´Ò¸´˝·¸Ù soframycin, gentamicin) ... Sofradex ED Gramicidine + framycetin SO 4 +...

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1013 §≈‘π‘° ªï∑’Ë 24 ©∫—∫∑’Ë 11 惻®‘°“¬π 2551 § ≈‘ π‘ ° ¬“À¬Õ¥ÀŸ ¡’ª√–‚¬™πå„π°“√√—°…“°“√Õ—°‡ ∫¢ÕßÀŸ™—ÈππÕ°·≈–ÀŸ™—Èπ°≈“ß √«¡ ∑—Èß°“√Õÿ¥μ—π¢Õߢ’ÈÀŸ °“√∑’ˇ√“®– “¡“√∂‡≈◊Õ°¬“À¬Õ¥ÀŸ∑’ˇÀ¡“– ¡°—∫‚√§ ®”‡ªìπμâÕß¡’ §«“¡√Ÿâæ◊Èπ∞“π‡°’Ë¬«°—∫™π‘¥·≈– à«πª√–°Õ∫¢Õ߬“À¬Õ¥ÀŸ √«¡∑—Èß‚√§∑“ßÀŸÕ¬à“ß∂Ÿ°μâÕß. ¬“À¬Õ¥ÀŸ ª√–°Õ∫¥â«¬  à«πª√–°Õ∫À≈—° 2 ™π‘¥§◊Õ 1. μ—«¬“ ”À√—∫À¬Õ¥ÀŸ. 2. πÈ”°√– “¬¬“ ”À√—∫¬“À¬Õ¥ÀŸ (vehicles). μ—«¬“ ”À√—∫À¬Õ¥ÀŸ ¬“À¬Õ¥ÀŸ·μà≈–™π‘¥¡’μ—«¬“ ”§—≠º ¡°—πÀ≈“¬™π‘¥ μ—«¬“∑’ ËÕ¬Ÿ à„π¬“À¬Õ¥ÀŸ·μà≈–™π‘¥ Õ“®®”·π°‡ªìπ 1. ¬“μâ“π®ÿ≈™’æ (antibiotic) ¡—°‡ªìπ¬“∑’Ë„™âº ¡„π¬“À¬Õ¥ÀŸ‡°◊Õ∫∑ÿ°™π‘¥ ·≈– ¡—°„™â¬“μâ“π®ÿ≈™’æ∑’Ë “¡“√∂ÕÕ°ƒ∑∏‘ω¥â°«â“ߢ«“ß ‡™àπ °≈ÿà¡ aminoglycosides (neomy- cin, soframycin, gentamicin) ´÷ ËßÕÕ°ƒ∑∏‘ ϧ√Õ∫§≈ÿ¡‡™◊ ÈÕ·∫§∑’‡√’¬·°√¡≈∫ °≈ÿ à¡ polypep- tides (polymyxin B, bacitracin, gramicidin) ´÷Ëß polymyxin B ‰¥âº≈¥’°—∫‡™◊ÈÕ·°√¡≈∫  à«π gramicidin ‰¥âº≈¥’°—∫‡™◊ÈÕ·°√¡∫«° °≈ÿà¡Õ◊ËπÊ ‡™àπ chloramphenicol ‰¥âº≈¥’°—∫ ∑—È߇™◊ÈÕ·°√¡∫«°·≈–·°√¡≈∫ ƒ∑∏‘ϧ√Õ∫§≈ÿ¡‡™◊ÈÕ¢Õ߬“μâ“π®ÿ≈™’æ∑’Ë„™â∫àÕ¬ 1 · ¥ß‰«â„π μ“√“ß∑’Ë 1. „π∑“ߪؑ∫—μ‘ ·π–π”„Àℙ⬓μâ“π®ÿ≈™’æ∑’Ë¡’ à«πº ¡¢Õß∑—Èß polymyxin B ·≈– π“π“ “√– ¬“À¬Õ¥ÀŸ ª“√¬– Õ“»π–‡ π æ.∫., ºŸ â™à«¬»“ μ“®“√¬å ¿“§«‘™“‚ μ π“ ‘° ≈“√‘ß´å«‘∑¬“ §≥–·æ∑¬»“ μ√廑√‘√“™æ¬“∫“≈ ¡À“«‘∑¬“≈—¬¡À‘¥≈

Transcript of ´Ò¸´˝·¸Ù soframycin, gentamicin) ... Sofradex ED Gramicidine + framycetin SO 4 +...

