Ear OTC - Ear Wax Flashcards
What do you need to look for when inspecting the outer ear? (4)
Redness
Swelling
Discharge
Bleeding
What do you need to look for when inspecting pinna? (3)
Dermatitis
Ulcer
Blistering
What do you need to look for when inspecting the mastoid area? (1)
Apply pressure directly behind the ear and if tender (mastoiditis - infection of mastoid bone of skill)
What do you need to look for when inspecting for ear canal? (2)
Adult: Hold top of ear and firmly pull up and back.
Child: gently firmly pull lobule down and back.
Define cerumen. (1)
Wax-like substance produced in external auditory canal by ceruminous glands.
What does earwax contain? (6)
Cerumen
Sebum
Dead skin cells
Sweat
Hair
Foreign matter (dust)
Explain the main role of normal and natural physiological substances. (2)
Ear canal protection.
What are the types of ear wax? (5)
Asian - dry type (grey + flaky)
White & African - moist type (honey to dark brown)
Soft cerumen - Children
Hard cerumen - Adults
Excessive/impacted ear wax:
- Lots of hair growth
- Narrow ear canals
- Use of earring aids / ear plugs
- Age.
Explain the process of cleaning the ear canal. (5)
Cells are formed in the centre of the tympanic membrane migrate outwards.
Accelerates towards the entrance of the ear canal.
Cerumen is carried outwards taking with it dirt, dust etc.
Earwax only removed if symptomatic.
Cotton nuts not recommended.
What are the tx options for ear wax? (2)
Cerumenolytics:
- Water-based: Urea Hydrogen Peroxide 5% (Otex), Sodium Bicarbonate 5% + glycerol, Docusate sodium 0.5% (Waxsol)
- Oil: Almond, Olive, Arachis/Chlorbutanol (Cerumol) oil. Beware of peanut allergies.
May take 7 days to achieve desired effect.
Ear syringing not recommended. (C/i = Hx of tympanic membrane perforation, unilateral deafness, Hx of recurrent otitis externa).
Counsel a patient on how to use ear drops. (10)
Warm the ear-drop bottle.
Unscrew cap of bottle, draw liquid into the dropper.
Lie on your side or tilt your head over.
Gently pull earlobe upwards, away from neck, squeeze correct no. Of drops into ear.
Keep your head tilted for 5 minutes.
Straighten your head, wipe away any excess liquid.
Replace cap on bottle.
Complete course.
Discharge any drops left over at end of course.
When do you not use drops? (6)
Tympanic membrane perforation (present, previous, suspected, grommets)
Previous middle ear or mastoid surgery.
Recurrent otitis externa / chronic middle ear disease.
Dizziness/tinnitus
People with nut allergies should not use arachis / almond oil.
With some drops earwax initially swells -> temporary deafness.
