Sometimes in our opd we keep patients aside and talk about ear drops (we means ENT specialist and Patients relatives ) and this talk is very frequent next only to how to clean our ear).
People having minor itching in the ear to the people hearing less- everybody want to quick fix the things with magical ear drop. If I mildly, jokingly or sometimes with force refuse the request to write the ear drops for relatives there is always a helping chemist to amuse them with the one perfect for the need.
So there are things which really don’t need an ear drops but at times it is absolutely necessary to talk about ear drops not to just prescribe the one.
Almost every one will agree that to be effective medicine should reach to the site of infection, so ear drops must also be delivered to the site of infection which is external ear canal in case of otitis externa & wax and middle ear in case of otitis media. Almost all cases of ototopical therapy failure are due to inadequate drug delivery.
Topical drug delivery can be improved in a number of ways–
Steps followed by the ENT professionals-
Hands should be cleaned with disinfectant.
Careful cleaning of ear (aural toilet) is prerequisite. The external auditory canal should be mopped dry prior to instillation of ear drops.
If too much of thick secretion is present irrigation of the external auditory canal with a small bulb syringe can be done before instillation of ear drop.
In case of refractory acute otitis media with tympanostomy tube fenestrated otowicks may be used to allow drainage and ventilation of the middle ear. Ear wicks of ribbon gauze may also be used in case of otitis externa.
In cases of failure to respond to drug health care provider should always keep in mind the possibility of diabetes, mastoiditis, cholesteatoma or MRSA ( methcillin resistant ) or immunocompromized status.
Steps to be explained to the patients
1. Wash hands with soap and water.
2. Clean outer part of the ear very gently ( do not use cotton buds inside the canal)
3. Shake the bottle well for 10 seconds to thoroughly mix
4. The patient should preferably be lying down with the affected ear up
5. Ear should be gently pulled backward and upward to straighten the canal to provide a linear path into middle ear (child younger than 3 years of age, pull backward )
6. Instill the number of drops in the ear as recommended.
7. Shake the ear and by one finger repeatedly press and release the tragus (small elevated part in front of the ear) to help better delivery of ear drops.
8. Keep the treated ear in the upright position for an average of 5-10 minutes (the longer, the better) after ear drops are instilled.
One thing I never fail to warn my patient with ear wax not to try to clean the wax by themselves after putting the drops however tempting it may be as wax may be further pushed inside and become impacted.
In case you experience pain or giddiness following an use of ear drop report to your doctor.