Drug Therapy For Disorders of the Ear

An 82-year-old resident of a long-term care facility has been diagnosed with necrotizing otitis externa. The nurse who provides care at the facility is aware of this resident's complex medical history and should recognize what risk factor that may have predisposed the resident to this disease? A. The resident has a diagnosis of type 2 diabetes B. The resident takes calcium and vitamin D supplements for the treatment of osteoperosis C. The resident was recently treated with antibiotics for an upper respiratory infection D. The resident has atrial fibrillation (NCLEX THE POINT)

ANSWER: A → Malignant necrotizing otitis externa most commonly affects elderly patients with diabetes mellitus and patients with the human immunodeficiency virus. Osteoperosis, atrial fibrillation, and recent antibiotic use are not risk factors for necrotizing otitis externa

Which of the following medications is administered for otitis externa & otitis media? A. ofloxacin (Floxin Otic) B. Burow's solution C. benzoyl alcohol D. Acetic acid as VoSoL Otic (NCLEX SUCCESS)

ANSWER: A → Ofloxacin (Floxin Otic) is administered for otitis externa and otitis media.

A 5-year-old child has been brought to the clinic with signs and symptoms that ate consistent with otits externa. What assessment question is most likely to address the etiology of this health problem? A. "Has he been swimming a lot in the last little while?" B. "Are all of his immunizations up-to-date?" C. "Has he been spending quite a bit of time around animals lately?" D. "How would you describe his overall level of hygeine? (NCLEX THE POINT)

ANSWER: A → Otitis externa in children is often attributable to moisture in the ear, often as a result of swimming. Poor hygiene, interaction with animals, and lack of immunications are not likely to be relevant factors.

An older adult with necrotizing otitis externa has been receiving IV ciprofloxacin and is now transitioning to the oral form of the drug. What health education should the nurse provide to the patient? A. "You can take this medication with food to reduce the chance that it will upset your stomach." B. "Try to avoid foods like aged cheese, red wine, and dark chocolate until you're finished with your course of antibiotics." C. "You should take this medication once per day, ideally first thing in the morning." D. "Try to increase your intake of calcium-rich foods while you're taking this drug." (NCLEX THE POINT)

ANSWER: A → Patients may take the oral preparation of Cipro with food to reduce GI upset. Concurrent use of calcium is contraindicated, and the drug is normally ever 12 hours. There is no need to avoid foods like aged cheese, red wine, and dark chocolate.

Which of the following nursing actions should be implemented when instilling eardrops? A. Tilt the head toward the opposite shoulder. B. Lay on the affected ear after instillation. C. Apply the medication on a cotton ball and insert in the outer auricle. D. Apply ear plugs after instilling ear drops. (NCLEX SUCCESS)

ANSWER: A → When instilling ear drops in the affected ear, tilt the head to the opposite shoulder.

A patient has received a diagnosis of acute otitis externa and been prescribed a combination otic solution. The nurse should teach the patient that this medication contains which of the following components? Select all that apply. A. An antibiotic B. A steroid C. An antiseptic D. An NSAID E. A topical anesthetic (NCLEX THE POINT)

ANSWER: A, B, & C → The otic solutions most commonly prescribed for acute otitis externa are combination solutions. These medications contain an anti-infective agent and antiseptic, glucorcticoid, and acidifying agent. They do not typically contain anesthetics or NSAIDS.

A woman is taking oral ciprofloxacin for necrotizing otitis externa. When she takes the ciprofloxacin, which of the following foods should be eliminated from her diet? A. Cranberry juice B. Calcium-enriched orange juice C. Bread D. Turkey (NCLEX SUCCESS)

ANSWER: B → A patient who is taking ciprofloxacin should not eat calcium-fortified juices, dairy products, iron, zinc, and cal- cium products along with antacids.

A 40-year-old man sought care because of several days of worsening otalgia that was accompanied by purulent discharge. He was subsequently prescribed Cortisporin Otic. The nurse should teach the patient that he should not exceed the maximum duration of treatment, which is how many days? A. 7 days B. 10 days C. 4 D. 14 (NCLEX THE POINT)

ANSWER: B → Adults should instill 4 drops of Cortisporin Otic three to four times daily for no more than 10 days.