Page 1: ´Ò¸´˝·¸Ù soframycin, gentamicin) ... Sofradex ED Gramicidine + framycetin SO 4 + dexamethasone 4. Antibiotic + Corticosteroid + Otosamthong ED Polymyxin B + neomycin SO 4 +

1013§≈‘π‘° ªï∑’Ë 24 ©∫—∫∑’Ë 11 惻®‘°“¬π 2551

§ ≈‘ π‘ °

¬“À¬Õ¥ÀŸ ¡’ª√–‚¬™πå„π°“√√—°…“°“√Õ—°‡ ∫¢ÕßÀŸ™—ÈππÕ°·≈–ÀŸ™—Èπ°≈“ß √«¡∑—Èß°“√Õÿ¥µ—π¢Õߢ’ÈÀŸ °“√∑’ˇ√“®– “¡“√∂‡≈◊Õ°¬“À¬Õ¥ÀŸ∑’ˇÀ¡“– ¡°—∫‚√§ ®”‡ªìπµâÕß¡’§«“¡√Ÿâæ◊Èπ∞“π‡°’Ë¬«°—∫™π‘¥·≈– à«πª√–°Õ∫¢Õ߬“À¬Õ¥ÀŸ √«¡∑—Èß‚√§∑“ßÀŸÕ¬à“ß∂Ÿ°µâÕß.¬“À¬Õ¥ÀŸ ª√–°Õ∫¥â«¬ à«πª√–°Õ∫À≈—° 2 ™π‘¥§◊Õ

1. µ—«¬“ ”À√—∫À¬Õ¥ÀŸ.2. πÈ”°√– “¬¬“ ”À√—∫¬“À¬Õ¥ÀŸ (vehicles).

µ—«¬“ ”À√—∫À¬Õ¥ÀŸ¬“À¬Õ¥ÀŸ·µà≈–™π‘¥¡’µ—«¬“ ”§—≠º ¡°—πÀ≈“¬™π‘¥ µ—«¬“∑’ËÕ¬Ÿà„π¬“À¬Õ¥ÀŸ·µà≈–™π‘¥

Õ“®®”·π°‡ªìπ1. ¬“µâ“π®ÿ≈™’æ (antibiotic) ¡—°‡ªìπ¬“∑’Ë„™âº ¡„π¬“À¬Õ¥ÀŸ‡°◊Õ∫∑ÿ°™π‘¥ ·≈–

¡—°„™â¬“µâ“π®ÿ≈™’æ∑’Ë “¡“√∂ÕÕ°ƒ∑∏‘ω¥â°«â“ߢ«“ß ‡™àπ °≈ÿà¡ aminoglycosides (neomy-cin, soframycin, gentamicin) ÷ËßÕÕ°ƒ∑∏‘ϧ√Õ∫§≈ÿ¡‡™◊ÈÕ·∫§∑’‡√’¬·°√¡≈∫ °≈ÿà¡ polypep-tides (polymyxin B, bacitracin, gramicidin) ´÷Ëß polymyxin B ‰¥âº≈¥’°—∫‡™◊ÈÕ·°√¡≈∫ à«π gramicidin ‰¥âº≈¥’°—∫‡™◊ÈÕ·°√¡∫«° °≈ÿà¡Õ◊ËπÊ ‡™àπ chloramphenicol ‰¥âº≈¥’°—∫∑—È߇™◊ÈÕ·°√¡∫«°·≈–·°√¡≈∫ ƒ∑∏‘ϧ√Õ∫§≈ÿ¡‡™◊ÈÕ¢Õ߬“µâ“π®ÿ≈™’æ∑’Ë„™â∫àÕ¬1 · ¥ß‰«â„πµ“√“ß∑’Ë 1. „π∑“ߪؑ∫—µ‘ ·π–π”„Àℙ⬓µâ“π®ÿ≈™’æ∑’Ë¡’ à«πº ¡¢Õß∑—Èß polymyxin B ·≈–

π“π“ “√–

¬“À¬Õ¥ÀŸ

ª“√¬– Õ“»π–‡ π æ.∫.,

ºŸâ™à«¬»“ µ“®“√¬å ¿“§«‘™“‚ µ π“ ‘° ≈“√‘ß å«‘∑¬“§≥–·æ∑¬»“ µ√廑√‘√“™æ¬“∫“≈¡À“«‘∑¬“≈—¬¡À‘¥≈

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µ“√“ß∑’Ë 1. ƒ∑∏‘Ï¢Õ߬“µâ“π®ÿ≈™’æ∑’Ëπ‘¬¡„™â„π¬“À¬Õ¥ÀŸ1.

