EAR DISORDERS Flashcards
a hydrophobic protective covering of the ear canal against water damage, infection, trauma, and foreign bodies
Cerumen
is the accumulation of cerumen causing obstruction in the external ear
Cerumen Impaction
What causes cerumen impaction?
S-swimmer’s ear
C- Conditions of the skin (asthma)
U- Unnecessary ear cleaning
B- Blockage within the ear canal
A- Autoimmune conditions
Clinical Manifestations of Cerumen Impaction
-Sensation of fullness inside ear
- Conductive Hearing loss
- Ear pain
Prevention of Cerumen Impaction
-Don’t clean ears with cotton buds
- Wear earplugs when swimming
The rationale on why ears don’t need to clean with cotton buds
The ears are self-cleaning and do not need to be cleaned unless there is cerumen impaction
Management for Cerumen Impaction
Irrigation of the Ear Canal
- Soften cerumen by instilling mineral oil or half- strength hydrogen peroxide (H202) 3o minutes prior to procedure
-Straighten the ear canal
- Warm saline irrigation is gently flushed toward the roof of the ear canal
-Position patient on affected side
-Instrumentation
The rationale on position the patient on affected side in the management of cerumen impaction
To promote drainage of fluids
Is the inflammation or infection of the external auditory canal (EAC)
Otitis Externa
Also called “Swimmer’s Ear”
Otitis Externa
Risk is increased with continuous water exposure of EAC and local trauma
Otitis Externa
Common pathogens of Otitis Externa
-Pseudomonas aeruginosis (yellow green)
- Staphylococcus aureus (creamy white)
Nerve impulse
Organ of corti
What are the 3 ossicles?
-Maleus
- Ileus
- Stapes
Medical Management of Otitis Externa
-Otic Preparations
-Ciprofloxacin Otic
-Ofloxacin Otic
-Alcohol Vinegar Otic Mix (Homemade)
- 50% rubbing alcohol, 25% white vinegar, 25% distilled water
-Used as prevention of or as flushing solution for fungal infections
Used as a prevention of or as flushing solution for fungal infections
Alcohol vinegar otic mix (Homemade)
Clinical manifestations of Otitis Externa
- Aural tenderness
-Ear pain - Otorrhea, initially clear but quickly becomes purulent and foul-smelling
-Hearing loss - Erythema, edema, and narrowing of EAC
-Fever (occasional
Hallmark sign of Otitis Externa
Aural Tenderness
Is any inflammation in the middle ear regardless of the etiology or pathogenesis
Otitis Media
Generally, less common among adults
Otitis Media
Characterized by changes in tympanic membrane (TM)
Otitis Media
Characteristics of Normal Tympanic Membrane
pearly-grey, translucent, and shiny
Characteristics of TM in Acute Otitis Media
Bulging TM
Characteristics of TM in Chronic Otitis Media
Retracted TM
Acute infection of the middle ear lasting less than 6 weeks
Acute Otitis Media
Usually precipitated by an Upper RTI
Acute Otitis Media
Clinical Manifestations of Acute Otitis Media
-Bulging tympanic membrane
-Otalgia
- Otorrhea
- Hearing loss
- Fever
Sudden relief is an indicator of TM perforation
Otalgia
Presence of fluids with/without signs of infection
Serous Otitis Media
Also called Otitis Media with Exudates (OME)
Serous Otitis Media
Commonly caused by eustachian tube dysfunction and barotrauma
Serous Otitis Media
Clinical Manifestation of Serous Otitis Media
-Dull tympanic membrane
- Fullness inside the ear
- Hearing Loss
- Popping or crackling sounds
Recurrent Acute Otitis Media
Chronic Otitis Media
Irreversible tissue pathology
Chronic Otitis Media
Clinical Manifestations of Chronic Otitis Media
-Hearing loss
- Persistent or intermittent, foul-smelling otorrhea
-Postauricular pain and tenderness, if with acute mastoiditis
-Cholesteatoma
Tumor situated at the external layer of the tympanic membrane into the middle ear
Cholesteatoma
Damages the mastoid bone
Cholesteatoma
First line drugs of Acute Otitis Media
Amoxicillin
Second line drugs of Acute Otitis Media
Co-amoxiclav
Third line treatment for Acute Otitis Media
Cefaclor
For H.influenzae cases resistant to amoxicillin or ampicillin
Cefaclor
Medical Management of Acute Otitis Media
-Broad Spectrum antibiotics (for bacterial etiology
-Amoxicillin
- Co-amoxiclav
-Cefaclor
-NSAIDs for pain
-Supportive Care, if viral
Surgical Management of Acute Otitis Media
Myringotomy
Surgical creation of an opening in the tympanic membrane to allow equalization of pressures
Myringotomy
Medical Management of Serous Otitis Media
-Broad-spectrums antibiotics
-Co-amoxiclav
-Corticosteroids
- Valsalva maneuver
if cause is barotrauma
Corticosteroids
First line drug of Serous Otitis Media
Co-amoxiclav
Opens eustachian tube
Valsalva Maneuver
Surgical Management of Serous Otitis Media
Myringotomy- if with significant hearing loss
Medical Management of Chronic Otitis Media
Otic antibiotic drops, as ordered for purulent discharge
-Ciprofloxacin otic
- Ofloxacin otic
Surgical Management of Chronic Otitis Media
-Tympanoplasty
- Ossiculoplasty
- Mastoidectomy
Surgical reconstruction of the TM
Tympanoplasty
Surgical reconstruction of the middle ear bones
Ossiculoplasty
Surgical removal of mastoid air cells
Mastoidectomy
Location of Incision in Mastoidectomy
Post-Auricular
Purpose of Mastoidectomy
-To remove cholesteatoma
- To gain access to diseased structures
- To create a dry healthy ear
Post-operative Health Teachings of Mastoidectomy
-Instruct patient to maintain mastoid pressure dressing for 24 to 48 hours
- Keep incision dry for 2 days
- Instruct patient to prevent water from entering external ear canal x 6 weeks
- Apply cotton ball with petroleum jelly to ear when showering or shampooing
- Instruct to avoid heavy lifting, straining, exertion, and nose blowing for 2 to 3 weeks after surgery to prevent dislodging the tympanic membrane graft or ossicular prosthesis
Hours to maintain mastoid pressure dressing patients undergoing mastoidectomy
24 to 48 hours (1 day or 2 days)
Days to keep incision dry in patients undergoing mastoidectomy
2 days
Irreversible Tissue Pathologies Associated with Chronic Otitis Media
-Tympanic membrane damage
- Destruction of the ossicles
- Mastoid involvement
is a disturbance of equilibrium caused by constant motion
Motion Sickness
What is the Pathophysiology of Motion Sickness?
Vestibular Overstimulation
Clinical Manifestations of Motion Sickness
-Sweating
- Pallor
- Nausea and vomiting
Medical Management of Motion Sickness
Meclizine (Bonoamine)
This drug is for nausea and vomiting
Meclizine (Bonoamine)
What is the mechanism of action of Meclizine (Bonoamine)
blocking the conduction of the vestibular pathway of the inner ear
The alternative medicine of motion sickness
Acupressure
The meclizine (bonoamine) must be taken
30 mins to 1 hr before the travel time
Location of acupressure
Acupressure at the P6 or Nei Guan Point
Used to treat nausea and vomiting and has been practiced in China for many years
Acupressure
Acupressure at ___ has been used successfully to decrease the symptoms of pregnancy sickness and with mixed results to decrease motion sickness
P6
