Medications Prescribed

Commonly Used Remedies

• Florical
• Prednisone
• Niacin

Florical

Florical is being prescribed for the treatment of otosclerosis. This treatment is not widely accepted, and has not been proven to be effective. A large uncontrolled study of about 1500 patients by Dr. Shambaugh and associates suggested that it was effective. Although this medication is not a cure, it is thought to have some benefit in slowing the progression of the disease. This supplement is widely used to prevent osteoporosis (the bone softening that occurs with aging). It is the only medical treatment available for otosclerosis.

This medication is available over-the-counter (ie. without a prescription). It comes in a tablet that contains 3.75mg of fluoride and 145 mg of calcium. Take one tablet three times a day with meals.

Side effects of Florical include occasional stomach upset, allergic itching, and increased joint pains. If aggravation of arthritis occurs, Florical should be stopped and the joints usually return to their previous state in a few weeks.

After two years of Florical treatment, the dose is reduced from three times a day to one tablet once a day. We will need to monitor your hearing in the interval.

If you are a woman of childbearing age contemplating pregnancy, do not take this medicine.

Prednisone

One of the medications you have been prescribed is Prednisone, a steroid used for its powerful anti-inflammatory properties. This medication requires a prescription. Typically, a strong dose is used for 10 days, followed by a tapering of the dose. This tapering of the medicine is important for your body to start producing its own steroids again after you discontinue the medicine. Do not discontinue the medication without your doctor’s advise.

Side effects include (but are not limited to) gastrointestinal distress such as heartburn or stomach pain, insomnia, mood swings, menstrual irregularities, and increased appetite. Stomach upset may be minimized by taking the medication with meals, particularly bland foods and milk. If you experience significant heartburn or stomach pain, try using an antacid such as ranitidine (Zantac) or famotidine (Pepcid) twice a day. If it persists, discontinue the medicine and contact our office.

Please do not use this medicine longer than prescribed. Inform your physician if you have diabetes, severe high blood pressure, kidney disease, psychiatric illness, tuberculosis or a duodenal ulcer. Blood sugar levels can be significantly affected in diabetic patients with this medicine.

When taken for a short periods of time, side effects are uncommon. Long-term treatment at high doses may result in puffiness of the face, weight gain, increased bone fragility, cataracts, acne, increased facial hair, and rarely a severe hip joint disorder.

The medication is taken as follows unless otherwise notified:

Seventy tablets of 10 mg each are prescribed.

If there are any questions about taking this medicine please ask your pharmacist or contact our office.

Niacin

One of the medicines you have been prescribed is niacin, or nicotinic acid. It is a vitamin that has been found to be quite helpful in a number of patients experiencing ear symptoms such as a ringing sound in the ear, or tinnitus, fullness, and occasionally vertigo. The mechanism of action is unknown although it is thought to exert its effect by opening the small blood vessels to the inner ear and improving its blood supply. It is commonly used in people with high cholesterol as well.

One of the side effects of this vitamin is that it can cause significant flushing–redness and the sensation of warmth–over the face and body. This usually occurs the first hour after taking the medication but can occur several hours after taking a dose. It usually subsides after several weeks of consistent use. If this appears to be a significant problem for you, the sustained-release formula can be used. It is sometimes also called an “extended-release”, “no-flush” or “flush-free” formulation. You can minimize the flushing by avoiding alcohol or hot drinks after taking the tablet. Also, the tablet should be taken with food.

Niacin can be found over-the-counter (without a prescription) in every drugstore, and most grocery stores. You will find that they vary considerably in the number of milligrams (mg) contained in each tablet. The typical dose is between 100 mg and 250 mg twice a day.

Do not take this medicine if you have or have had any significant liver disease. If you have any questions ask your pharmacist or call our office.

Before Your Procedure

What You Should Know Prior To Your Appointment

Auditory Brainstem Response (ABR) or Brainstem Auditory-Evoked Response (BAER)

For all ABR (Auditory Brainstem Response) Testing Appointments:

For Adults: A current audiogram needs to have been done within the last 3-6 months prior to the ABR appointment. For patient convenience, an audiogram can be scheduled just prior to an ABR test, on the same day. For an ABR appointment only, please allow 45 minutes. For an ABR & Audiogram appointment, please allow 60 minutes. The intake of caffeine or alcohol must be avoided for 24 hours prior to your test.

For Children: Children between the ages of 0-6 months can be tested without sedation. If your child is older, please schedule a sedated ABR. Please bring a blanket, bottle, pacifier, and extra diaper. Please have your infant fed and changed and try to keep the child awake during the ride to our office. It is also advised to schedule your infant’s test during his/her regular nap time. For a Pediatric ABR appointment, please allow 120-180 minutes

Electronystagmography (ENG)

Electronystagmography (ENG) is used to evaluate patients with dizziness, vertigo, or balance dysfunction. ENG includes the use of electro-oculography to record eye movements. The vestibular system monitors the position and movements of the head in order to stabilize retinal images. ENG provides an objective assessment of the oculomotor and vestibular systems. ENG consists of three parts: oculomotor evaluation, positioning/positional testing, and caloric stimulation of the vestibular system.

