Topical and Systemic Glucocorticoids for Otitis

Chapter 109

Topical and Systemic Glucocorticoids for Otitis

Glucocorticoids are helpful in almost any animal with otitis, regardless of the underlying cause. This chapter considers the why and how of glucocorticoid use for management of otitis in canine and feline patients.

Should Topical or Systemic Glucocorticoids Be Used?

The choice between topical and systemic glucocorticoids depends largely on the severity of the otitis. It is important carefully to assess the degree of pain, firmness, mobility, erythema, swelling, fibrosis, hyperplasia, and stenosis of the ear canals by palpation and otoscopy (see Chapter 108). Topical therapy is preferred because it delivers the drug to the affected site, avoiding systemic exposure. The ear canal is a self-contained unit ideally suited to topical treatment, and most polyvalent ear products contain a glucocorticoid. Systemic treatment is necessary if the ear canals are stenosed, if there is severe fibrosis or hyperplasia, if topical therapy cannot be administered safely, and/or with some cases of otitis media. Once the ear canals have opened it is usually possible to switch to topical therapy. Animals may also tolerate topical therapy better once the pain and inflammation have decreased.

Which Topical Glucocorticoids Should Be Used?

The antiinflammatory potency of topical glucocorticoids varies widely (Table 109-1 and Figure 109-1). Lotions and gels are easier and less messy to apply and dry quickly, leaving fewer residues. Oils, creams, and ointments may moisten and soothe dry and inflamed skin but can be occlusive and are contraindicated for use in exudative or seborrheic ears.

The topical glucocorticoids incorporated in most polyvalent ear medications are appropriate for managing the mild to moderate inflammation in acute otitis externa. Use of antimicrobial-containing products, however, is not indicated in the absence of infection.

A variety of glucocorticoid-containing eyedrops, eardrops, and ear cleaners are available, although some of these are human products not licensed for use in animals. Soluble glucocorticoid preparations also can be added to tromethamine/ethylenediaminetetraacetic acid (Tris-EDTA) solutions or compounded with sterile saline to create solutions with an appropriate glucocorticoid concentration (e.g., 0.02% to 0.1% dexamethasone).

Mild inflammation responds rapidly to low-potency topical glucocorticoids, but progressively more severe inflammation requires longer courses of more potent products. Fluocinolone acetonide in 60% dimethylsulfoxide (DMSO) is particularly effective at reducing tissue hyperplasia.

Products should be applied once or twice daily until remission occurs; efficacy may be greater with more frequent administration, but compliance with treatment may be lower. Once the otitis has resolved, topical glucocorticoids should be used at the lowest frequency that controls the inflammation or discontinued if possible. When continued use is required, data on owner compliance from studies of atopic dermatitis and recurrent pyoderma suggest that a regimen of treatment on 2 or 3 consecutive days each week (i.e., “weekend therapy”) is better adhered to than therapy every other day or twice weekly (Carlotti et al, 2004; Martins et al, 2012).

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Jul 18, 2016 | Posted by in PHARMACOLOGY, TOXICOLOGY & THERAPEUTICS | Comments Off on Topical and Systemic Glucocorticoids for Otitis

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