Ear Conditions Flashcards
List some protective purposes of earwax
Mechanical protection
Slightly acidic = protect against bacterial and fungal infection
Traps dirt, repels water
Aids removal of organisms
Lubricate ear canal
What are the symptoms of earwax?
(I think they mean excessive, idk)
Discomfort (blocked/full)
Can be itchy
Gradual reduction in hearing
Dizziness, tinnitus (less common)
What contributes to excessive earwax?
Overactive ceruminous glands
narrow ear canal, large amount of hair in canal
Insufficient talking/chewing
Age - earwax becomes drier and harder
Outline the steps for ear examinations
1) Take history, 2) wash hands, 3) inspect external ear for redness/swelling 4) apply pressure to mastoid area directly behind pinna, 5) move pinna up and down, manipulate the tragus, 6) examine the EAM
What questions can you ask to identify excessive earwax?
Can you describe your symptoms? How did they develop?
How painful is it on a scale from 0 to 10?
Have you experienced this before? If so, how did you manage it? Did it work?
Is there a history of trauma to your ear?
What medicines do you take?
Name some differential diagnoses for earwax (compaction??)
(they’re not very clear on the slides…)
Otitis externa = inflammation/infection of outer ear (redness/inflamm, itch)
Otitis media = middle ear infection (pain, fever, history of cold)
Inner ear = dizziness, tinnitus
Trauma to ear canal = laceration of the ear canal after cleaning with pens, cotton buds
Foreign bodies = similar symptoms as ear wax initially, discharge and pain over time, common in children.
What are the goals of treatment for earwax
Relieve symptoms/ improve quality of life, reduce risk/prevent complications
Soften and aid removal of ear wax
Manage with evidence based treatment
How is wax impaction treated?
> 30% clear in 5 days without treatment
Avoid cotton bud and ear candle use
Ear syringe by doctor is effective = flush ear with warm water or saline
- can be done prior or after earwax softeners
Comment on the use of Cerumenolytics in earwax compaction
Able to loosen/soften wax to aid removal, all have similar efficacy.
Safe in children and no medicine interactions
ADRs = few, local irritation, brief deafness inc
Precautions = peanut or almond oil allergy, irritation or rash occurs
Contraindication = inflammation in ear canal, perforation of eardrum
What medications can be used in treatment of external ear conditions? (e.g. earwax compaction/earwax)
Carbamide peroxide (ear clear)
Dichlorobenzene with chlorbutol (cerumol)
Docusate (waxol)
Instructions of use and notes for carbamide peroxide (Ear clear) use
Adults + children >12 y/o
5-10 drops, up to 4 days. DO NOT plug ear
Mild temporary effervescence
Instructions of use and notes for Dichlorobenzene with chlorbutol (cerumol) use
No age limit, contains arachis oil (peanut allergy?)
Up to 5 drops twice daily, few days
Plug ear with ear-drop moistened cotton plug
Instructions of use and notes for docusate (waxol) use
Fill ear for 2 consecutive nights
When to refer for ear wax conditions?
Signs of middle ear involvement (e.g. pain, fever, malaise)
Signs of inner ear involvement (e.g. dizziness, tinnitus)
Pain beyond discomfort, medication not working/making it worse
Potential trauma or foreign body
Provide useful patient information about earwax
Wax keeps ears clean/protective function
Wax build up/impaction generally harmless and will resolve
Talking/chewing helps earwax move out
Avoid cleaning ears with cotton buds (best prevention)
What is otitis externa?
Inflammatory condition of external ear canal (can inc. pinna or ear drum)
- cellulitis of skin and subdermis of external ear canal
Breakdown of skin integrity, less cerumen, or blockage with cerumen predisposing
Typically acute, can become chronic in kids >3 months
What are some causes of otitis externa?
Trauma (scratching)
High humidity, swimming (x5 more likely)
Skin conditions (dermatitis, seborrheoic dermatitis)
Allergy (e.g. antibiotic ear drops)
Chemical irritants
Who can be affected by otitis externa?
