9 - Ear Disorders Flashcards
What is found in the outer ear?
- Auricle (pinna), directs sound waves into ear
- External auditory canal
What is the main function of the middle ear?
Sound transmission
What is found in the middle ear?
- Eardrum
- Ossicles - malleus, incus, and stapes (vibrations of eardrum are picked up by these bones and sent to the inner ear)
What is the Eustachian tube and what is its function?
- Hollow tube that connects middle ear to nasopharynx
- Functions as pressure equalizing valve for middle, which is normally filled w/ air
What is found in the inner ear?
- Sensory and equilibrium system
- Cochlea, vestibule, and semicircular canals
How should ear drops be instilled for children younger than 3 y/o?
Pull ear down and back
Why are children more at risk of middle ear infections?
- Shape and direction of Eustachian tube is more horizontal than vertical, which makes drainage difficult
- Easier entry of nasopharyngeal aspiration into middle ear, leading to proliferation of bacteria
How should ear drops be instilled for children over 3 y/o and adults?
Pull ear up and back
What makes the external auditory canal a good environment for bacteria and fungus?
Warm, dark, and prone to becoming moist
What makes the external auditory canal easily traumatized?
Skin is very thin
What are the special defenses of the external auditory canal?
- Cerumen
- Epithelial migration
- S shape of canal
- Hair in canal
What does failure of the defenses or damage of epithelium of the external auditory canal lead to?
Otitis externa
What are some self-treatable outer ear disorders?
- Cerumen impaction
- Water-clogged ears
Which part of the ear is involved in cerumen impaction and water-clogged ears?
External auditory canal
What are NOT symptoms of cerumen impaction or water-clogged ears?
- Inflammation
- Infection
- Pain
- Discharge
What is the maximum length of self-treatment for cerumen impaction and water-clogged ears?
4 days
What are some red flags for cerumen impaction and water-clogged ears?
- Earache/pain (moderate to severe in adults; any kind in children)
- Younger than 12 y/o
- Discharge/drainage or bleeding
- Signs of infection
- Fever
- Sudden hearing loss
- Foreign body in ear
- Tinnitus or dizziness
- Recent ear surgery (w/in 6 weeks); possible tympanic membrane rupture; any ear injury
- Tympanostomy tubes present
- Recent/recurrent otitis media or externa
- Abnormal ear structure
What is cerumen?
- Mixture of secretions from ceruminous and sebaceous glands combined w/ exfoliated squamous epithelium
- Contact w/ air causes it to darken and harden
Why is cerumen impaction more common in elderly?
Have drier wax
What is the function of cerumen?
- Protective component of outer ear
- Lubricates and entraps foreign materials
- Water repellant, preventing maceration of EAC
- Acidic, so bactericidal
What are some risk factors for cerumen impaction?
- Use of cotton-tipped applicators
- Abnormally narrow or mishaped EAC
- Excessive hair growth in canal
- Overactive ceruminous glands
- Physiological anomaly that disrupts normal migration of cerumen
- Use of hearing aids, ear plugs, and sound attenuators
- Atrophy of ceruminous glands (elderly)
- Previous impaction
What are symptoms of cerumen impaction?
- Feeling of pressure or fullness
- Pruritus
- Gradual hearing loss
- General discomfort (no pain)
What are the treatment goals of cerumen impaction?
- Soften and remove cerumen using safe and effective method to relieve symptoms
- Prevent future impaction
- Prevent infection
- Avoid damage to EAC
What is the first line tx for cerumen impaction?
Cerumen softening agent, non-water, non-oil based (carbamide peroxide 6.5% in anhydrous glycerin, Murine) 5-10 drops in affected ear(s) BID for 4 days
- Safe for anyone over 12 y/o
Why are non-oil based cerumen softening agents better than oil based?
Non-oil based tend to offer more immediate relief of sx b/c oil-based products just simply lubricate the EAC and don’t disintegrate cerumen
What products can be used to prevent cerumen impaction?
Hydrogen peroxide and sodium bicarbonate daily or 2-3 times/week
- Hydrogen peroxide 1% diluted in water 1:1
- Sodium bicarbonate 10-15% solution
What are some examples of water-based cerumen softening agents?
Water and saline
What is the recommended self-tx approach for cerumen impaction?
