Ear Conditions

Question 1

what are the 3 parts of the ear?

Answer 1

outer ear
middle ear
inner ear

Question 2

what two structures are found in the outer ear?

Answer 2

auricle - directs sound waves into the ear

external auditory canal (EAC)

Question 3

what makes up the middle ear?

Answer 3

eardrum and small bones (ossicles)

malleus, incus, stapes

Question 4

what is the Eustachian tube? what is its function?

Answer 4

hollow tube which connects the middle ear with the nasopharnyx
function: pressure equalizing valve for the middle ear which is normally filled with air

Question 5

what is the function of the middle ear?

Answer 5

vibrations of the eardrum are picked up by the ossicles and sent to the inner ear

Question 6

what is found in the inner ear?

Answer 6

cochlea, vestibule, semicircular canals

Question 7

what is the function of the inner ear?

Answer 7

houses the sensory and equalizing valve for the middle ear which is normally filled with air

Question 8

what is the shape of the EAC in someone younger than 3y.o? someone older than 3y.o?

Answer 8

younger: shorter, straighter, flatter (more horizontal than verticle)
older: longer and forms an S shape

Question 9

how do you instil ear drops in a child younger than 3y.o? older than 3y.o?

Answer 9

younger: pull ear downward and back
older: pull ear upward and back

Question 10

what is the problem with the shape of the EAC in children younger than 3?

Answer 10

drainage is more difficult

easier entry of nasopharyngeal aspiration into middle ear, leading to proliferation of bacteria

Question 11

list some reasons why the EAC is a good environment for bacterial/fungal growth?

Answer 11

1) warm, dark, and prone to becoming moist
2) skin is very thin and easily traumatized
3) exit of debris, secretions, and foreign bodies is impeded by a curve at the junction of the cartilage and bone
4) presence of hair causes further impediment of debris

Question 12

what are 4 defences the EAC has against bacterial entry/growth?

Answer 12

cerumen (ear wax)
epithelial migration
S shape of canal
hair located in the canal

Question 13

what are 3 outer ear disorders?

Answer 13

otitis externa
cerumen impaction
water-clogged ears

Question 14

what is otitis externa?

Answer 14

inflammation or infection of the EAC

aka swimmer’s ear

Question 15

what are some symptoms of otitis externa?

Answer 15

pruritis
severe pain
inflammation
foul-smelling watery discharge
plugging and hearing loss can occur

Question 16

what are some aggravating factors of otitis externa?

Answer 16

1) more likely to occur in summer when humidity is higher
2) prolonged exposure of ear to water (fresh water rather than pool or salt water)
3) excessive moisture or removal of protective ear wax makes the skin in the EAC more prone to infection
4) infections of outer ear can lead to swimmer’s ear

Question 17

what are some treatment options for otitis externa?

Answer 17

Antibiotic +/- corticosteroid eardrops:
gentamycin +/- betamethasone
ciprofloxacin +/- dexametansone
polymixin B + gramicidin

Question 18

what is cerumen impaction?

Answer 18

earwax accumulates in the inner part of the ear canal and blocks the eardrum

Question 19

what is the function of cerumen?

Answer 19

protective component of outer ear
functions to lubricate and entrap foreign materials
water repellant, preventing maceration of the EAC
acidic pH that is bactericidal

Question 20

what are some risk factors for cerumen impaction?

Answer 20

1) abnormally narrow or misshaped EAC
2) excessive hair growth in the canal
3) overactive ceruminous glands
4) physiological anomaly that disrupts the normal migration of the cerumen
5) use of hearing aids, ear plugs, and sound attenuators
6) atrophy of ceruminous glands
7) previous impaction

Question 21

what are some signs and symptoms of cerumen impaction?

Answer 21

1) feelings of pressure and fullness
2) pruritus
3) gradual hearing loss
4) general discomfort

Question 22

what class of drug is recommended for treatment of cerumen impaction?

Answer 22

cerumen softening agent

Question 23

what is a cerumen-softening agent? give an example

Answer 23

softens the ear wax
ex) carbamide peroxide 6.5% in anhydrous glycerin
(Murine Ear Wax drops)

Question 24

what are the directions of use for Murine Ear Wax drops?

Answer 24

5-10 drops in affected ears BID for 4 days

Question 25

who is able to use Murine ear wax drops?

Answer 25

adults and children over 12y.o

Question 26

what may occur when using the Murine ear wax drops?

Answer 26

initial fullness/hearing loss due to swelling of wax with use of products

Question 27

what misc products also act as cerumen softening agents?

Answer 27

olive oil/vegetable oil
light mineral oil
glycerin
propylene glycol
hydrogen peroxide 3# diluted in water (1:1)
sodium bicarbonate (10-15% solution)

Question 28

what are the directions of use for the misc cerumen softening agents?

Answer 28

4-6 drops in affected ears BID for 4 days

These agents can also be used daily or 2-3 times per week for prevention

Question 29

what is another class of drug that can be used for cerumen impaction? give examples

Answer 29

cerumenolytic agents - cerumen dissolving agents
triethanolamine polypeptide oleate condensate 10% (Cerumenex)
Chlorbutol 5%, oil of terebinth 10% (oil of turpentine), paradichlorobenzene 2% and peanut oil (Cerumol)
These products are generally not recommended

Question 30

what are the directions of use for Cerumenex?

Answer 30

should not be left in ear for more than 15 minutes

followed by syringing or irrigation of the ear

Question 31

what are the monitoring parameters for cerumen impaction?

Answer 31

duration of self-treatment is 4 days max

up to 7 days if advised by a physician

Question 32

when should you refer in the case of cerumen impaction?

Answer 32

development of fever, pain, discharge (or other red flags occur)
condition worsens or there is no improvement after 4 days

Question 33

what is an available product for ear irrigation?

Answer 33

Murine Earigate

Question 34

what is water-clogged ears?

Answer 34

excessive moisture in the EAC

Question 35

what are some symptoms of water-clogged ears?

Answer 35

feeling of wetness/fullness in the ear
Gradual hearing loss can occur
Can lead to itching, pain, inflammation, or infection if condition progresses

Question 36

what are the treatment goals for water-clogged ear?

Answer 36

dry out ears using a safe and effective agent

prevent recurrences in individuals prone to this condition