All ages, common 7-12 y/o; women up to 65y/o
less common in >50 y/o
Narrow ear canals pre-disposes
What time of year is otitis externa commonly seen?
End of summer, increased humidity and after swimming
What are the symptoms of otitis externa?
Sudden onset (w/in 48 hrs), acute onset of ear pain
Discomfort (blocker/full feeling), itchy (could be scratching w/ cotton bud)
Reduced hearing (due to swelling)
Pinna, tragus can be tender/painful if pull on ear
Swollen ear canal or discharge (on otoscopic examination)
Questions to ask when assessing otitis externa
Describe symptoms? How did they develop/when did you first notice them?
How painful is it on a scale from 0 to 10?
What have you done to manage this? Has it worked?
Is there a history of trauma to the ear? something stuck in the ear?
Any other medical conditions/medications?
What have you been doing? Swimming?
What are some differential diagnoses for otitis externa?
Otitis externa chronic = inflammation/infection of outer ear, discharge, itch
otitis media = children 3-6, pain predominant feature, fever, history of cold
inner ear = dizziness, tinnitus
contact dermatitis = much less likely, allergic reaction
furunuclosis = localised infection and pain of hair follicle on outer ear
dermatitis= itch, unlikely symptoms would be elsewhere
trauma to ear canal, foreign bodies,
viral/cancer = severe pain, taste disturbances, no relief with treatment
What are the goals of treatment for otitis externa?
Relieve pain, treat infection
reduce risk of complications
prevent recurrence
manage with evidence-based treatment = pharmacy medicine, prescription only medicine
Generally, how is otitis externa managed?
Uncomplicated otitis externa can resolve irrespective of treatment, limited OTC options available
Eardrop choice determined by = patient preference, managing risk factors, likelihood of effective use of medicines, severity
Pain management = simple analgesics
For infection = antibiotic eardrops w/ or w/out corticosteroid more effective than acetic acid
Used acidifying agent in fungal infection
How can you prevent otitis externa?
Maintain skin integrity, avoid risk factors, avoid trauma caused by ear cleaning, manage skin conditions, avoid triggers of contact dermatitis
Avoid water accumulation in ear, use acidifying ear drops after swimming
use mouldable silicone ear plugs when swimming
Name some drugs used to treat otitis externa
Acetic acid + isopropyl alcohol (aqua ear), glycerol plus isopropyl alcohol + propyl glycol diacetate (audiclean)
Auralgan = benzocaine and phenazone
Paracetamol/Ibuprofen
Antihistamines
Considerations/use for Audiclean and Aqua Ear in Otitis externa treatment
Any age = 4-6 drops each ear after swimming/bathing
Used for prevention of swimmer’s ear
ADR = transient stinging/burning when used
Contraindicated with discharge grommets/ear drum rupture
What drugs can you use to relieve ear pain for otitis externa?
Auralgan (benzocaine and phenazone)
Paracetamol/Ibuprophen
Considerations/use for Auralgan in treatment of otitis externa
pain reliever
There is a potential for sensitisation/allergy
When should you refer a patient with otitis externa/ear pain?
Signs of middle ear involvement (pain, fever, malaise)
Signs of inner ear involvement (dizziness, tinnitus), infection (fever, nausea, vomiting), itching/discharge inside ear canal
infant <6month, symptoms >4 days or recurrent
Inflammation of pinna
Slow growing growth on ear in elderly, history/sus of perforated ear drum
persistent/sever hearing loss
pain beyond discomfort
What else can you tell people with otitis externa?
Avoid water during initial treatment, avoid water accumulation in ear
avoid swimming in polluted water
use ear plugs when swimming, shower caps for bathing, dry ears thoroughly after swimming/ bathing
Fill ear canal with drops, massage pinna
Avoid cleaning ears with cotton buds