- Non-water, non-oil based or water based cerumen softening agent
- Bilateral tx
- Some initial fullness/hearing loss due to swelling of wax w/ use of products
What are some advantages and disadvantages to ear irrigation?
- Advantage - provide faster relief
- Disadvantage - can cause trauma to external ear canal, otitis externa, pain, nausea, vertigo, perforation of eardrum
Are syringes or commercially available irrigation products safer?
Syringes
When is ear irrigation recommended?
- No red flags present
- Use of a commercial product (Murine, Earigate)
- Recommended to have assistance
Is ear irrigation considered safe?
Yes
What is the recommended volume for ear irrigation?
240 mL (8 oz)
Irrigation fluid should be at ____ temperature
Body
How is ear irrigation performed?
- Use gentle pressure w/ irrigation bulb to introduce fluid
- Ensure fluid drains out of ear canal
- If pain or dizziness occurs, discontinue process
What are monitoring parameters for cerumen impaction?
- Relief of sx (ear fullness, hearing loss, ear discomfort) should occur as soon as wax is expelled
- Tx should be max of 4 days or 7 days if advised by physician
- Follow-up in 3-4 days
- Relief may take 5-7 days w/ oil-based products and w/o syringing
When should you refer cerumen impaction?
- Condition worsens
- No improvement after 4 days
- Development of fever, pain, discharge
- Red flags appear
What are some non-pharms for cerumen impaction prevention?
- Appropriate ear hygiene
- Stop improper or excessive attempts to remove cerumen
- Remove earwax w/ washcloth-draped index finger
What is ear candling?
- Hollow cone or tube made from cotton/linen soaked in wax or paraffin
- One end in px ear and other is lit
- Claims to create a vacuum and pressure draws wax from ear
Is ear candling recommended?
No
What can cause water-clogged ears?
- Excessive moisture in ears from hot, humid climates
- Swimming, bathing
What are symptoms of water-clogged ears?
- Feeling of wetness/fullness in ear
- Gradual hearing loss can occur
- Itching, pain, inflammation, or infection if condition progresses
What are the tx goals for water-clogged ears?
- Dry out ears using a safe/effective agent
- Prevent recurrences
What are some ear-drying agents?
Isopropyl alcohol 95% in 5% anhydrous glycerin
Why is glycerin mixed w/ alcohol in ear-drying agents?
Reduces moisture in ear w/o over drying
In what ages can ear-drying agents be used?
Adults and children 12 years and older
What is the dosing os isopropyl alcohol for treatment and for prevention of water-clogged ears?
- Tx - 4-5 drops in each ear daily for 4 days
- Prevention - 4-5 drops in each ear after swimming, showering, or bathing
- Max 10 drops/ear per day (5 drops/ear twice daily)
What is the recommended self-tx for water-clogged ears?
Ear-drying agent (isopropyl alcohol 95% in 5% anhydrous glycerin)
What is the duration of tx for ear-drying agents?
- Max. 4 days for self-tx of water-clogged ears
- For acute otitis externa, Rx for 7-10 days (up to 14 days may be needed)
When do you refer for water-clogged ears?
- Development of fever, pain, discharge (or any other red flags)
- Condition persists or worsens after 4 days of proper tx
What are some non-pharms for prevention of water-clogged ears and swimmers ear?
- After swimming/bathing, tilt affected ear down and gently manipulate auricle to help expel excessive water
- Use blow dryer on low setting around (not directly into) ear
- Use bathing cap while swimming
- Use safe and effective ear-drying agent preventatively
- Avoid overzealous wax removal
- Avoid water sports for 7-10 days after acute otitis externa
What are some otic conditions that must be referred?
- Otitis externa (swimmer’s ear)
- Otitis media
- Hearing loss (sudden)
- Ear pain (otalgia)
- Objects in ear
- Ear drainage (otorrhea)
- Tinnitus, vertigo, dizziness more than 24 hours
- Perforated eardrum
What is otitis externa?
Inflammation or infection of external auditory canal
What is the technical term for swimmers ear?
Acute diffuse otitis externa
What are the symptoms of otitis externa?
- Range from pruritus to severe pain and discharge
- Pain often worsens w/ motion of ear
What is the difference btwn water-clogged ears and swimmers ear?
- Swimmers ear is an infection
- Water-clogged ears may be a cause of swimmers ear
What is swimmers ear?
