The Problem of Permeability and Anesthesia of the Tympanic Membrane

Uhde, George I.

doi:10.1001/archotol.1957.03830280021004

Cited by 24 publications

(12 citation statements)

References 65 publications

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“…The ideal method for local sur¬ face anesthesia of the TM remains elusive. 6 Ideally, the anesthetic agent would be able to penetrate the effec¬ tive barrier of the TM epithelium7 and react with the nerve endings in the lamina propria8 without damaging the TM tissue itself.…”

Section: Resultsmentioning

confidence: 99%

The Influence of Lidocaine and Iontophoresis on the Pain Threshold of the Human Eardrum

Johannessen¹,

Hvidegaard²,

Brask³

1982

Archives of Otolaryngology - Head and Neck Surgery

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\s=b\The purpose of this study was to investigate the analgesic effect of lidocaine hydrochloride applied with and without iontophoresis on the human tympanic membrane. Pain thresholds were measured in 20 normal ears using a dc stimulus applied directly to the tympanic membrane with an isolated floating electrode. There was a significant rise in pain threshold with lidocaine both with and without iontophoresis, but the total anesthetic effect on the tympanic membrane was inadequate and unpredictable. Our findings are contrasted with those of other investigators. (Arch Otolaryngol 1982;108:201-203) Asimple noninvasive technique for tympanic membrane anes¬ thesia for minor surgery, eg, myrin¬ gotomy, in the outpatient clinic set¬ ting remains elusive. The purpose of this study was to investigate the effi¬ cacy of lidocaine hydrochloride, ap¬ plied with and without iontophoresis, in achieving adequate tympanic mem¬ brane (TM) anesthesia as reported by other investigators.13 Iontophoresis is a procedure in which charged mole¬ cules or ions are induced to migrate through tissues under the influence of a direct electrical current. SUBJECTS AND METHODSTympanic membrane pain thresholds were investigated in 20 otoscopically nor¬ mal ears in 14 adult volunteers. All had normal hearing and normal tympanograms. An additional three patients with otosclerosis were also studied both before and after lidocaine infiltration of the pos¬ terior canal wall.Subjects were placed in a recumbent position with the head turned sideways so that the TM was horizontal. A small quan¬ tity of normal saline (0.2 to 0.3 mL) was placed over the TM to allow correct place¬ ment of the floating electrode (Fig 1), which was carefully positioned with the otomicroscope. The amount of saline was varied slightly to permit correct placement in each subject. The electrode wire passed through the low-density insulating materi¬ al ("the float") so that the only active, exposed part of the electrode was that placed against the TM (Fig 1). A constant current source was used to provide a 0.2-ms, 500-Hz dc-impulse stimuli. Current intensity was increased from zero, and the threshold was recorded in milliamperes when the subject indicated pain in the ear.The normative investigation was re¬ peated four times-once to familiarize the subject with the aural sensations and the following three times to obtain the mean pain thresholds given in the Table. The saline overlying the TM was then removed and replaced with an equal quantity of 5% lidocaine hydrochloride with 0.05% epinephrine hydrochloride. Pain thresholds (t) were measured and recorded immedi¬ ately after substitution with lidocaine (tO) and 20 minutes later (t20). The floating electrode was then removed, and the ear canal was filled with 5% lidocaine hydro¬ chloride and 0.05% epinephrine hydrochlo¬ ride. Iontophoresis was performed with an ionesthetizer that delivered a current of 0.5 mamp for ten minutes. The ear canal was then emptied by suction, and the same amount of normal saline as originally insert...

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Section: Resultsmentioning

confidence: 99%

The Influence of Lidocaine and Iontophoresis on the Pain Threshold of the Human Eardrum

Johannessen¹,

Hvidegaard²,

Brask³

1982

Archives of Otolaryngology - Head and Neck Surgery

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“…It was somewhat surprising that ciprofloxacin solution alone had any therapeutic effect on OM, given that the TM is relatively impermeable to small molecules (7, 9, 33) and ototopical antibiotics are only used for middle ear disease in situations where the TM has been breached (for example, with myringotomy tubes) (34). The effect of ciprofloxacin drops in OM may be explained by the fact that the TM became 5- to 31-fold more permeable to drug flux in OM despite also becoming five times thicker than in healthy animals.…”

Section: Discussionmentioning

confidence: 99%

Treatment of otitis media by transtympanic delivery of antibiotics

et al. 2016

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Otitis media is the most common reason U.S. children receive antibiotics. The requisite 7- to 10-day course of oral antibiotics can be challenging to deliver in children, entails potential systemic toxicity, and encourages selection of antimicrobial-resistant bacteria. We developed a drug delivery system that, when applied once to the tympanic membrane through the external auditory canal, delivers an entire course of antimicrobial therapy to the middle ear. A penta-block copolymer poloxamer 407–polybutylphosphoester (P407-PBP) was designed to flow easily during application and then to form a mechanically strong hydrogel on the tympanic membrane. U.S. Food and Drug Administration–approved chemical permeation enhancers within the hydrogel assisted flux of the antibiotic ciprofloxacin across the membrane. This drug delivery system completely eradicated otitis media from nontypable Haemophilus influenzae (NTHi) in 10 of 10 chinchillas, whereas only 62.5% of animals receiving 1% ciprofloxacin alone had cleared the infection by day 7. The hydrogel system was biocompatible in the ear, and ciprofloxacin was undetectable systemically (in blood), confirming local drug delivery and activity. This fast-gelling hydrogel could improve compliance, minimize side effects, and prevent systemic distribution of antibiotics in one of the most common pediatric illnesses, possibly minimizing the development of antibiotic resistance.

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“…The poor effect in acute otitis media is probably due to a low pH in an infected area which, as shown, reduces the diffusion of a topical anaesthetic [1], Therefore, it appears especially important under such circum stances that the topical anaesthetic applied is the alkalized un-ionized B.…”

Section: Discussionmentioning

confidence: 99%

“…Different concentrations of cocaine, alco hol, phenol, menthol, tetracaine, lidocaine and sometimes added adrenaline [1,2] have been used as topical anaesthetics.…”

Section: Introductionmentioning

confidence: 99%

Topical Anaesthesia of the Normal Tympanic Membrane: A Controlled Clinical Trial of Different Suspensions of Lidocaine

Møller

Grøntved

1990

ORL

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The purpose of this investigation was to find an effetive method for topical lidocaine anaesthesia of the tympanic membrane for minor therapeutical procedures. Twelve subjects with healthy ears were tested in a randomized double-blind crossover trial. Xylocaine® (lidocaine) aerosol 10%, lidocaine 4%, and lidocaine hydrochloride 5% were tested against placebo. Xylocaine aerosol was sprayed into a small container, shaken, and tempered. This made the application painless. The eardrum was stimulated by a point of a needle effective 25 min after application (p = 0.008 and p < 0.05, respectively). Lidocaine hydrochloride showed no effect. No side effects were observed. The effectiveness seems to be dependent on the ionization of the drug, since the two effective drugs lidocaine and Xylocaine are un-ionized, whereas the ineffective lidocaine hydrochloride is ionized.

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The Problem of Permeability and Anesthesia of the Tympanic Membrane

Cited by 24 publications

References 65 publications

The Influence of Lidocaine and Iontophoresis on the Pain Threshold of the Human Eardrum

The Influence of Lidocaine and Iontophoresis on the Pain Threshold of the Human Eardrum

Treatment of otitis media by transtympanic delivery of antibiotics

Topical Anaesthesia of the Normal Tympanic Membrane: A Controlled Clinical Trial of Different Suspensions of Lidocaine

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