¬“µâ“π®ÿ≈™’æ Polymyxin B Neomycin Chloramphenicol

‰¥âº≈µàÕ‡™◊ÈÕ - P. aeruginosa - S. aureus - Streptococcus

- E. coli - Proteus - Staphylococcus

- Klebsiella - E. coli

- Enterobacter - Proteus- Klebsiella- Enterobacter- B. fragilis

¥◊ÈÕµàÕ‡™◊ÈÕ - Streptococcus - Streptococcus - P. aeruginosa

- Staphylococcus - P. aeruginosa

- Proteus - Anaerobe ∑ÿ°µ—«- B. fragilis √«¡∑—Èß B. fragilis

neomycin °àÕπ ‡π◊ËÕß®“°§≈ÿ¡‡™◊ÈÕ·∫§∑’‡√’¬ à«π„À≠à∑’ˇªì𠓇Àµÿ¢Õß°“√µ‘¥‡™◊ÈÕ„πÀŸ™—ÈππÕ°·≈–™—Èπ°≈“ß (acute otitis externa, chronic otitismedia) 2. „π√“¬∑’Ë·æ⬓ polymyxin B Õ“®„Àâgentamicin ™π‘¥‡¥’¬«·∑π‰¥â ‡¡◊ËÕ‰¡à‰¥âº≈Õ“®æ‘®“√≥“„™â chloramphenicol ·∑π. ªí®®ÿ∫—π¡’°“√𔬓„π°≈ÿà¡ quinolone ‡™àπ ciprofloxacin,ofloxacin ¡“∑”„π√Ÿª otic solution ´÷Ë߬“ª√–‡¿∑π’ȧ√Õ∫§≈ÿ¡‡™◊ÈÕ·°√¡≈∫‰¥â¥’ ®÷ß¡—°„™â„π√“¬∑’Ë¡’°“√µ‘¥‡™◊ÈÕ·°√¡≈∫√ÿπ·√ß ‡™àπ ¥◊ÈÕµàÕ¬“™π‘¥Õ◊ËπÊ ¥—ß°≈à“«¢â“ßµâπ.

¡’°“√»÷°…“æ∫«à“¬“„π°≈ÿà¡ quinolone π’È ·¡â„™âÀ¬Õ¥ºà“π‡¬◊ËÕ∫ÿ·°â«ÀŸ∑’Ë∑–≈ÿ°Á‰¡à∑”„À⇰‘¥ oto-toxicity3 πÕ°®“°π—È𠧫“¡‡¢â¡¢âπ¢Õ߬“°≈ÿà¡π’Ȭ—ß Ÿß¡“°æÕ ∑’Ë®–¡’ƒ∑∏‘Ï bactericidal µàÕ‡™◊ÈÕ°àÕ‚√§∑ÿ°™π‘¥ ·¡â·µà B. fragilis4. ¬“µâ“π®ÿ≈™’æπ’È à«π„À≠à„™â„π√“¬∑’Ë¡’°“√Õ—°‡ ∫¢ÕßÀŸ™—ÈππÕ° ·≈–/À√◊ÕÀŸ™—Èπ°≈“ß∑’Ë¡’‡¬◊ËÕ∫ÿ·°â«ÀŸ∑–≈ÿ. „π√“¬∑’Ë¡’ mucopurulentdischarge À√◊Õ debris Õ¬Ÿà¿“¬„π™àÕßÀŸ™—ÈππÕ°§«√À¬Õ¥¬“À≈—ß®“°∑”§«“¡ –Õ“¥ÀŸ™—ÈππÕ° (ear

toilet) ·≈â« ‡æ◊ËÕ„À⬓µâ“π®ÿ≈™’æ “¡“√∂ —¡º— ·≈–·∑√°´÷¡ÕÕ°ƒ∑∏‘ϵàÕ∫√‘‡«≥∑’˵‘¥‡™◊ÈÕ‰¥âÕ¬à“ß¡’ª√– ‘∑∏‘¿“æ. §«“¡∂’Ë¢Õß°“√À¬Õ¥¬“À¬Õ¥ÀŸ¢÷Èπ°—∫§«“¡√ÿπ·√ߢÕß°“√µ‘¥‡™◊ÈÕ ¬‘ËßÀ¬Õ¥∫àÕ¬ ¬‘Ëß¡’ª√– ‘∑∏‘¿“æ„π°“√ÕÕ°ƒ∑∏‘Ï¡“°.

2. ¬“√–ß—∫ª«¥ (anesthesia) ¡—°‡ªì𬓙“‡©æ“–∑’Ë ‡™àπ lidocaine À√◊Õ benzocaine ‚¥¬¡—°º ¡√à«¡°—∫¬“µâ“π®ÿ≈™’æ ¬“™“æÕ¥Ÿ¥´÷¡‰¥â∫â“ߙ૬≈¥Õ“°“√ª«¥ÀŸ „π√“¬∑’Ë¡’°“√Õ—°‡ ∫µ‘¥‡™◊ÈÕ·≈–≈¥°“√√–§“¬‡§◊Õß∑’ˇ°‘¥®“°¬“‡Õß.

3. ¬“µâ“π°“√Õ—°‡ ∫ (corticosteroid)

¡—°‡ªì𬓄π°≈ÿà¡ corticosteroid ‡™àπ prednisolone,dexamethasone, hydrocortisone ´÷Ëß¡’ƒ∑∏‘Ï≈¥°“√Õ—°‡ ∫‰¥â¥’ ∑”„Àâ‡π◊ÈÕ‡¬◊ËÕµà“ßÊ ‡™àπ º‘«Àπ—ߢÕßÀŸ™—ÈππÕ° À√◊Õ‡¬◊ËÕ∫ÿÀŸ™—Èπ°≈“߬ÿ∫∫«¡ ¡—°„™â„π√“¬∑’Ë¡’°“√Õ—°‡ ∫¢ÕßÀŸ™—ÈππÕ° ‡™àπ otitis externa,°“√Õ—°‡ ∫¢Õߺ‘«Àπ—ߢÕß™àÕßÀŸ™—ÈππÕ°®“°‚√§psoriasis, seborrheic dermatitis À√◊Õ°“√Õ—°‡ ∫„πÀŸ™—Èπ°≈“ß (chronic otitis media). „π√“¬∑’Ë¡’™àÕßÀŸ™—ÈππÕ°∫«¡¡“° Õ“®µâÕß„™âºâ“ gauze

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∑”‡ªìπ ear wick ‡ªìπ –æ“π„À⬓¥Ÿ¥´÷¡‡¢â“‰ª„π™àÕßÀŸ‰¥â¥’¢÷Èπ ‰¡à§«√„™â¬“À¬Õ¥ÀŸ∑’Ë¡’ corticosteroid‡ªìπ à«πº ¡„π√“¬∑’Ë ß —¬«à“¡’°“√µ‘¥‡™◊ÈÕ√“ ‡™◊ÈÕ«—≥‚√§ À√◊Õߟ «—¥„π™àÕßÀŸ.

