Ears and eyes Flashcards
Outline the role of the ear
- Hearing organ and helps to regulate balance
- Consists of three parts, outer
ear middle ear and inner ear - The rigid parts of the inner
ear called the bony labyrinth
are involved in balance hence
the balance/hearing
condition labyrinthitis
Outline hardened ear wax as an ear condition
- Earwax is a secretion in the auditory canal which protects the ears from dirt and infection and irritation from water.
- Flakes or crusts of earwax break off and fall out of the ear from time to
time. - Patients with excessive ear wax may find lumps of earwax on their pillow and affects hearing and becomes uncomfortable
- Older people and people who use hearing aids or earplugs might
experience worse problems in comparison to the rest of the
populations
Outline what causes hardened ear wax
- A number of possible causes:
- Internal factors
- Excessive ear wax secretion
- Hairy or narrow auditory canal
- Age
- External factors
- Hearing aid and earplugs
- Cotton buds!!
Outline signs and symptoms of hardened ear wax
- Earache
- Reduced or difficulty hearing
- Itchiness in the ear with temptation to use a cotton bud
- Dizziness if severe
- Increased risk of ear infection
- Ringing or high pitched tone in the ear
Outline when to refer for heardened ear wax
- If a proprietary ear wax softening product hasn’t cleared a blocked ear
after 5 days - If the ear is painful
- If the sufferer has difficulty hearing
Outline patients likely to be affected from hardened ear wax
- Common in older adults (rare in children)
- Older adults who may have impaired hearing often don’t notice build
up of wax. Many cases of conductive hearing loss/impairment are
caused by excessive wax build up - A child may show signs of excessive ear wax by sticking objects in
their ears out of irritation
Outline 1 treatment option for hardened ear wax
- Oil based wax softeners which claim to soften wax in the ear
- Assists the natural shedding process
- Can result in thinner wax that may be cleared from the outer ear by wiping away any residue
- Not particularly effective and many patients will still require
mechanical removal by a healthcare professional
Outline a 2nd treatment option for hardened ear wax
Chemical softeners
* Ingredients are alkaline and ear wax is slightly acidic
* Both products release gas to aid the break up of wax
* Sodium bicarbonate releases carbon dioxide
* Urea hydrogen peroxide releases oxygen
- Examples include: sodium bicarbonate and urea hydrogen peroxide (Otex express)
Outline a downside of chemical softeners
- Can dry out and
irritate the auditory canal - Some patients find the fizzing sensation upsetting or disorientating
- Some manufacturers have added glycerine to their drops to aid the
softening process and to reduce the sensation of dryness and
irritation
Outline how to use ear drops
- Warm the ear drops before insertion
- Lay on your side or tilt your head
- Pull on the outer ear gently to open the ear canal so that it is easier to
insert the drops - Insert drops into the ear canal without the bottle touching the ear
- Rub the tragus to ensure that the ear drops have reached all the way
down the ear canal - Wait 2-3 minutes for the drops to be absorbed
- Return to an upright position wiping away any residue that had
formed at the opening of the ear
Outline lifestyle advice for heardened ear wax
- Using olive oil drops may soften wax and ease its removal
- Ear candles do not work so don’t waste money
- Ear wax is natural so aggressive removal can worsen ear health
- Cotton buds should NEVER be inserted into the ear
Outline otits media as an ear condition
- Patients typically
experience acute otitis
media as a result of colds
and flu, bacterial infections
and inflammatory
conditions such as mumps. - If the swelling in the middle
ear becomes too great the
fluid may escape by
perforating the ear drum
Outline otitis externa as an ear condition
- Patients who suffer from dermatitis or
eczema are more likely to experience
otitis externa - Patients who swim a lot are also
susceptible as water and chemicals in
swimming pools can strip away ear
wax and irritate the skin - Secondary infection commonly occurs
due to irritation and damage to the
skin
Outline what causes otitis media
- Inflammation of the middle ear
- Fluid can accumulate in the middle
ear for a number of reasons - Sufferers experience throbbing pain in
one or both ears and it can affect
