Ear wax impaction Flashcards
Clinical Features of earwax impaction
History of gradual hearing loss Ear discomfort Itching Tinnitus Dizziness occurring infrequently Otoscope examination should reveal excessive wax
Specific questions to ask
age pain? duration? hearing impaired? HPC DHX MHX Describe symptoms using earing aids? course of symptoms associated symptoms hx of trauma use of medicines
specific questions to ask
Course of symptoms- Patient usually has a history of gradual of gradual hearing loss with earwax impaction
Associated symptoms- Dizziness and tinnitus indicate an inner ear problem and should be referred as ear wax impaction rarely causes tinnitus or true pain
History of trauma- check if the patients has recently tried to clean the ears. this often leads to wax impaction.
Use of medicines: If a patient has used an appropriate OTC meds correctly this would necessitate referral for further investigation and possibly ear irrigation
Use
Use of medicines TRied any OTC PMH DHX Age? fever in children could mean otitis media Are your ears fitted with hearing aids? Nature of discharge odour of discharge
State the conditions to eliminate in ear wax impaction
Trauma of the ear canal- refer
foreign bodies- most common in children - refer for removal;
polyp of the ear canal- persistent or recurring watery discharge, often smelly, discharge from the ear, slight discomfort in their ear
Treatment of earwax impaction
BNF suggests olive oil/almond oil/ sodium bicarbonate (BD/TDS up to 3 days)
Cerumol – cerumunolytic, 5d BD/TDS, plug with moistened cotton wool
Otex/Exterol – peroxide-based, 5d OD/BD, keep head tilted, do not plug 3-4days
Waxsol – docusate, fill the ear with the drops for max 2 consecutive nights
When to refer
dizziness/tinnitus- suggest inner ear problem
fever or general malaise in children - middle ear infection
OTC failure
Associated trauma-related conductive deafness
foreign body in the EAM