The nurse in an extended care facility has instilled medicated eardrops into a resident's left ear as ordered. What instruction should the nurse provide after administering this medication? A. "Let's put your hearing aid back in place." B. "Keep lying on your right side for the next 20 minutes or so." C. "Gently massage your ear until you can hear normally." D. "Try to avoid touching your left ear for the next hour." (NCLEX THE POINT)

ANSWER: B → After instillation of eardrops, the patient should lie on the side opposite the side of administration for 20 minutes. It would be inappropriate to reinsert a hearing aid immediately. It is unnecessary to massage the ear or, conversely, to avoid touching the ear.

A 76-year-old woman is receiving amoxicillin (Amoxil) for acute otitis media. She also has gout. Which of the following antigout medications increases the effect of amoxicillin? A. Allopurinol B. probenecid C. aspirin D. Acetaminophen (NCLEX SUCCESS)

ANSWER: B → Amoxicillin combined with probenecid results in increased effects of the amoxicillin.

A 70-year-old man has been diagnosed with necrotizing otitis media. What is the patient at risk for developing while being treated with ciprofloxacin? A. Edema B. Tendon rupture C. Decreased QT interval D. Chest pain (NCLEX SUCCESS)

ANSWER: B → Older patients who receive ciprofloxacin are at risk for tendon rupture.

Which of the following patients are at risk for the development of otitis externa? A. A patient who wears ear plugs while swimming B. A patient who has hearing loss C. A patient who wears a hearing aid D. A patient with labyrinthitis (NCLEX SUCCESS)

ANSWER: C → A patient who wears hearing aids is prone to the development of otitis externa.

A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform? A. Assess whether the child has ever has tuberculosis skin test B. Assess the child for allergies to salicylates C. Assess the child for allergies to penicillin's D. Assess the child's immunization status (NCLEX THE POINT)

ANSWER: C → Amoxicillin (Amoxil) is the preferred antibacterial agent for the treatment of acute otitis media. Because this medication is a penicillin, it is necessary to assess for allergies to these antibiotics. The child's immunization status, history of TB skin tests, and allergies to salicylates are not central to the child's care.

A patient has been prescribed combination eardrops to treat otitis externa. What nursing action should be performed prior to drug administration? A. Assessing the patient's vestibular function by testing balance B. Irrigating the ear with a 1% chlorhexidine solution C. Removing any excess cerumen from the patient's ear D. Having the patient lie on the side of the infected ear for 15 to 20 minutes (NCLEX THE POINT)

ANSWER: C → If cerumen is present, cleaning of the ear canal with a cotton swab prior to ear drop instillation is important. Irrigation is unnecessary and assessment of balance is not required. The patient should not lie on the affected side prior to administration of eardrops.

A patient has presented with signs and symptoms characteristics of otitis externa and is requesting prescription eardrops. The nurse would recognize that the safe and effective use of Cortisporin Otic would be contraindicated by what variable? A. The patient uses a wide variety of herbal supplements on a daily basis. B. The patient is allergic to penicillin's. C. The patient's infection is thought to have a viral etiology. D. The patient takes oral corticosteroids to treat joint inflammation. (NCLEX THE POINT)

ANSWER: C → Prescribers should not order Cortisporin Otic for viral, fungal, or mycobacterial infections. Herbal supplements are not noted to interact with this medication, and an allergy to penicillin's is not problematic. Concurrent use of corticosteroids is acceptable.

A 2-year-old boy has been diagnosed with an ear infection and the prescriber has chosen to treat the child's infection with Cipro HC, a combination medication that contains ciprofloxacin and hydrocortisone. What is a potential advantage of this medication over Cortisporin Otic? A. It does not require follow-up blood work in a laboratory. B. It is available over the counter but is equally effective as Cortisporin Otic. C. It does not have to be administered as frequently as Cortisporin Otic. D. It can be administered as an oral suspension that has a pleasant flavor. (NCLEX THE POINT)

ANSWER: C → The combination drug Cipro HC contains ciprofloxacin and hydrocortisone. Its twice-daily administration makes it more convenient for parents with young children. Neither Cortisporin Otic nor Cipro HC is available OTC, is available as an oral suspension, or requires blood work.

What is the duration of therapy for neomycin-polymyxin B-hydrocortisone (Cortisporin Otic)? A. 5 days B. 8 days C. 10 days D. 14 days (NCLEX SUCCESS)

ANSWER: C → The duration of therapy with Cortisporin Otic is 10 days. The medication should be stopped after 10 days to prevent the development of resistance to the drug.