hearing - Can lead to glue ear which is chronic
inflammation of the middle ear
Outline what causes otitis externa
- Inflammation of the auditory
canal - Irritation and swelling of the skin
in the auditory canal which is
susceptible to secondary
infection
Outline signs and symptoms of otitis media
Pain in the ear which is
throbbing
* Pain may worse with movement
particularly the jaw
* Patients may experience a high
temperature and very young
children may experience
vomiting or diarhoea
Outline signs and symptoms of otitis externa
- Ear canal is itchy and irritated
- Patient has probably tried to
releve symptoms by scratching
or insertion of cotton bud so
skin trauma possible
Outline when to refer for these types of ear pain
- Pain
- Discharge
- Impaired hearing
- Vertigo
- Tinnitus
- Deafness
Outline patients likely to be addected from ear pain
- Children
- Rates of otitis media are higher in unvaccinated children
- Patients with eczema and dermatitis are at greater risk of otitis
externa
Outline how to treat innear ear infections vs outer ear infections
INNER
* Antibiotics are not normally
required and do not make much of
a difference to symptoms such as
pain
OUTER
* Effective treatments are available
on prescription:
* antibiotic ear drops – to treat a
bacterial infection
* steroid ear drops – to bring down
swelling
* antifungal ear drops – to treat a
fungal infection
* antibiotic tablets – if your bacterial
infection is severe
Outline lifestyle advice for ear pain
- do not stick cotton wool buds or your fingers in your ears
- use ear plugs or a swimming hat over your ears when you swim
- try to avoid water or shampoo getting into your ears when you have a
shower or bath - make sure children are up to date with vaccinations
- Analgesics such as paracetamol or ibuprofen may relieve pain
symptoms, however patients experiencing pain should be referred to
their GP
Outline the role of the eyes
- The sight organ of the body, is made
up of two component parts separated
by the lens - The iris is a muscle which control the
amount of light entering the eye - The white of the eye (Sclera) is the
thicker protective coat which
maintains the shape of the eye. - Infections of the eye usually affect the
conjunctiva or surrounding structures
Outline conjuctivitis as an eye infection
- The conjunctiva is a transparent layer that covers the cornea and sclera
- Irritation usually occurs first followed by reddening and soreness which is
exacerbated by rubbing the eye - Conjunctivitis can have multiple causes and symptoms may differ slightly
depending on the cause. - The most commonly described symptom by patients is a gritty sensation in
the eye
Outline allergic causes for conjuctivitis
- Irritation of the conjunctiva
caused by an allergen or irritant - Common causes include
- Cosmetics (eye make up)
- Chemicals
- Pollen (associated with hay
fever) - Usually affects both eyes
Outline infective causes for conjuctivitus
- Most commonly bacterial infections
which results in thicker secretions
which are yellowish in colour - Viral conjunctivitis usually results in a
more watery secretion - Eyelids often become stuck together
during sleep - Usually affects one eye first
Outline how to treat allergic conjuctivis
Allergic
* Avoid causative agents if
identifiable
* Sodium cromoglycate eye drops
are considered effective
* Most witch hazel products do
little more than lubricate
* Vasoconstrictor eye drops
improve appearance but do little
to improve symptoms
Outline how to treat infective conjuctivitis
- If bacterial chloramphenicol eye
drops or ointment are the most
effective - Older agents such as propamidine
isethionate are less effective but
still available - Viral conjunctivitis should not be
treated OTC as prescription
antivirals may be necessary
Outline when to refer for conjuctivitis
- pain in your eyes
- sensitivity to light
- changes in your vision, like wavy lines or flashing
- intense redness in 1 eye or both eyes
- your baby has red eyes – get an urgent appointment if your baby is
less than 28 days old - you wear contact lenses and have conjunctivitis symptoms as well as
spots on your eyelids – you might be allergic to the lenses - your symptoms have not cleared up after 2 weeks
Outline 1 treatment option for bacterial/infective conjuctivitis
E.g. chloramphenicol 0.5% eye drops or 1% ointment
- Apply one drop every 2 hours for the first 2 days then 4
hourly thereafter. Treatment should continue for five days
even if symptoms improve.
