Ear conditions Flashcards
when examining the ear what do you check?
- Inspect outer ear - redness/ swelling/ discharge/ bleeding
- Check pinna – dermatitis, ulcer/blistering
- Mastoid area – apply pressure directly behind the ear- if tender possibly infection of the mastoid bone of the skull
how do you inspect the ear canal for a adult/ child?
- adult - hold top of ear and firmly pull up and back
- child - gently firmly pull lobule down and back
what is ear wax?
combination of cerumen, sebum,
dead skin cells, sweat, hair, foreign matter
(e.g. dust).
Normal and natural physiological substance
that protects ear canal. Quantity produced
varies.
how does the colour and consistency differ in various patient groups?
- Asians- dry type (grey and flaky)
- White & Africans – moist type (honey to dark brown)
- This is genetically determined!
- Soft cerumen - Children
- Hard cerumen – Adults
what can result from excessive or impacted ear wax?
- Lots of hair growing in ears
- Narrow ear canals
- Use of hearing aids/ear plugs
- Age
what is the natural cleaning process of the ear?
- “Conveyor belt” process
- Cells formed in centre of tympanic membrane
migrate outwards - Accelerate towards the entrance of the ear canal
- Cerumen also carried outwards, taking with it
dirt, dust etc
what is the purpose of cerumenolytics?
- Available as ear drops to soften hardened wax.
what are the different types of cerumenolytics?
Water-based
* Urea Hydrogen Peroxide 5% (Otex)
* Sodium Bicarbonate 5%+ glycerol
* Docusate sodium 0.5% (Waxsol)
Oil-based Beware peanut allergies!!
* Almond oil
* Olive oil
* Arachis oil/chlorbutanol
how long do cerumenolytics take to achieve the desired effect?
7 days
when is ear syringing contraindicted?
Hx of perforation of tympanic
membrane, unilateral deafness, Hx of
recurrent otitis externa
how should you use ear drops?
- Warm the ear-drop bottle
- Unscrew cap of the bottle, draw liquid into dropper.
- Either lie on your side or tilt your head over
- Gently pull your earlobe upwards, away from neck,
- Squeeze correct no. of drops into ear.
- Keep your head tilted for about 5 mins
- Straighten your head, wipe away any excess liquid
- Replace the cap on bottle.
- Complete the course.
- Discard any drops left over at end of course.
when should you not use ear drops?
Perforation of Tympanic membrane
present, previous, suspected, or grommets
* Previous middle ear or mastoid surgery
* Recurrent Otitis Externa or chronic middle ear disease
* Dizziness or tinnitus
* People with nut allergies should not use arachis / almond oil.
what are the common outer ear disorders?
- Dermatitis – dry, itchy irritation of pinna / ear canal
- Tx – Emollients
- Contact dermatitis – sensitivity to earrings/ ear plugs/ aids
- Tx – Topical HC – advise avoid nickel containing earrings
- Seborrhoeic dermatitis – can affect ear in isolation
or alongside scalp dandruff / eye brow scaling
what is otitis externa?
swimmers ear
* Inflammation of the pinna skin/external ear canal* Localised/ diffuse* Acute/ chronic
what are the pre-disposing factors to otitis externa?
- Ear trauma* Use of cotton buds* Syringing* Excessive moisture* Humid environment* Chemicals – shampoo/hair dye
what are the different types of otitis externa?
- Infective exudate discharged
- Reactive form of dermatitis (atopic/contact)
- Furuncle (boil like) – s.aureus, severe pain, small red swelling
what are the common symptoms of acute cases of otitis externa?
- Pain in the ear canal (usually mild)
- Itching
- Impaired hearing (usually mild)
- Fowl smelling discharge
- Red ear
- Swollen / scaly ear
what is the POM treatment for acute otitis externa?
- Corticosteroid drops – for inflammation
- Topical ABx drops – for infection
- No more than 7 days Tx course
what is the OTC treatment for otitis externa?
