Ear Disorders Flashcards
Describe the outer ear
- EAC (external auditory canal)
- auricle (pinna) - directs sound waves into the ear
Describe the middle ear
Made up of eardrum and 3 small bones (ossicles):
- malleus/hammer
- incus/anvil
- stapes/stirrup
- Vibrations of the eardrum are picked up by these bones and sent to the inner ear
- Eustachian tube is a hollow tube which connects the middle ear with the nasopharynx
- The eustachian tube functions as a pressure equalizing value for the middle ear which is normally filled with air
Describe the inner ear
Houses sensory and equilibrium system
Consists of:
- cochlea
- vestibule
- semicircular canals
Compare the EAC (external auditory canal) in adults and children
Children:
- EAC is shorter, straighter, and flatter than in adults.
- Shape and direction of eustachian tube is more horizontal than vertical. This makes drainage more difficult
Adults:
- EAC longer and forms an S shape.
- Eustachian tube lengthens downward as it enters the nasal cavity
- This design promotes drainage and inhibits aspiration of nasopharyngeal content into the middle ear
How do you put drops into a child’s ear? (under 3 yrs old)
pull down and back
How do you put drops into an adults’ ear? (over 3 yrs old)
pull up and back
List some special defences of the EAC (external auditory canal)
- cerumen
- epithelial migration
- S shape of canal
- hair located in the canal
What does failure of the defences or damage of the epithelium of the EAC result in?
otitis externa
Otitis Externa is an ______ ____ disorder
outer ear
Describe Otitis Externa
- inflammation or infection of EAC
- most often unilateral
- symptoms range from pruritus (itchy skin) to severe pain and discharge
- pain often worse with motion of the ear
Acute diffuse OE is generally referred to as?
swimmers ear
Do you have to refer swimmers ear?
yes
Cerumen (wax) impaction is an ___ ___ disorder
outer ear
water-clogged ears are an ___ ____ disorder
outer ear
3 outer ear disorders
1) otitis externa
2) cerumen impaction
3) water-clogged ears
acute otitis media (AOM) is a ____ ___ disorder
middle ear
What is acute otitis media
- inflammation or infection of middl e ear
- most often viral and self-limiting
- symptoms include acute ear pain, fever, and reduced hearing
- pain is often unilateral
Are topical agents used in AOM
no
What could you recommend for pain for AOM?
acetaminophen
ibuprofen
-local heat application may be beneficial
**systemic ABs (antibiotics) may be required
Secretor otitis media is an ___ ___ disorder
middle ear
Describe secretor otitis media
- otitis media with effusion
- middle ear space becomes full with sticky effusion which is unable to escape
Chronic suppurative otitis media is an ____ ____ disorder
middle ear
Describe chronic suppurative otitis media
involves a hole in the eardrum and active bacterial infection within the middle ear space
Otic barotrauma or aerotitis media is a ____ ___ disorder
middle ear
What is otic barotrauma or aerotitis media commonly referred to as?
airplane ear
Describe otic barotrauma or aerotitis media
- pain resulting from increased air pressure
- due to respiratory infection or mechanical pressure (from scuba diving or flying for example)
What is the only self-treatable middle ear disorder?
otic barotrauma or aerotitis media
Vertigo (and dizziness) is an ____ ___ disorder
inner ear
Describe vertigo
- feeling that you or your surroundings are moving when there is no actual movement
- major symptom of a balance disorder
If vertigo persists for more than __ hours = referral
24
What can vertigo be accompanied by?
tinnitus
decreased hearing
ear pain
Common causes of vertigo?
- viral infections
- inner ear disturbances (Ménière’s disease)
- ototoxic drugs
- trauma to ear or head
- vascular disorders
What is tinnitus ?
ringing in the ear
Ménière’s disease is an ___ ____ disorder
inner ear
What is Ménière’s disease believed to result from?
fluctuation pressure of the fluid within the inner ear
Symptoms of Ménière’s disease?
-vertigo
-feeling of fullness/pressure in the ear
-fluctuation hearing loss
tinnitus
Referral necessary for Ménière’s disease ?
yes
Tinnitus > __ hours requires a referral
24
Many ototoxic drugs can lead to??
tinnitus
vertigo problems
What are some high risk ototoxic agents?
aminoglycosides
antineoplastics
IV diuretics
What are some low risk ototoxic agents?