A child receives a diagnosis of acute otitis media. His physician orders amoxicillin (Amoxil). Which of the following adverse effects warrants the discontinuation of the medication? A. Onset of diarrhea B. Onset of abdominal pain C. Onset of diminished appetite D. Onset of wheezing (NCLEX SUCCESS)

ANSWER: D → A child who develops wheezing with the administration of amoxicillin (Amoxil) is having an allergic reaction. It is essential that the drug be discontinued and the child taken to the emergency department for an evaluation.

Which of the following assessment Findings reveals that the amoxicillin (Amoxil) is decreasing the symptoms of acute otitis media? A. Retracted tympanic membrane B. Otalgia C. Otorrhea D. Visible cone of light (NCLEX SUCCESS)

ANSWER: D → A visible cone of light on the tympanic membrane reveals a decrease in fluid in the tympanic membrane and a resolving infection.

Which nursing action should be implemented prior to instilling eardrops? A. Evaluate the patient's pain level. B. Assess the amount of hearing loss. C. Instruct the patient to lie on the affected ear. D. Assess if cerumen is visible. (NCLEX SUCCESS)

ANSWER: D → Prior to instilling eardrops, it is necessary to assess the patient's ear for visible cerumen. Removal of the cerumen should occur before giving the eardrops.

The nurse has administered a patient's first scheduled dose of amoxicillin after the patient was diagnosed with acute otitis media. What subsequent assessment finding should prompt the nurse to discontinue the use of this drug? A. The patient states that she has a frontal lobe headache. B. The patient complains of acid reflux. C. The patient states that she feels nauseous. D. The patient complains of shortness of breath. (NCLEX THE POINT)

ANSWER: D → Shortness of breath is suggestive of a hypersensitivity reaction and would likely warrant discontinuation of the drug. Nausea, reflux, and headache should each be addressed, but none likely necessitates discontinuation of drug therapy.

A patient has a diagnosis of otitis media and has just begun antibiotic treatment. The patient complains of otalgia and has asked for medication. The nurse should anticipate the administration of A. Morphine sulfate B. Ketoralac C. Hydromorphone (Dilaudid) D. Acetaminphen (Tylenol) (NCLEX THE POINT)

ANSWER: D → Tylenol is the first-line analgesic for most cases of otalgia accompanying otitis. Opioids and ketorolac are not normally indicated.

Nonnarcotic Analgesic Antipyretic: Adjuvant Medications to Treat Pain and Fever Related to Infections of the Ear

Acetaminophen equivalent to aspirin in analgesic & antipyretic effects. Safe for children. Acts on the hypothalamus to increase vasodilation & sweating. Mechanism of action is unknown. Route: oral or rectal. Alternating acetaminophen and ibuprofen every 4 hours over a 3-day period to control fever in young children (ages 6-36 months) has been shown to be more effective than monotherapy w/ either agent.

Salicylates: Adjuvant Medications to Treat Pain and Fever Related to Infections of the Ear

Aspirin is the prototype. Has ability to inhibit prostaglandin synthesis (inflammatory effect). Believed to act on the thermoregulatory center of the hypothalamus, blocking the effects of the endogenous pyrogens & inhibiting the synthesis of prostaglandins. Route: oral or rectal. To prevent gastric irritation, take the oral preparation w/ food.

neomycin-polymyxin B-hydrocortisone (Cortisporin Otic): Assessing for Therapeutic Effects

Assess for decreased ear pain, itching, & decreased drainage from the ear canal. Assess for signs of hearing loss due to ototoxicity, burning & stinging.

ciprofloxacin (Cipro): Assessing for Therapeutic & Adverse Effects

Assess for diminished pain w/ chewing, otalgia, otorrhea, & patient's renal function during the course of treatment.

The client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder involving this part of the ear? A. Pruritis B. Tinnitus C. Hearing loss D. Burning in the ear (NCLEX SAUNDERS)

B. Tinnitus

The nurse is caring for a hearing-impaired client. Which of the following approaches will facilitate communication? A. Speak loudly B. Speak frequently C. Speak at a normal volume D. Speak directly into the impaired ear. (NCLEX SAUNDERS)

C. Speak at a normal volume

Otitis Media: Pathophysiology

Causes an obstruction of the eustachian tube, resulting in fluid retention & suppuration of retained secretions. More common in children because the eustachian tube is straighter, allowing pathogen to enter the ear more easily.