- Ointments should be used 3-4 times daily
Outline a 2nd treament option for bacterial/infective conjuctivtis
E.g. propamidine isethionate 0.1% or dibromopropamide isetionate
* Apply one to two drops
up to four times a day
* Eye ointments should be
applied once or twice a day
Outline 1 treatment option for allergic conjuctivits
E.g. sodium cromoglycate, lubricants/witch hazel, vasoconstrictors
Outline lifestyle advice for conjuctvitis
- Use clean cotton wool (1 piece for each eye). Boil water and then let it cool
down before you: - gently rub your eyelashes to clean off crusts
- hold a cold flannel on your eyes for a few minutes to cool them down
- Do not wear contact lenses until your eyes are better. wash hands regularly with warm soapy water
- wash pillows and face cloths in hot water and detergent
- do not share towels and pillows
- Do not rub your eyes
Outline styes as an eye infection and its causes
- A stye is a small, painful lump on or inside the eyelid or around the eye.
- Surrounding skin is usually
reddened, swollen and the stye
may be filled with yellow pus.
CAUSED BY BACTERIA INFECTING EYELASH FOLLICLE OR EYELID
COMMON IN PATIENTS WITH BLEPHARITIS
Outline signs and symptoms of styes
- A red, hot, exquisitely tender swelling near the edge of the eyelid
- Inflamed (red and swollen) eyelids
- Burning or sore eyes
- Crusty eyelashes
- Itchy eyelids
Outline when to refer for styes and who is likely to be affected
- If the stye is very painful or swollen
- If the stye does not get better within a few weeks
- If the stye affects the patients vision
ANYONE CAN HAVE - May develop into chalazion or prespetal cellulitis
Outline treatment options for styes
- Products such as dibropropamidine
isethionate (see conjunctivitis) may be
used but are of limited benefit. - Treatments usually are not
recommended as they are self limiting
Outline lifestyle advice for styes
- Do not try to burst a stye
- Do not try to remove an infected eyelash yourself.
- Both actions can spread the infection.
- wash your face and remove eye make-up before bed
- replace your eye make-up every 6 months
- keep your eyelids and eyelashes clean, especially if you have blepharitis
- do not share towels or flannels with someone who has a stye
- do not rub your eyes if you have not recently washed your hands
- do not put contact lenses in before washing your hands
Outline blepharitis as an eye condition
- Blepharitis is not usually a
serious condition, but can lead
to other problems, such as dry
eyes and conjunctivitis if it’s
not treated. - It may be triggered by a
bacterial infection or skin
condition such as dermatitis
Outline signs and symptoms of blepharitis
- sore eyelids
- itchy eyes
- a gritty feeling in the eyes
- flakes or crusts around the roots of the eyelashes
- red eyes or eyelids
- eyelids sticking together in the morning when you wake up
Outline when to refer for blepharitis
- No response to over-the-counter treatments
- If there is any sign of ulceration
Outline treamtent options for blepharitis
Antibacterial eye drops could be recommended if there are signs of an
infection otherwise treatment usually consists of good eye hygiene and
a cleaning regime.
Outline lifestyle advice for blepharitis
- Cleaning the eyelids effectively
- Soak a clean flannel or cotton wool in warm water and place on your eye
for 10 minutes. - Gently massage your eyelids for around 30 seconds.
- Clean your eyelids using cotton wool or a cotton bud. It might help to use a
small amount of baby shampoo in water. - Clean your eyes every day even if symptoms improve or go away
- Don’t wear contact lenses whilst symptoms continue
- Do not use any make up as it could worsen symptoms or could be
contaminated - Don’t use milk, traditional remedy more likely to make the condition
worse/cause infection