4. ¬“µâ“π‡™◊ÈÕ√“ (antifungal) ¡—°„™â„π√“¬∑’Ë¡’‡™◊ÈÕ√“„π™àÕßÀŸ ÷Ëß„π∑“ߧ≈‘π‘°µâÕß·¬°≈—°…≥–°“√¡’‡™◊ÈÕ√“„π™àÕßÀŸ ÕÕ°‡ªìπ

- Superficial fungal colonization §◊Õ°“√∑’Ë¡’‡™◊ÈÕ√“Õ¬Ÿà„π™àÕßÀŸ™—ÈππÕ° ‚¥¬‰¡à¡’°“√Õ—°‡ ∫¢Õߺ‘«Àπ—ß™àÕßÀŸ. À≈—ß®“°‡Õ“‡™◊ÈÕ√“ÕÕ° æ∫«à“º‘«Àπ—ß™àÕßÀŸ¡’≈—°…≥–ª°µ‘À√◊Õ·¥ß‡≈Á°πâÕ¬ „π√“¬‡™àππ’È °“√„™â suction ¥Ÿ¥‡™◊ÈÕ√“ÕÕ°„ÀâÀ¡¥ ·≈â«„™â tincture merthiolate ™π‘¥‡¥’¬«°—∫∑’Ë„™â„π°“√∑”·º≈¶à“‡™◊ÈÕ‚√§ ªÑ“¬„Àâ∑—Ë«™àÕßÀŸ°Á‡æ’¬ßæÕ·≈â«.

- Otomycosis §◊Õ °“√∑’ˇ™◊ÈÕ√“∑”„À⇰‘¥°“√Õ—°‡ ∫¢Õߺ‘«Àπ—ß™àÕßÀŸ™—ÈππÕ° æ∫«à“º‘«Àπ—ߢÕß™àÕßÀŸ™—ÈππÕ°®–·¥ß ·≈–Õ“®¡’ÀπÕߪ°§≈ÿ¡À√◊ÕÕ“®æ∫‡™◊ÈÕ√“§≈ÿ¡Õ¬Ÿà∫πÀπÕߥ⫬ „π√“¬‡™àππ’ȧ«√„™â suction ¥Ÿ¥‡™◊ÈÕ√“·≈–ÀπÕßÕÕ°„ÀâÀ¡¥ ·≈â«„™â¬“µâ“π‡™◊ÈÕ√“À¬Õ¥ÀŸ.

¬“µâ“π‡™◊ÈÕ√“∑’Ë¡’®”Àπà“¬„π√Ÿª¬“À¬Õ¥ÀŸ §◊Õ1% clotrimazole ‚¥¬¡’ƒ∑∏‘ϵàÕ Aspergillus ·≈–Candida sp. ´÷Ë߇ªìπ‡™◊ÈÕ “‡Àµÿ∑’Ëæ∫∫àÕ¬¢Õß o to-mycosis πÕ°®“°π—Èπ tincture merthiolate,povidone-iodine, gention violet °Á‰¥âº≈¥’‡™àπ°—π.

5. ¬“≈–≈“¬¢’ÈÀŸ ¡—°„™â„π√“¬∑’Ë¡’¢’ÈÀŸÕÿ¥µ—π(impact cerumen) „π™àÕßÀŸ™—ÈππÕ° ÷ËßÕ“®·Àâß·≈–·¢Áß ∑”„Àâ°“√‡Õ“ÕÕ°§àÕπ¢â“߬“°·≈–Õ“®∑”„À⺟âªÉ«¬‡®Á∫. ¬“≈–≈“¬¢’ÈÀŸ®–∑”„À⢒ÈÀŸÕàÕππÿà¡ “¡“√∂‡Õ“ÕÕ°‰¥â‚¥¬ßà“¬ Õ“®„™â¬“∑’Ë¡’®”Àπà“¬Õ¬Ÿà„π∑âÕßµ≈“¥ À√◊Õ„™â 2.5% NaHCO3 °Á‰¥â ´÷Ëß¡—°π‘¬¡„™â¬“µ—«À≈—߇π◊ËÕß®“°‡µ√’¬¡‰¥âßà“¬ √“§“∂Ÿ° ·≈–‰¥âº≈¥’.°“√„™â¬“≈–≈“¬¢’ÈÀŸ™π‘¥Õ◊ËπÕ“®µâÕß√–«—ß ‡π◊ËÕß®“° à«πª√–°Õ∫∫“ß™π‘¥®–∑”„À⇰‘¥°“√√–§“¬‡§◊ÕßµàÕ™àÕßÀŸ™—ÈππÕ°‰¥âßà“¬. °“√À¬Õ¥¬“≈–≈“¬¢’ÈÀŸ §«√„À⺟âªÉ«¬À¬Õ¥∫àÕ¬Ê À√◊Õ«—π≈–‰¡àµË”°«à“ 4 §√—Èß

ª√–¡“≥ 1 —ª¥“Àå °àÕππ—¥ºŸâªÉ«¬¡“‡æ◊ËÕ∑” eartoilet.