Otitis Externa

Causes: moisture in the ear canal, allergic reactions (psoriasis), or trauma of the ear canal related to itching/scratching. Pseudomonas aeruginosa, Proteus, & Staphylococcus aureus: bacteria that may play a role. Aspergillus is the fungus that thrives in the most ear canal.

Anti-Infective, Antiseptic, Glucocorticoid, and Acidifying Agents

Combination drug neomycin-polymyxin B-hydrocortisone (Cortisporin Otic) for treatment of acute external otitis media. Neomycin & polymyxin B are antibiotics & Hydrocortisone (steroid), reduces actions of chemicals that cause inflammation, redness, & swelling.

The nurse is performing an otoscopic examination on a client with mastoiditis on examination of the tympanic membrane, which of the following would the nurse expect to observe? A. A pink-colored tympanic membrane B. A pearly colored tympanic membrane C. A transparent and clear tympanic membrane D. A red, dull, thick, and immobile tympanic membrane (NCLEX SAUNDERS)

D. A red, dull, thick, and immobile tympanic membrane

The nurse notes the physician has documented a diagnosis of presbycusis on the client's chart. The nurse plans care knowing that the condition is: A. Tinnitus that occurs with with aging B. Nystagmus that occurs with aging C. A conductive hearing loss that occurs with aging D. A sensoruneural hearing loss that occurs with aging (NCLEX SAUNDERS)

D. A sensoruneural hearing loss that occurs with aging

Amoxicillin (Amoxil): Action

Has bactericidal properties. It inhibits cell wall synthesis of sensitive organisms, resulting in cell death.

Propionic Acid Derivatives: Adjuvant Medications to Treat Pain and Fever Related to Infections of the Ear

Ibuprofen (Motrin, Advil) is a NSAID agent that inhibits prostaglandin synthesis in both the central and peripheral nervous systems. There are two forms of cyclooxygenase, COX-1 and COX-2. Ibuprofen blocks prostaglandin synthesis & modulates T-cell production, inhibiting the chemotaxis of the inflammatory cells & increasing their destruction. Blocks COX-1 & COX-2 & is more selective w/ COX-1. Administered to reduce pain, inflammation, & fever. Route: orally or IV. For treatment of otalgia & fever, drug is administered orally.

Amoxicillin (Amoxil): Preventing Interactions

If patient takes the drug w/ food, there is a delay or reduction in its absorption. • Drugs That Decrease the Effects: Chloramphenicol, tetracycline = Cause inhibition of the activity of amoxicillin • Drug That Increases the Effects of Amoxicillin: Probenecid = Prolongs the activity of amoxicillin

ciprofloxacin (Cipro): Action

Inhibits DNA gyrase in susceptible organisms & inhibits the supercoiled DNA, promoting breakage of the double-stranded DNA.

Otitis Externa: Pathophysiology

Involves presence of moisture in external ear canal, leading to inflammation of the pinna & canal. Canal becomes itchy, red, & tender, & increased swelling makes it narrower. Ear pain occurs w/ movement because of the inflammation. Watery or purulent drainage, and intermittent hearing loss may result • Necrotizing otitis externa is a soft tissue infection of the external auditory canal. The epidermis becomes thickened & inflamed & the underlying dermis exhibits chronic inflammation. Involvement of the osseous portion of the external auditory canal can lead to temporal bone osteomyelitis; progressive causing rapid debilitation. If the infection spreads to the base of the skull, it can be fatal.

Amoxicillin (Amoxil): Administering the Medication

It is necessary to take amoxicillin orally in divided doses around the clock. Take the full course of antibiotics & not discontinue them, even if the otitis media seems to be improving.

neomycin-polymyxin B-hydrocortisone (Cortisporin Otic): Pharmacokinetics

Metabolism/transport effects of polymyxin & neomycin: unknown. Hydrocortisone metabolized in liver, & excretion occurs in the urine.

ciprofloxacin (Cipro): Administering the Medication

Parenteral administration should occur over 60 minutes. May take w/ food to reduce GI upset. However, take within 2 hours of eating dairy products, calcium-fortified juices, antacids, zinc, or iron.

ciprofloxacin (Cipro): Use

Treatment of P. aeruginosa in patients with necrotizing otitis externa. Dosage adjustment for renal impairment

neomycin-polymyxin B-hydrocortisone (Cortisporin Otic): Use

Treatment of acute otitis externa Use in Children—Recommend Cortisporin Otic in children only for bacterial infections of external auditory canal due to ototoxicity. Hydrocortisone may cause suppression of the hypothalamic-pituitary-adrenal axis in children.