The subtests of an ENG evaluate the oculomotor and vestibular systems. Comparison of the results obtained assists in determining the source of your dizziness or unsteadiness. This includes assessing the system responsible for rapid eye movements and refixation, the presence, absence, and ability of fixation of spontaneous nystagmus, the ability of the oculomotor system to track a target within the visual field, the presence or absence of nystagmus associated with benign paroxysmal positional vertigo (BPPV), the presence or absence of nystagmus in various body positions, and if a site of lesion can be inferred from results of caloric irrigation.

The test requires about ninety (90) minutes to complete. Although some people experience some dizziness during the test, the dizziness is usually of short duration.

In order to achieve the best test results, you should carefully follow these instructions:

1. Clean face, no makeup.
2. Remove contact lenses before the examination (bring your eyeglasses).
3. No solid foods for 2 to 4 hours before the test.
4. No coffee, tea, or cola after midnight on the day of the test.
5. No alcoholic beverages/liquid medication containing alcohol 48 hours before the test.
6. Discontinue all medication for 48 hours prior to the test, except “maintenance” medications for your heart, blood pressure, diabetes, or seizures, and any medications deemed by your physician to be necessary. Please consult your physician with any questions.

The following medications should be discontinued 48 hours prior:

• Allergy pills
• Tranquilizers (Valium, Libruim, Xanax, etc.)
• Sedative pills (all sleeping pills or tranquilizers)
• Decongestants/Antihistamines (Benadryl, Sudafed, Dimetapp, Chlortrimeton, Seldane)
• Pain pills
• Diet pills
• Nerve/muscle relaxant pills (Robaxin, Valium)
• Dizziness pills (Antivert, Meclizine, Bonine, ear patches, etc.)
• Aspirin or aspirin substitutes (Tylenol, etc.)
• Narcotics/Barbiturates (Codeine, Demerol, Percodan, Phenobarbital, antidepressants)

Note: It is helpful if you bring a list of the medications you take regularly, or even the medications themselves. Medications can be resumed immediately following the ENG testing procedures. If there are any questions about the test or medication, please contact your doctor or our office at (949) 631-HEAR.

Your cooperation in following these instructions will improve the quality of your hearing evaluation. For more information on what to do before your procedure, contact Shohet Ear Associates located convenient to Orange County and Los Angeles, California.

Medications To Avoid

Exercise Caution Prior To Your Procedure

The following is a partial list of products, which contain aspirin, salicylates or other components, which can cause bleeding if taken before surgery. Please avoid these and, if necessary, check your medications with a pharmacist. (ALL ANTI-INFLAMMATORY MEDICATIONS CAN CAUSE BLEEDING)

The products listed above are only a few of the many, which contain aspirin or like substances. If you have any questions, call our office located convenient to Orange County and Los Angeles.

Post-Operative Instructions

Take Care After Your Surgery

Listed below are instructions for Post-Operative Care. The doctor will review these instructions with you before your procedure. You may print a copy for your own reference.

1. Your surgeon will give you instructions concerning a return appointment to our office, at the time of your discharge from the hospital.
2. You may resume your regular activates as you feel able. Set your own pace. Please refrain from lifting anything heavier than 25 pounds for at least three weeks. If you have a tendency toward constipation, take a stool softener to lessen the need to strain while having a bowel movement.
3. There may be a plastic bubble over your ear. If there is, remove it the day after your operation by unfastening the velcro strap. The bubble will then just peel off your ear. Remove the piece of gauze from behind the ear. Clean the incision and apply bacitracin or polysporin to the wound twice a day for three days. Change the cotton ball in the ear canal 3 times a day until your return appointment.
4. Your hair, including the incision site, may be washed 5 days after the operation.
5. DO NOT LET WATER GET INTO THE EAR CANAL. If you have a cotton ball in your ear, change the cotton ball 3 times a day. There is ointment in the ear canal which will warm to your body temperature and eventually drain from your ear. The cotton ball prevents the drainage from getting on your clothes.
6. There may be some bloody drainage from the ear canal or behind your ear for a couple of weeks after your operation. This is normal. If you are concerned about the amount coming out, call your surgeon.
7. Things to watch for when you get home: Clear water-like drainage from the nose or incision site.
   a. Swelling of the wound.
   b. Pain or cramping in the legs.
   c. Redness, pain or pus-like drainage from the incision.
   d. Fever greater than 101.5 F.
   e. If you experience any of these, call your surgeon.
8. Do not blow your nose forcibly for two weeks following surgery. Air can be transmitted through the Eustachian tube into the middle ear space and disrupt the graft or any prostheses that has been placed.
9. If you must sneeze, try to do so through your mouth instead of your nose.

Should you experience difficulty upon returning home, or if you simply have questions, please contact us immediately at our center located convenient to Los Angeles and Orange County. Once we have assessed your situation, we will be prepared to make specific suggestions for your care.