™π‘¥·≈–µ—«Õ¬à“ߢÕ߬“À¬Õ¥ÀŸ™π‘¥µà“ßÊ „πª√–‡∑»‰∑¬ µ“√“ß∑’Ë 2.

πÈ”°√– “¬¬“ ”À√—∫¬“À¬Õ¥ÀŸ (vehicles) à«π„À≠à¡—°„™â¢Õ߇À≈«∑’Ë¡’§«“¡Àπ◊¥ ‡æ◊ËÕ

∑”„À⬓À¬Õ¥ÀŸµ‘¥Õ¬Ÿà°—∫ºπ—ß™àÕßÀŸ‰¥âπ“π “√∑’Ë„™â∫àÕ¬‰¥â·°à propylene glycol ·≈– glycerine‡æ√“– “¡“√∂≈–≈“¬¬“ ∑—Èß™π‘¥¡’ª√–®ÿ·≈–‰¡à¡’ª√–®ÿ‰¥â (polar and non-polar drugs) ·≈–¡’§ÿ≥ ¡∫—µ‘‡ªìπµ—«∑”≈–≈“¬∑’ˉ¡à∑”„À⇙◊ÈÕ·∫§∑’‡√’¬‡µ‘∫‚µ ·≈–º ¡‡¢â“°—∫¢’ÈÀŸ‰¥â¥’ ‡π◊ËÕß®“°‡™◊ÈÕ°àÕ‚√§„π™àÕßÀŸ¡—°®–‡®√‘≠‰¥â¥’„π¿“«–·«¥≈âÕ¡∑’ˇªìπ¥à“ߥ—ßπ—È𠬓À¬Õ¥ÀŸ¡—°¡’ à«πª√–°Õ∫∑’ˇªìπ°√¥™π‘¥„¥™π‘¥Àπ÷Ëß√à«¡¥â«¬ ‡™àπ °√¥ boric À√◊Õ acetic ‡æ◊ËÕ∑”„Àâ¿“«–·«¥≈âÕ¡‡ªìπ°√¥ ‡™◊ÈÕ‚√§µà“ßÊ ‰¡à “¡“√∂‡æ‘Ë¡®”π«π‰¥â. ¬“À¬Õ¥ÀŸ∫“ß™π‘¥∑’˙૬ªÑÕß°—π°“√µ‘¥‡™◊ÈÕ¢ÕßÀŸ™—ÈππÕ°„ππ—°«à“¬πÈ” (swimmerûsear) À≈—ß°“√«à“¬πÈ” ¡—°¡’ à«πº ¡¢ÕßπÈ” â¡ “¬™Ÿ(white vinegar) ·≈–·Õ≈°ÕŒÕ≈åÕ¬Ÿà¥â«¬.

¢âÕ∫àß™’È „π°“√„™â¬“À¬Õ¥ÀŸ2

1. Acute diffuse otitis externa ¡—°‡°‘¥®“°‡™◊ÈÕ P. aeruginosa ∫àÕ¬∑’Ë ÿ¥ √Õß≈ß¡“§◊Õ S. au-reus, proteus, Klebsiella, E. Coli.

2. Otomycosis ¡—°‡°‘¥®“° Aspergillusniger À√◊Õ Candida albicans.

3. Chronic external otitis/ dermatitis ‡™àπpsoriasis, seborrheic dermatitis, contact derma-titis.

4. Cerumen impaction.5. Chronic otitis media with acute exacer-

bation ¡—°‡°‘¥®“° P. aeruginosa, S. aureus,

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ª√–‡¿∑¢Õ߬“À¬Õ¥ÀŸ ™◊ËÕ∑“ß°“√§â“ à«πª√–°Õ∫

(ED = Ear Drop)

1. Antibiotic Kemicetine otologic EDSilmycetin ED 1% ChloramphenicolChloracil EDGrammicin ED 0.3% GentamicinTarivid otic solution 0.3% Ofloxacin

2. Antibiotic + Anesthesia Archifen ED 1% Chloramphenicol + lidocaine HClLignosporin ED Polymyxin B + lidocaine HClSTC ED Nitrofural + nifuroxime +

lidocaine HCl

3. Antibiotic + Corticosteroid Dexoph ED 0.35% Neomycin SO4 + dexamethasoneOtosporin ED Polymyxin B + neomycin SO4 +

hydrocortisonePrednisil ED Neomycin SO4 + prednisoloneSofradex ED Gramicidine + framycetin SO4 +

dexamethasone

4. Antibiotic + Corticosteroid + Otosamthong ED Polymyxin B + neomycin SO4 + Anesthesia lidocaine HCl + fludrocortisone

5. Antifungal Candid ED 1% ClotrimazoleTincture merthiolate

6. Otic analgesic Auralgan ED Benzocaine + antipyrine

7. Cerumenolytic Waxsol ED Docusate sodium

µ“√“ß∑’Ë 2. ™π‘¥·≈–µ—«Õ¬à“ߢÕ߬“À¬Õ¥ÀŸ™π‘¥µà“ßÊ „πª√–‡∑»‰∑¬.