Inflammation of external auditory canal often due to infection
What are the symptoms of swimmers ear?
- Acute pain
- Itching
- Inflammation
- Foul-smelling watery discharge
- Some plugging and hearing loss can occur
Is swimmers ear self-treatable?
No
What is the tx for swimmer’s ear?
Antibiotic +/- corticosteroid ear drops
What is acute otitis media?
- Inflammation or infection of middle ear
- Most often viral and self-limiting
What are symptoms of acute otitis media?
- Acute ear pain (usually unilateral, developing over a few hours)
- Fever
- Reduced hearing
What is secretor otitis media?
- Otitis media w/ effusion
- Middle ear space becomes full w/ sticky effusion which is unable to escape
What is chronic suppurative otitis media?
Involves a perforation (hole) in eardrum and active bacterial infection w/in middle ear space
What is another name for airplane ear?
Otic barotrauma, or aerotitis media
What causes otic barotrauma?
- Increased air pressure
- Respiratory infection or mechanical pressure factors (scuba diving, flying)
What is the pathophysiology of otic barotrauma?
- Injury to middle ear caused by a rapid change in air pressure
- Normally Eustachian tube equalizes pressure on both sides of eardrum, so a rapid change in pressure can cause ear drum to bulge out or retract in, or unequal pressure on eardrum (muffled sound, pain)
- Blocked Eustachian tube (congestion) or narrower Eustachian tube (children)
What are signs and symptoms of otic barotrauma?
- Discomfort or pain in ear
- Feeling of fullness or stuffiness in ear
- Slight hearing loss
- Tinnitus
- Bleeding from ear
- Dizziness
- Sx may last few hours up to 2-3 days
When should otic barotrauma be referred?
- Lasts more than 24 hours
- Bloody discharge
- Severe case
What are risk factors for otic barotrauma?
- Any condition that blocks Eustachian tube or limits its function
- Small Eustachian tube, esp in infants and toddlers
- Nasal congestion
- Sinus infection
- Hay fever
- Middle ear infection
- Sleeping on an airplane during ascent and descent
- Scuba diving
- Mountain climbing or driving through mountains
- Water skiing (hitting water at high speed)
- Slapped or hit on the ear
What is the tx for otic barotrauma?
- Mild case – self treatment (oral analgesics for pain; oral or topical decongestants)
- Severe case – refer
What are some non-pharms for otic barotrauma prevention?
- Avoid flying when you have a cold, sinus infection, nasal congestion, ear infection, or recent ear surgery (if unavoidable, recommend oral decongestant 30 mins prior to flight and descent or nasal decongestant 30 mins before descent or ascent)
- Take allergy medication 1 hour before flying if px has allergies
- Yawn and swallow during ascent and descent
- Suck on candy or chew gum
- Avoid sleeping during ascent and desent
- Drink water to avoid dehydration (avoid alcohol and caffeine)
What are some non-pharms for otic barotrauma for infants and children?
- Drink fluids on take-off and landing to encourage frequent swallowing
- Give acetaminophen 30 mins before take-off to control any discomfort
What is vertigo?
Feeling that you or your surroundings are moving when there is no actual movement
What are common causes of vertigo?
- Viral infections
- Inner ear disturbances (Meniere’s disease)
- Ototoxic drugs
- Trauma to ear or head
- Vascular disorders
What is dizziness?
Variety of sensations including motion sickness, lightheadedness, fainting, spinning
What is the cause of Meniere’s disease?
Fluctuating pressure of the fluid w/in the inner ear
What are symptoms of Meniere’s disease?
- Vertigo
- Nausea, vomiting
- Feeling of fullness/pressure in the ear
- Fluctuating hearing loss
- Tinnitus
When is Meniere’s disease referred?
Always b/c often drug-induced
What is tinnitus?
- Continuous or intermittent alien nose in ear
- Noise described as buzzing, ringing, whistling, hissing, ticking, or “wooshing”
When should you refer tinnitus?
Lasting over 24 hours
What are some possible causes of tinnitus?
- Loud noises for prolonged periods
- Impacted cerumen
- Airplane ear
- Chronic otitis media
- Drug-induced (alcohol, NSAIDs)
- Stimulants, caffeine, nicotine may often worsen existing problem
The interim care for earaches is ____
Oral analgesics