Amoxicillin (Amoxil): Use

Treatment of acute otitis media. Active against Staphylococcus pneumoniae, H. influenzae, Streptococcus pyogenes, & Moraxella catarrhalis.

Amoxicillin (Amoxil): Contraindications

known hypersensitivity to cephalosporin, or other allergens. In event of a penicillin allergy w/out urticaria or anaphylaxis, the patient is prescribed cefdinir, cefpodoxime, or cefuroxime.

ciprofloxacin (Cipro): Contraindications

known sensitivity & administration of ciprofloxacin w/ tizanidine is contraindicated.

Otitis Media: Clinical Manifestations

marked fluid & inflammation in the mucosa lining the middle ear space. Otalgia, diminished hearing, Fever may/may not be present, upper respiratory tract infection or seasonal allergic rhinitis commonly precedes acute otitis media. Changes in equilibrium may occur. If the tympanic membrane ruptures, patients report a reduction or relief of ear pain.

neomycin-polymyxin B-hydrocortisone (Cortisporin Otic): Adverse Effects & Contraindications

o Adverse effects: burning, stinging, & ototoxicity. o Contraindications: known hypersensitivity, Prescribers should not order it for viral, fungal, or mycobacterial infections.

ciprofloxacin (Cipro): Adverse Effects

o Frequent effects: (GI) N/V, & abdominal discomfort. Dizziness & mild headache may occur. o Reports of allergic skin reactions, photosensitivity can occur, & patients older than 60 years of age are at risk for tendonitis or tendon rupture.

ciprofloxacin (Cipro): Pharmacokinetics

o IV, onset: 10 minutes, Peak: 30 minutes, & Duration: 4 to 5 hours. o Oral, Onset: varies, Peak: 60 to 90 minutes, & the same duration of action. o IV & orally, absorbed rapidly & distributed to the kidneys, gallbladder, liver, lungs, gynecological or prostate tissue, & the CSF. 20% to 40% protein bound, Metabolism: liver, half-life: 3 to 5 hours, & Excretion: urine and feces.

Otitis Media

o More common in children than adults. o Cause: Haemophilus influenzae, Streptococcus pneumoniae, & Moraxella catarrhalis. o They enter the middle ear as a result of an alteration in the eustachian tube. Can be caused by upper respiratory congestion, inflammation, or allergic reaction. Bacteria may enter the middle ear from the contaminated secretions of the nasopharynx or perforation of the tympanic membrane of the middle ear.

Amoxicillin (Amoxil): Adverse Effects

o Most common: hypersensitivity, w/ the development of rash/severe reactions w/ anaphylaxis. o Most common GI effects: glossitis, stomatitis, gastritis, sore throat, N/V/D & abdominal pain. o Other effects include the development of superinfections.

neomycin-polymyxin B-hydrocortisone (Cortisporin Otic): Action

o Neomycin (aminoglycoside) inhibits bacterial protein synthesis by irreversibly binding to the 30S ribosome of susceptible bacteria. o Polymyxin B (antiinfective agent) binds to the lipid phosphates in the bacterial cell membrane, which changes the membrane permeability to prevent leakage of cytoplasm from the bacterial cell wall, contributing to cell death. o Hydrocortisone (steroid) decreases inflammation by stabilizing the leukocyte lysosome membrane, inhibiting phagocytosis & release of allergic substances.