proteus species, Klebsiella, E. coli.6. Acute suppurative otitis media with

tympanic membrane perforation ¡—°‡°‘¥®“°S. pneumoniae, H. influenzae, M. Catarrhalis.

7. Postoperative otorrhea after myringo-tomy tube placement „π√“¬∑’ˇ°‘¥„π™à«ßÀπâ“Àπ“«À√◊ÕÀπâ“Ωπ √à«¡°—∫Õ“°“√¢ÕßÀ«—¥ À√◊Õ‡°‘¥„π‡¥Á°Õ“¬ÿπâÕ¬°«à“ 3 ªï ¡—°‡°‘¥®“° S. pneumoniae,H. influenzae ·≈– M. catarrhalis ·µà„π√“¬∑’ˇ°‘¥®“°πÈ”¿“¬πÕ°‡¢â“ÀŸ ‡™àπ À≈—ßÕ“∫πÈ” À√◊Õ«à“¬πÈ” À√◊Õ·º≈∑’輈ҵ—¥µ‘¥‡™◊ÈÕ À√◊Õ‡°‘¥„π‡¥Á°Õ“¬ÿ¡“°°«à“ 3 ªï5 ¡—°‡°‘¥®“° Pseudomonas À√◊Õ

S. aureus.8. Draining mastoid cavity.9. Perioperative skin preparation.

º≈¢â“߇§’¬ß1. Ototoxicity °“√„™â¬“À¬Õ¥ÀŸ„π‚√§

ÀŸ™—Èπ°≈“ß∑’Ë¡’‡¬◊ËÕ·°â«ÀŸ∑–≈ÿµâÕß√–«—ß ‡æ√“–Õ“®¡’æ‘…µàÕ‡´≈≈åª√– “∑ÀŸ™—Èπ„π‰¥â à«π„À≠à¡—°‡°‘¥®“°¬“„π°≈ÿà¡ aminoglycoside. ¬“∑’Ë¡’√“¬ß“π«à“‡°‘¥æ‘…µàÕÀŸ™—Èπ„π„π —µ«å∑¥≈Õß ‰¥â·°à polymyxin,neomycin, streptomycin, tetracyclin, chloram-

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phenicol, gentamicin À√◊Õ·¡â·µà¬“™“‡©æ“–∑’ˇ™àπ lignocaine °Á¡’√“¬ß“π ·µàæ∫‰¥âπâÕ¬¡“° ‡™◊ËÕ«à“æ‘…µàÕÀŸ™—Èπ„π‡°‘¥®“°¬“ºà“π·°â«ÀŸ∑’Ë∑–≈ÿ‡¢â“‰ª„πÀŸ™—Èπ°≈“ß ·≈⫺à“π‡¢â“‰ª∑’Ë membranous labyrinth‚¥¬ºà“π∑“ß round window membrane ®“°°“√»÷°…“æ∫«à“ ototoxicity ∑’ˇ°‘¥„π§π ‡π◊ËÕß®“°¬“À¬Õ¥ÀŸπ—Èπæ∫πâÕ¬¡“° §◊Õ æ∫‡æ’¬ß√âÕ¬≈– 3.46 „π

ÀŸ¢Õߧπ‰¡à§àÕ¬‡°‘¥ ototoxicity ®“°¬“À¬Õ¥ÀŸ‡æ√“–7

- Round window membrane ¡’ niche°—ÈπÕ¬Ÿà ·≈–∫π membrane ¡’ false membrane´÷Ë߇ªìπ cuboidal epithelium §≈ÿ¡Õ¬ŸàÕ’°™—ÈπÀπ÷Ëß.

- Round window membrane „π§π®–Àπ“°«à“„π —µ«å species Õ◊ËπÊ.

- Round window membrane ¡’ inter-mediate layer Àπ“ ´÷Ë߇ªìπ physical barrier ∑’Ë¥’.

