean closure time was 18.1±11.4days (range=3–65days). Purulent otorrhea was found after treatment in five patients, but resolved after oral amoxicillin and ofloxacin ear drops. Of these five patients, four achieved complete closure. However, only 9/17 (52.9%) perforations achieved complete spontaneous closure in the observation group. FGF-treated groups had significantly improved closure rates compared to the observation group (91.7% vs. 52.9%, respectively, P=0.03). ConclusionsAlthough the margin of the perforation was not trimmed, direct application of bFGF on human subacute TMP was feasible, and it could significantly improve the closure rate of the subacute TMPs. The technique was simple and convenient. Thus, direct application of bFGF should be recommended pre-myringoplasty.

Granular myringitis: current status of management

<p class="abstract"><span lang="EN-US">The Granular Myringitis (GM) is not uncommon though in medical literature it has been reported among the rarer conditions. The aim of this article is to review the clinical features and management of Granular Myringitis (GM). GM is characterized by granulation tissue on the outer surface of the Tympanic Membrane (TM) with or without the involvement of deep bony External Auditory Canal (EAC). The granulations are either localized or diffuse. The granulations over tympanic membrane continue to grow slowly for years. The ensuing fibrosis in patients with granulations of deep bony meatal wall can result into an atresia of the deep bony EAC. The presenting symptom of GM is an ear discharge which may be foul-smelling. However many patients have a sensation of fullness, irritation, mild pain or itching in the ear. If perforation occurs the underlay perichondrium or temporalis fascia grafting is done. In some of the refractory cases granulations are removed and the raw area is covered with skin. Many patients respond well to meticulous microscopic aural toilet and topical antibiotic and steroid ear drops. If patients do not respond then application of topical caustic agents are employed.</span></p>

Radiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management.

To document our experience with osteoradionecrosis (ORN) of the temporal bone. Retrospective case review. Tertiary care medical center. Patients who developed exposed necrotic bone of the external auditory canal after radiation therapy to the head and neck. Temporal bone ORN was managed conservatively in all patients with a combination of systemic antibiotics, antibiotic ear drops, and in-office debridement. Three patients required surgery, two of which were for a cholesteatoma. The need for surgical intervention in the management of ORN. Twenty-three patients with ORN of the temporal bone comprise the study group. The average age of patients at the time of diagnosis was 58 years (range, 34-75 yr). The parotid gland was the most common primary tumor site (n = 10). The mean lag time from completion of radiotherapy to diagnosis of ORN was 11 years (range, 2-48 yr). The most common presenting symptom was hearing loss (n = 18), followed by tinnitus (n = 13) and otorrhea (n = 13). All 23 patients were managed conservatively with antibiotic therapy and in-office debridement of necrotic bone. None of the patients required temporal bone resection and/or free-flap reconstruction. ORN of the temporal bone is a rare adverse event that can occur after radiotherapy for a variety of neoplasms of the head, neck, and central nervous system. Conservative management, which includes directed antibiotic therapy and regular in-office debridement of necrotic bone, can adequately control the disease process and symptomatology, thus avoiding more invasive surgical interventions.

FDA taking action against unapproved ear drops

FDA taking action against unapproved ear drops

Utility of the auditory brainstem response evaluation in non-clinical drug safety evaluations

IntroductionThe Food and Drug Administration (FDA) requires thorough evaluation of the potential safety hazards of all new drugs, food additives, and therapeutic devices that are intended for human use. Drugs that are otically administered (i.e., ear drops), or are known to systemically distribute to the inner ear, require additional specialized safety testing to ensure that the drug does not permanently impair auditory function. MethodsTo properly determine a drug's impact on auditory function, the FDA's Center for Drug Evaluation and Research requires the use of the Auditory Brainstem Response (ABR) evaluation. The ABR evaluation uses auditory stimuli evoked potentials to assess function by establishing minimum intensity thresholds. These thresholds can be monitored following drug treatment to determine an impact on hearing loss. This review discusses methodical considerations for conducting ABR evaluations as they apply to specialized drug safety studies. Alternative assays are discussed and compared to the utility of the ABR evaluation. Conclusions: The ABR evaluation provides reliable and sensitive measures of hearing function that are suitable for definitive drug safety evaluations or hazardous risk assessments.