Amoxicillin (Amoxil): Pharmacokinetics

o Variable onset of action; Peak: 1 hour. Duration: 6 to 8 hours, half-life: 1 - 1.4 hours. o Metabolism: liver, Excretion: unchanged in urine. Crosses the placenta & enters the breast milk, which is a consideration because penicillin agents are often given during pregnancy.

neomycin-polymyxin B-hydrocortisone (Cortisporin Otic): Administering the Medication

• Administration is directly in the external ear canal. Necessary to shake the medication well. If cerumen is present, cleaning of the ear canal w/ a cotton swab is important. • QSEN: It is necessary to assess the tympanic membrane with an otoscope before inserting Cortisporin Otic. If the tympanic membrane is torn, then the medication is absorbed directly by the inner ear, leading to hearing loss. • Tilting the head toward the opposite shoulder, pulling the superior aspect of the auricle upward, & instilling the eardrops into the ear canal. The patient should then lie on the side opposite the side of administration for 20 minutes. To maximize medication absorption, the patient should have a cotton ball placed in the ear canal.

Penicillin: Amoxicillin

• Amoxicillin (Amoxil), a penicillin, is the preferred antibacterial agent for the treatment of acute otitis media. • Administration is oral. Many people with acute otitis media do not benefit from antibiotics because the cause of their illness is viral, not bacterial, or the infection resolves without the use of a drug.

Amoxicillin (Amoxil): Assessing for Therapeutic Effects

• Assess for otalgia & otorrhea. Both pain & drainage should decrease w/ antibiotics. Also assess hearing. As the fullness of the tympanic membrane decreases, the patient reports improvement in hearing. Inspects the tympanic membrane for bulging. As the infection resolves, the tympanic membrane becomes shiny gray w/ a visible cone of light from the otoscope.

Amoxicillin (Amoxil): Assessing for Adverse Effects

• Assess for s/s of hypersensitivity, w/ symptoms of wheezing, rash, or difficulty breathing. Assess for GI adverse effects such as N/V/D, stomatitis, mouth irritation, sore throat, & abdominal pain. Also assess for superinfection.

ciprofloxacin (Cipro): Patient Teaching

• Avoid exposure to sunlight & apply sunscreen during the course of drug treatment. • Do not operate machinery or drive if experiencing dizziness or lightheadedness occurs. • Stay well hydrated during the course of treatment. • Do not drink calcium-fortified juices or dairy products while taking the drug. • Do not take antacids, zinc, or iron supplements during the course of drug treatment. • Report tendon pain to the primary care provider. • Report nausea, vomiting, or diarrhea.

ciprofloxacin (Cipro): Preventing Interactions

• Drugs That Increase the Effects: Antidysrhythmics = Possibly prolong QT interval • Corticosteroids = Increase risk of tendon-related side effects • Theophylline = Reduces theophylline clearance • Warfarin = Increases international normalized ratio • Drugs That Decrease the Effects: Aluminum-, calcium-, iron-, & magnesium- containing products = Impair absorption • Didanosine = Decreases serum concentrations • Sucralfate = Impairs absorption • Quinapril (contains magnesium) = Impairs absorption

Amoxicillin (Amoxil): Patient Teaching

• Ensure that the child takes the entire course of the drug. • Administer the drug around the clock. • Take the medication on an empty stomach to enhance the drug's effectiveness. • Report ear pain or diminished hearing.

Otitis Externa: Clinical Manifestations

• In acute otitis externa: ear pain & discharge (foul yellow or green) from the external auditory canal, feeling of "fullness" in the ear, decreased hearing, & pruritus. • In necrotizing otitis externa: otalgia (ear pain) & otorrhea (purulent drainage). Pain experienced at night & extend to the temporomandibular joint when chewing. Advancement of infection results osteomyelitis of the skull & temporomandibular joint.

Fluoroquinolone: Ciprofloxacin

• The fluoroquinolone ciprofloxacin (Cipro) is the drug of choice for necrotizing otitis externa. • Initially, administration is intravenous, until symptoms decrease; then it is oral.

Patient Teaching Guidelines for Cortisporin

• Use eardrops properly. Put them directly in the ear canal. Prior to administering, shake well. If earwax is present, use a cotton swab to remove it. o Tilt head toward the opposite shoulder, pull the top of your outer ear upward, and & the ear drops into the ear canal. o Then lie on the side opposite the side of administra-tion for 20 minutes. To maximize medication absorp-tion, place a cotton ball in your ear for that time. • Refrain from inserting anything in the ear canal. • Do not let water enter ear canal during the treatment period. If swimming, use ear plugs, shake the ear dry after swimming, & use a blow dryer on the low setting 12 inches away to dry the ear canal. • Stop using the medication after 10 days, Have a follow-up assessment in 1 to 2 weeks.