- Acetic acid 2% Spray - 1st line for mild bact/fungal
- adults & over 12yr olds
- one spray tds - continued two days after symptoms resolved.
- Maximum dosage frequency one spray every 2 - 3 hours
- Max 7 days usage
when should you refer otitis externa?
- Internal Ear pain- likely infection
- Foreign body: suspect particularly in children.
- Otitis media: ear pain, if eardrum perforates,
purulent smelly discharge….see later - Mastoiditis: pt feels unwell, has marked hearing
loss, or mastoid tenderness/swelling - Barotrauma: Possible in divers or patients who have recently flown or had a blow to the ear
what is otitis media?
- Middle ear inflammation
- It occurs in the area between the tympanic membrane and the inner ear
- It is one of the most common causes of otalgia - earache
- Often preceded by upper respiratory symptoms, including
a cough and rhinorrhoea.
what may happen with otitis media?
The tympanic membrane may perforate known as suppurative otitis media …..key symptom is otorrhoea (fluid discharge)
what does an inflamed tympanic membrane look like?
bulging and injection of blood vesselsLimited mobilisation of the membrane
who is acute otitis media most commonly seen in?
- 1 in 4 children have 1 episode before age 10
- peak incidence: 3-6 years of age
- causes pain and deafness.
what are the signs of acute otitis media?
- Pulling at the ear
- Sleeplessness
- Irritability
- Fever
- Perforation of ear drum gives relief & usually heals naturally
are antibiotics needed for acute otitis media?
usually not needed
may cause unwanted effects such as diarrhoea, stomach pains and rash
as well as antibiotic resistance
what is the treatment for acute otitis media?
paracetamol for both adults and children
what is otitis media with effusion?
Glue ear” inflammation of the middle ear accompanied by accumulation of fluid…blockage of the eustachian tube
does glue ear occur reularly?
- Spontaneous resolution is common
- 50% resolve within 3 months , 95% within a year
- If episodes frequent / persistent, speech/language development,
behaviour may be adversely affected
what are the risk factors for glue ear?
- Gender - Males
- Exposure to tobacco smoke
- Young age (peak 2yrs old)
- Formula feeding
- Season (more prevalent in winter)
- Sibling Hx of G.ear
what is tinnitus?
Inner Ear Disorders
* Tinnitus – sound in absence of stimuli
* Buzzing, ringing, whistling, hissing
* Varies between- intermittent, continuous, pulsatile
what is tinnitus associated with?
hearing impairment, impacted wax, head injury, toxicity, Meniere’s disease,
what is the treatment for tinnitus?
- No cure
- Correct hearing loss
- Counselling
- Sound therapy
- Support group
what is meniere’s disease?
- Progressive disorder of inner ear – unknown cause
- Fluid build up in the inner ear
- Age 30-60
- Attacks can last 20mins - hours
- Attack frequent/once every few months
what are the symptoms of meniere’s disease?
- Vertigo
- Dizziness
- Nausea
- Vomiting
- Dulled hearing, Tinnitus
- Pressure
- Headache (migraine like aura)
what is vertigo?
A symptom rather than a condition!
Problem with the balance functions of
the inner ear
what are the causes of vertigo?
- Viral infection
- Brain stem ischaemia
- Eustachian tube dysfunction
- Chronic Otitis media
- Epilepsy/MS
- Head injury
- Travel sickness
- Nasopharyngeal carcinoma
how should menieres be managed?
- Acute attacks: Prochlorperazine 5mg tds 7/7 (POM)
- Vertigo & nausea & vomiting
- Buccally /rectally
- Cinnarizine 30mg tds 7d…can be supplied OTC
what is the prophylactic management of menieres?
- Betahistine (POM)
- BNF: 24-48mg od with food
- RCT – statistically significant reduction in intensity & no. of attacks, treated with betahistine 16mg BD for 3 months
what drugs can cause hearing impairment?
- Chemotherapeutics - Cisplatin
- Antibiotics - Aminoglycosides
- Loop diuretics - Furosemide
- Antimalarials - Mefloquine
- NSAID - aspirin