Ear drops best for otorrhoea in children with grommets

Ear drops best for otorrhoea in children with grommets

Update on Vestibulotoxicity: How can we Recognize and Prevent it

Drugs and other substances may cause irreversible damage to the inner ear. The term vestibulotoxicity refers to the toxic effect on the peripheral vestibular system and is usually caused by damage to the hair cells of the semicircular canals and otolithic organs. The devastating consequence of vestibulotoxicity is bilateral peripheral vestibular loss, including the phenomenon of oscillopsia. Parenterally administered streptomycin and gentamicin are the most common cause of vestibulotoxicity. There are few descriptions of other potentially vestibulotoxic drugs and substances, including cisplatin, solvents, organophosphate poisoning and others. Analysis of the literature shows weak evidence for true vestibulotoxicity. Unilateral vestibulotoxicity has been described after the use of ear drops containing gentamicin and, interestingly, also after parenteral use of gentamicin. We here present an updated review of vestibulotoxicity, and suggest the appropriate investigation for suspected unilateral and bilateral vestibular loss.

Development and Validation of Advance Simultaneous Equation Methods for Lidocaine Hydrochloride and Clotrimazole in Ear Drop

A simple, accurate and precise spectroscopic method was developed for simultaneous estimation of Lidocaine Hydrochloride and Clotrimazole in Ear Drop by Advance simultaneous equation method. A zero order spectrum was recorded and convert in ratio second order derivative. The Lidocaine Hydrochloride shows max absorbance at 243.20 nm and Clotrimazole show max absorbance at 225 nm. The method was found to be linear (r2>0.999) in the concentration range of 20–100μg/ml for Lidocaine Hydrochloride and 10–50μg/ml for Clotrimazole. The limit of determination was 0.2498μg/ml and 0.0837μg/ml for Lidocaine Hydrochloride and Clotrimazole, respectively. The limit of quantification was 0.7570μg/ml and 0.2537μg/ml for Lidocaine Hydrochloride and Clotrimazole, respectively. The accuracy of this method was evaluated by recovery studies and good recovery result was obtained greater than 99%. The method was successfully applied for simultaneous determination of Lidocaine Hydrochloride and Clotrimazole in Ear Drop.

Observations on the current bacteriological profile of chronic suppurative otitis media in South eastern Nigeria.

Background:Chronic suppurative otitis media (CSOM) is a disease well-known for its recurrence and persistence despite treatment. The situation is compounded by the increasing resistance to antimicrobial agents by bacteria these days.Aim:This study was carried out to examine the current local bacteriological profile of CSOM and to compare the profile of either ear in bilaterally discharging ears.Materials and Methods:We carried out a retrospective analysis of ear swab cultures from 133 unilateral and 73 bilateral consecutive tubotympanic CSOM cases seen at the Ear-Nose-Throat clinics of a referral health institution during a 4 year period ending 2013. Sensitivities to eight locally available antibiotics were analyzed. Aerobic bacterial isolates were analyzed separately for the unilateral and bilateral cases. Comparison was made between the ears in the bilateral cases.Results:We analyzed 279 ear swab culture results from 206 patients with age ranging from 5 months to 86 years and a mean of 21.3 (19.5) years. Pseudomonas aeruginosa was the most common isolated bacteria (44% [109/250]) followed by Staphylococcus aureus (17% [42/250]), and Proteus Mirabilis (15% [38/250]). The most and least sensitive bacteria were Klebsiella Spp and Escherichia Coli, respectively. The most effective antibiotics were gentamicin and ciprofloxacin. The two ears differ significantly in the rates of isolation of S. aureus and E. coli (P = 0.01 and P = 0.04, respectively).Conclusion:Pseudomonas is the most common bacteria involved in CSOM in this part of the country. Ciprofloxacin as ear drops is recommended as first-line drug in the management of active CSOM as it is cheap, less ototoxic, and locally available. Separate ear swab culture should be obtained in bilateral CSOM.

Analysis of ofloxacin in ofloxacin ear drops by microfluidic chip coupled with contactless conductivity detection.

A method using a microfluidic chip coupled with contactless conductivity detection (C(4)D) is demonstrated for the determination of ofloxacin in Ofloxacin Ear Drops. Settings, optimizing procedures, electrophoresis conditions, regression equations, and the average recovery rate are discussed. Under optimum conditions, the determination of ofloxacin in standard solution is achieved within 1 min, which allows detection of ofloxacin in Ofloxacin Ear Drops. The demonstrated method is rapid, high efficient, sensitive, and economical.