- „π¢≥–∑’Ë„™â¬“À¬Õ¥ÀŸ ºŸâªÉ«¬∑’ˇªìπchronic otitis media ¡—°¡’ mucosa ¢ÕßÀŸ™—Èπ°≈“ß∑’ËÀπ“®“°°“√Õ—°‡ ∫ ™à«¬ªÑÕß°—𬓇¢â“¡“ Ÿà roundwindow ·≈–™à«¬≈¥°“√¥Ÿ¥´÷¡¢Õ߬“‡¢â“ ŸàÀŸ™—Èπ„π¡’√“¬ß“π«à“ sensorineural hearing loss ®“°¬“À¬Õ¥ÀŸ ¡—°‡ªìπ high tone loss (> 8,000 Hz) ‡æ√“–round window Õ¬Ÿà™‘¥°—∫ basal portion ¢Õßorgan of corti. πÕ°®“°π—È𠬓¬—ß “¡“√∂´÷¡ºà“π‡¢â“‰ª∑”≈“¬ vestibular labyrinth ∑”„Àâ¡’°“√ Ÿ≠‡ ’¬°“√∑√ßµ—« À√◊Õ‡«’¬π»’√…–‰¥â. ‡¡◊ËÕ¡’Õ“°“√¥—ß°≈à“« §«√À¬ÿ¥¬“À¬Õ¥ÀŸ∑—π∑’ ·≈–§«√µ√«®°“√‰¥â¬‘π¢ÕߺŸâªÉ«¬. ºŸâªÉ«¬∑’Ë¡’‡¬◊ËÕ·°â«ÀŸ∑–≈ÿ ·≈–‰¡à¡’Õ“°“√Õ—°‡ ∫¢Õ߇¬◊ËÕ∫ÿÀŸ™—Èπ°≈“ß™—¥‡®π §«√‡≈◊Õ°„™â¬“µâ“π®ÿ≈™’æ∑’ˉ¡à¡’æ‘…µàÕÀŸ™—Èπ„𠇙àπ ciprofloxacinÀ√◊Õ ofloxacin8.

2. Õ“°“√ª«¥ ‡°‘¥®“°°“√∑’Ë„™â¬“À¬Õ¥ÀŸ„π√“¬∑’Ë¡’·°â«ÀŸ∑–≈ÿ ‚¥¬‡©æ“–¬“À¬Õ¥ÀŸ∑’Ë¡’§ÿ≥ ¡∫—µ‘‡ªìπ°√¥ À√◊Õ¡’·Õ≈°ÕŒÕ≈凪ìπ à«πª√–°Õ∫. ¬“chloramphenicol ·≈– vehicle ´÷Ë߇ªìπ propyleneglycol ∑’Ë„™â°—π¡“°„π‡«™ªØ‘∫—µ‘π—Èπ “¡“√∂∑”„À⇬◊ËÕ∫ÿÀŸ™—Èπ°≈“ß√–§“¬‡§◊Õ߉¥â. ∂⓺ŸâªÉ«¬‰¡à “¡“√∂∑π‰¥â §«√‡ª≈’ˬπ‡ªìπ ophthalmic solution ´÷Ëß¡’ à«πª√–°Õ∫ ∑’Ë∑”„À⇰‘¥°“√√–§“¬‡§◊ÕßπâÕ¬°«à“.8

3. °“√·æ⬓ æ∫‰¥â‚¥¬‡©æ“– neomycin∑”„Àâ·æ≥â∫àÕ¬ ‚¥¬Õ“®¡’º◊Ëπ·æâ∑’˺‘«Àπ—ß (contactdermatitis) ¢Õß™àÕßÀŸ™—ÈππÕ°·≈–„∫ÀŸ ™àÕßÀŸ™—ÈππÕ°Õ“®∫«¡ ·¥ß À√◊Õ¡’µÿà¡„ ¢÷Èπ∑’Ë√ŸÀŸ À√◊Õ„∫ÀŸÕ“®¡’

¿“æ∑’Ë 1. °“√À¬Õ¥¬“À¬Õ¥ÀŸ∑’Ë∂Ÿ°µâÕß.

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1018 §≈‘π‘° ªï∑’Ë 24 ©∫—∫∑’Ë 11 惻®‘°“¬π 2551

Õ“°“√§—π√à«¡¥â«¬. °“√„™â¬“µâ“π®ÿ≈™’æ™π‘¥Õ◊Ëπ°ÁÕ“®æ∫‰¥â §«√µâÕßÀ¬ÿ¥À¬Õ¥¬“∑—π∑’ ‡¡◊ËÕ¡’Õ“°“√¥—ß°≈à“«.

4. °“√µ‘¥‡™◊ÈÕ√“·∑√°´âÕπ ‡°‘¥®“°°“√„™â¬“µâ“π®ÿ≈™’懪ìπ√–¬–‡«≈“π“πÊ §«√µâÕßÀ¬ÿ¥¬“µâ“π®ÿ≈™’æπ—Èπ‡ ’¬ ·≈–√—°…“‚√§‡™◊ÈÕ√“„πÀŸ.

°“√À¬Õ¥¬“À¬Õ¥ÀŸ°“√√—°…“‚¥¬°“√„™â¬“À¬Õ¥ÀŸ„À≥âº≈ Ÿß ÿ¥

π—Èπ ®”‡ªìπµâÕßÕ∏‘∫“¬„À⺟âªÉ«¬∑√“∫∂÷ß«‘∏’°“√À¬Õ¥ÀŸ∑’Ë∂Ÿ°µâÕß (¿“æ∑’Ë 1).

1. §«√∑”§«“¡ –Õ“¥™àÕßÀŸ™—ÈππÕ°°àÕ𠇻… ‘Ëß °ª√° À√◊ÕÀπÕß §«√®–∂Ÿ°‡Õ“ÕÕ°°àÕπ ‚¥¬„™â‰¡âæ—π ”≈’‡™Á¥ÕÕ° À√◊Õ‚¥¬°“√¥Ÿ¥ (suction).

