Chapter 15: Medicines optimization: ensuring quality and safety
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Otic administration
Definition
Related theory
Drugs administered via this route are intended to have a localized effect and act within the anatomy of the ear and auditory canal (Aldridge [4]). Ear preparations can be presented in the form of drops, sprays, ointments or solutions. Certain factors can affect the absorption or action of drugs in the ear, including ear wax and the acidic environment around the ear skin's surface.
Evidence‐based approaches
The internal structures of the ear are very sensitive to temperature extremes and so solutions should be administered at room temperature. When drops are instilled cold, patients may experience vertigo, ataxia or nausea (Chernecky et al. [39], Perry [281]). Solutions should never be forced into the ear canal as medication administered under pressure can injure the eardrum. The ear drop solution should be labelled to indicate the ear it is intended to treat.
The dropper should be held as close to the ear as possible without touching to reduce the risk of cross‐infection. Some ear drops are highly coloured and can stain skin and the patient's clothing. Care should be taken to minimize excess liquid running out of the ear and causing staining. The use of a tissue to catch excess liquid is usually sufficient. In addition, although ototoxic drugs such as gentamicin are safe to use in ears with an intact tympanic membrane, they should not be used if the membrane is perforated (BNF [25]).
Pre‐procedural considerations
Specific patient preparation
The ear should be examined, taking note of any discharge, redness or swelling, and the amount and texture of any ear wax present, as these will give an indication of the general health of the ear (Rotherham NHS Foundation Trust [308]). The patient's current level of hearing should also be ascertained. It should be explained to the patient that they must lie still during the procedure as sudden movements could cause injury from the ear dropper.
Procedure guideline 15.10
Medication: ear drop administration
Post‐procedural considerations
Ask the patient to report any changes in order to monitor the effectiveness of the intervention. Consideration should also be given to the patient's hearing aids (where relevant) and assistance should be given to help clean these. Check for any irritation and/or pain of the meatus.
