Drug Delivery to the Ear

Abstract

Drug delivery to the ear is used to treat conditions of the middle and inner ear such as acute and chronic otitis media, Ménière's disease, sensorineural hearing loss and tinnitus. Drugs used include antibiotics, antifungals, steroids, local anesthetics and neuroprotective agents. A literature review was conducted searching Medline (1966-2012), Embase (1988-2012), the Cochrane Library and Ovid (1966-2012), using search terms 'drug delivery', 'middle ear', 'inner ear' and 'transtympanic'. There are numerous methods of drug delivery to the middle ear, which can be categorized as topical, systemic (intravenous), transtympanic and via the Eustachian tube. Localized treatments to the ear have the advantages of targeted drug delivery allowing higher therapeutic doses and minimizing systemic side effects. The ideal scenario would be a carrier system that could cross the intact tympanic membrane loaded with drugs or biochemical agents for the treatment of middle and inner ear conditions.

Update on otitis media – prevention and treatment

“…Local delivery of antibiotics directly to the ear as a treatment for OM, as opposed to systemic administration, could be an efficient strategy and a safer one in view of the risk of systemic toxicity, especially if a high dose is required 84. Broadly speaking, there are two strategies, transtympanic and intratympanic delivery.…”

Shaping Magnetic Fields to Direct Therapy to Ears and Eyes

“…In the clinic, there are no effective nonsurgical techniques to direct drugs through the tympanic membrane (eardrum) (156). Researchers have proposed temporarily chemically permeabilizing the tympanic membrane to enable transport of small molecules (157,158).…”

Efficacy and safety of fluocinolone acetonide 0.025% otic solution in patients with otic eczema: a randomized, double-blind, placebo-controlled clinical trial

“…In the present study, fluocinolone acetonide was assessed at 0.025% based on previous results reporting the safety and good tolerability of this fluocinolone concentration in combination with antibiotics, 17 , 18 with the hypothesis that 0.025% fluocinolone acetonide would achieve high biological activity and induce a rapid response, at a minimum risk of AEs. In addition, otic solutions can release high local concentrations of the active ingredient within the external auditory canal, 26 thus becoming efficacious alternatives to other formulations, such as ointments or creams. Moreover, single-dose formats are expected to favour the correct instillation of the appropriate volume and to increase patient compliance.…”