2. ºŸâªÉ«¬§«√®–µ–·§ß‡Õ“ÀŸ¥â“π∑’Ë®–À¬Õ¥¢÷Èπ∫π.

‡Õ° “√Õâ“ßÕ‘ß1. ÿ‡¡∏ æ’√«ÿ≤‘. °“√„™â¬“À¬Õ¥ÀŸ. „π : ÿ‡¡∏ æ’√«ÿ≤‘,

∫√√≥“∏‘°“√. ¿“«–‡√àߥà«π∑“ßÀŸ. °√ÿ߇∑æœ :æ—∫≈‘§∫‘ ‡π æ√‘Èπ∑å, 2529:211-24.

2. Fairbanks DNF. Selection of drugs for externalear infections (ototopicals). In : Pocketguide to antimicrobial therapy in Otolary-ngology-Head and Neck Surgery. 10th ed. Al-exandria : American Academy of Otolaryngo-logy-Head and Neck Surgery Foundation,2001:53-5.

3. Tutkun A, Ozagar A, Koc A, Batman C, UneriC, Sehitoglu MA. Treatment of chronic eardisease. Topical ciprofloxacin vs. topicalgentamicin. Arch Otolaryngol Head Neck Surg1995; 121:1414-6.

4. Jones RN, Milazzo J, Seidlin M. Ofloxacin

3. °“√À¬Õ¥ÀŸ®–‰¥âº≈¥’ ÿ¥ ∂â“¡’§πÀ¬Õ¥„Àâ‚¥¬‡©æ“–„π‡¥Á° À√◊ÕÕ“®À¬Õ¥‡Õß ‚¥¬¥÷ß„∫ÀŸ‰ª¥â“π∫π·≈–‰ª∑“ߥâ“πÀ≈—ß ‡æ◊ËÕ„Àâ™àÕßÀŸ™—ÈππÕ°µ√ß.

4. À¬Õ¥¬“À¬Õ¥ÀŸ≈߉ª„π™àÕßÀŸ™—ÈππÕ°„Àâ∑à«¡ (ª√–¡“≥ 3-5 À¬¥) „π√“¬∑’Ë¡’‡¬◊ËÕ·°â«ÀŸ∑–≈ÿÕ“®µâÕßÀ¬Õ¥¡“°°«à“π’È.

5. Õ“®π«¥∫√‘‡«≥ tragus ‡æ◊Ëՙ૬¥—𬓉ª¬—ß™àÕßÀŸ™—ÈππÕ° à«π≈÷° √«¡∂÷߇¢â“‰ª„πÀŸ™—Èπ°≈“ߺà“π∑“߇¬◊ËÕ·°â«ÀŸ∑’Ë∑–≈ÿ‰¥â¥’¢÷Èπ.

6. πÕπµ–·§ßÕ¬Ÿà„π∑à“‡¥‘¡ª√–¡“≥ 5-10 π“∑’§«√·π–π”ºŸâªÉ«¬∑’Ë¡’‡¬◊ËÕ·°â«ÀŸ∑–≈ÿ«à“ Õ“®¡’¬“‰À≈≈ߧՉ¥â (∂â“∑àÕ¬Ÿ ‡µ‡™’¬π ´÷Ë߇ªìπ∑àÕ∑’ˇ™◊ËÕ¡µàÕ√–À«à“ß‚æ√ßÀ≈—ß®¡Ÿ° ·≈–ÀŸ™—Èπ°≈“ß ¬—ß∑”ß“π‰¥â¥’).

7. °àÕπ≈ÿ°¢÷Èπ À√◊ÕÀ¬Õ¥ÀŸÕ’°¢â“ß §«√π” ”≈’Õÿ¥∑’Ë™àÕßÀŸ™—ÈππÕ° ‡æ◊ËÕ„À⬓§â“ß·≈– —¡º— Õ¬Ÿà„π™àÕßÀŸπ“π∑’Ë ÿ¥‡∑à“∑’Ë®–π“π‰¥â ·≈– “¡“√∂π” ”≈’π’ÈÕÕ°‰¥âÀ≈—ß®“°π—Èπ 20-30 π“∑’.

otic solution for treatment of otitis externain children and adults. Arch OtolaryngolHead Neck Surg 1997; 123:1193-200.

5. Schneider ML. Bacteriology of otorrheafrom tympanostomy tubes. Arch OtolaryngolHead Neck Surg 1989; 115:1225-6.

6. Lundy LB, Graham MD. Ototoxicity andototopical medications : a survey of otolary-ngolosits. Am J Otol 1993; 14:141.

7. Roland PS. Clnical ototoxicity of topicalantibiotic drops. Otolaryngol Head Neck Surg1994; 110:589.

8. Force RW, Hart MC, Plummer SA, Powell DA,Nahata MC. Topical ciprofloxacin for otorrheaafter tympanostomy tube placement. ArchOtolaryngol Head Neck Surg 1995; 121:880-4.