NSAIDs
antibiotics
Examples of antineoplastics
Cisplatin Carboplatin Vincristine Vinglastine Nitrogen Mustard
What can cisplatin and carboplatin cause?
hearing loss
tinnutis
What can vincristine and vinblastine cause?
hearing loss
What can nitrogen mustard cause?
vertigo
Examples of antibiotics
minocycline
erythromycin
vancomycin
What can minocycline cause?
vertigo (generally reversible)
What can erythromycin cause?
- hearing loss or vertigo
- high doses generally reversible
What can vancomycin cause?
- hearing loss if used with ahminoglycosides
- little evidence of toxicity if used alone
Examples of NSAIDs
ASA
Naproxen
Indomethacin
What can ASA cause?
tinnitus
hearing loss
vertigo
(high doses - generally irreversible)
What can naproxen cause?
hearing loss
maybe irreversible
What can indomethacin cause?
tinnitus
generally reversible
Does swimmer’s ear (otitis externa) need to be referred
yes
Does otitis media need to be referred ?
yes
Tinnitus, vertigo, and dizziness less than 24 hours need to be referred?
nope
does sudden hearing loss need to be referred?
yes
objects in the ear and perforated ear drums - do they need to be referred
yes
does ear pain need to be referred (otalgia)
yes
does ear drainage (otorrhea) need to be referred?
yes
What 2 ear disorders are self-treatable? Why are they self-treatable?
- cerumen impaction
- water-clogged ears
*self-treatable because they involve no inflammation, infection, pain, or discharges
Cerumen impaction and water-clogged ears are self-treatable for how many days?
max 4
pH of cerumen
5-7.2 (acidic, bactericidal)
wax build up is ?
self-limiting
symptoms of cerumen impaction
- feeling of pressure or fullness
- pruritis
- gradual hearing loss
- general discomfort
What is carbamide peroxide 6.5%?
cerumen softening agent
Murine Ear Wax Removal Drops
Application for carbamide peroxide 6.5%?
5-10 drops in affected ear(s) BID for 4 days
Application for: any type of oil glycerol hydrogen peroxide 3% diluted in water (1:1) sodium bicarbonate (10-15% solution)
?
*these are all cerumen softening agents
4-6 drops in affected ear(s) BID for 4 days
Cerumenex is a cerumenolytic agent which should not be left in the ear for more than ___ mins
*and should be followed by syringing or irrigation of the ear
15
Cerumol is a cerumenolytic agent - has ___ In it
peanuts
Describe self treatment approach for cerumen impaction
-recommend a cerumen-softening agent
(Murine is product of choice)
5-10 drops in affected ear(s) BID f 4 days
or use oil or glycerol
4-6 drops BID f 4 days
(these agents may be used daily or 2-3 times weekly for prevention)
Cerumenolytics usually require ?
irrigation of the ear
Cerumenex and Cerumol are ?
cerumenolytics
duration of treatment for cerumen impaction
4 days
-up to 7 days if advised by a physician
Irrigation fluid should be at ___ temp
body
Recommended volume for ear irrigation = ___ mL
240 mL
Isopropyl alcohol (95%) in 5% anhydrous glycerin (auro-dri or swim ear) is an ??
ear drying agent
Recommended treatment for ear drying agents?
instill 4-5 drops in each ear daily after showering, swimming, or bathing for 4 days
*max 10 drops/ear per day
Ear-drying agents are contraindicated with what type of pts?
Pts who have tympanostomy tubes
Duration of treatment for ear-drying agents?
4 days for WCE ?
7-10 days for AEO (acute otitis externa)
AOE (acute otitis externa) (swimmers ear) may need what treatment?
gentamicin/betamethasone (Rx)
ciproflox/dexamethasone (Rx)
polymyxin B + gramicidin (OTC)
Should you use a local anesthetic for an ear disorder?
you can but it only has an onset of 45 mins so using an oral analgesic (acet or ibu) is better
Risk factors for otic barotrauma? (Airplane ear)
- any condition that blocks the eustachian tube or limits it’s function
- a small eustachian tube, especially infants and toddlers
- nasal congestion
- sinus infection
- hay fever (allergic rhinitis)
- middle ear infection
- sleeping on airplane during ascent or descent
- scuba divers
- mountain climbers/driving through mountains
- falling/hitting water at high speed (water sports)
- being slapped or hit on the ear
Treatment for otic barotrauma (airplane ear)
mild case:
oral analgesics for pain
oral or topical decongestants
severe case:
refer
