ear Flashcards
what is cerumen
- combination of secretions from ceruminous glands (modified apocrine sweat glands) & sebaceous glands + desquamated sheets of stratum corneum (layers of shed skin) and hair
- cerumen colourless & fluid but darken & harden with sustained exposure to air
properties of cerumen
1) antibacterial & antimicrobial
- saturated & unsaturated fatty acids, alcohol, cholesterol, IgG, IgA, acidic (pH < 6.5 = bactericidal)
2) water repelling properties
- fatty acids
- oily mechanical barrier, prevent organisms that enter from causing infection
3) sticky nature
- protect tympanic membrane from penetrations by insects/dust/airborne particles
4) lubricating nature
- prevent pruritus of external ear
5) self cleaning property
- ceruminokinesis
aetiologies of cerumen impaction
impaired/dysfunction of ceruminokinesis
risk factors for cerumen impaction
1) genetics
- stenotic ear canal (abnormally narrow), more hair
2) elderly
- lesser ceruminokinesis cuz lesser secretory glands & hair > coarse w age
3) conditions that increases scaling in ear canal
- eczema, seborrheic dermatitis
4) mechanical obstruction
- ear plug/aid, hearing device
5) poor hygiene
- inadequate shampooing = accumulation of skin particles that gets trapped in ear web
signs and symptoms of cerumen impaction
1) feeling of fullness/pressure
2) ear discomfort (muffled hearing)
3) severe: vertigo, tinnitus, pruritus
4) chronic cough
- pressure on tympanic membrane
- stimulation of auricle nerve on vagus branch
5) gradual hearing loss (> 80% blocked)
6) pain not usually present (refer)
7) uni/bilateral
when to refer for cerumen impaction
1) signs of infection (pain, discharge, fever)
2) pain associated with discharge
3) recent ear surgery (prior 6 wks)
4) bleeding/signs of trauma
5) suspected/signs of ruptured tympanic membrane (sudden sharp pain)
6) presence of tympanostomy tube (drain pus)
7) inability to use otic drops (shaky hands, cognitive problems()
8) hypersensitivity to ear drops
9) no improvement after 4 days of self care
treatment for cerumen impaction
1) water based
. docusate sodium (GSL)
- mild emulsifier
- MOA: penetrate & disperse ear wax
- SE: allergic reaction (redness of skin +/- rash)
. hydrogen peroxide 3% (not avail in community pharm)
- MOA: release nascent O2 in moisture, mechanical removal of earwax
- caution: no overuse
2) oil base
- almond oil, arachis oil, mineral oil
- MOA: lubricant, soften earwax, facilitate removal of earwax
3) non water/oil base
. carbamide peroxide (urea-hydrogen peroxide)
- MOA:
1) react with catalase in tissue, urea-hydrogen peroxide broken down, release O2, effervescence remove earwax
2) weak antibacterial effect
- SE: crackling/bubbling sound in ear
. glycerin
- MOA: emollient, act as humectant to soften ear wax
- not for patients with active ear infection
ear cleaning
- isotonic seawater (non medicated) to prevent buildup
- irrigation at clinic
- manual removal
symptoms vs location of ear
itch: external
pain: external, middle
discharge: external, middle
deafness: external, middle, inner
dizziness: inner
tinnitus: inner
water clogged ears
. water retention in ears
- fullness/discomfort in ear
- compromise natural defense -> tissue maceration -> infection
when to refer for water clogged ears
similar to cerumen impaction
1) signs of infection (pain, fever, discharge)
2) pain associated with discharge
3) ear surgery within 6 wks
4) bleeding/signs of trauma
5) suspect/signs of tympanic membrane rupture (sudden sharp pain)
6) inability to use ear drops (shaky hands, cognitive problem()
7) presence of tympanostomy tube (Drain pus)
8) hypersensitivity to otic eardrugs
9) no improvement within 4 days of self care
treatment of water clogged ears
. pharmacological: isopropyl alcohol 95% & glycerin 5% ear drops
- alcohol > 70% to dry ear
- glycerin as humectant
. nonpharmacological therapy
- avoid water exposure
- shower/swim cap, ear plugs
- pull ear back and gently shake excess water
otitis externa (swimmer ear) - general
- diffuse inflammation of external ear with no secondary infection
- risk factors: Warm climate, high humidity, increase water exposure
otitis externa (swimmer ear) - causes
1) tissue maceration -> cerumen breakdown -> change pH environment -> susceptible to infection
2) trauma from cleaning -> entry of organisms that can cause infection
3) chronic dermatological conditions: eczema, psoriasis, seborrheic dermatitis
otitis externa (swimmer ear) - signs & symptoms
1) itch, irritability, erythema
2) pain (esp when pull back ear)
3) drainage of foul smelling watery discharge
4) ear fullness w/wo jaw pain
5) impaired hearing
6) no systemic conditions
