Ethics

Question 1

ear wax impaction cause

Answer 1

narrowed ear canal/ abnormalities
elderly - drier harder wax, hearing aid
attempt to remove - cotton bud hair pin

Question 2

ear wax impaction symptom

Answer 2

feeling of discomfort
sensation ear is blocked
gradual hearing loss

Question 3

treatment

Answer 3

cerumenolytics for softening, dislodging & removal
ear irrigation - hose

Question 4

cerumenolytics

Answer 4

adverse effect - irritation
contraindications - infect/inflame external canal or perforation
if fail refer to doctor

Question 5

reason refer

Answer 5

history of trauma
- conductive deafness
- discharge from ear canal
obstruction
- mimic ear wax impaction, -discharge & pain develop
dizziness/tinnitus
pain from inner ear

Question 6

otitis external - swimmers ear
what, factors

Answer 6

general inflammation external ear canal - associate bacteria & fungi
precipitating factors
- ear trauma
- chemicals
- skin condition - eczema
- moist humid environment

Question 7

swimmer ear signs symptoms

Answer 7

active <6 weeks
chronic >3months
pain - chewing, pull ear
red, swollen
discharge - clear(depend cause) –> foul smell
itchy
mild hearing loss

Question 8

swimmers ears management

Answer 8

pain management
dont make it worse/ avoid contributing factors - keep ear dry, avoid trauma,
treatment
- ear toilet if discharge problem
- drying ear drop (usually prevention)
- antibiotics (OTC)
- dont recommend etc anaesthetic ear drop

Question 9

ear drop - prevention

Answer 9

shake water out ear first
adverse effect - stinging instillation, irritate skin
contraindication - perforated ear drum

Question 10

antibiotics

Answer 10

only prescription
systemic not recommended (except severe, immunocompromised)
topical - depend cause (antibacterial, antifungal, corticosteroid)

Question 11

otitis external reason referral

Answer 11

ear pain younger 6 yrs
hearing impaired
severe pain, not helped OTC
symptoms >7days
effects other part ears
mucus/pus discharge
pain when press behind ear

Question 12

acute otitis media

Answer 12

infection middle ear compartment –> blockage eustachian tube & fluid forms
common in children due to angle
caused by virus & bacteria
spontaneous resolution >80% 2-3 days

Question 13

eustachian tube

Answer 13

link nasopharynx to middle ear
equalise pressure (yawn, swallow) drain mucus from middle ear

Question 14

otitis media signs symptoms

Answer 14

abrupt onset short duration
associated common cold
sensation fullness in ear
pain
fever
bulge reddened ear drum –> if burst less pain more mess
temporary deafness

Question 15

otitis media management

Answer 15

reassure self limiting usually last 2-3 days regardless antibiotics
provide pain management
NO ANTIHISTAMINE

Question 16

otitis media referral

Answer 16

antibiotics 0 amoxicillin
<6months
<2yrs both ears
otorrhoea - discharge
aboriginal/ torres strait islanders
systemic symptoms - pale, irritable, lethargy
symptoms dont improve 48-72hrs
advance prescription - prescribe if necessary - educate when necessary

Question 17

recurrent otitis media

Answer 17

3 episode 6 month or 4/12
prophylaxis antibiotic not recommended except A&TSI structural abnormalities
understand & reduce risk factor
treat as acute, may require referral

Question 18

otitis media with effusion

Answer 18

fluid behind ear drum no infection
insufficient drainage fluid middle ear
75-90% resolve spontaneously 3 months
watch and see
- no hearing loss its fine
if >3 months, refer

Question 19

otitis media with effusion treatment

Answer 19

surgery remove fluid
insert grommet - drain plug
normally fall out
earplug necessary sometime - deep sea diving always

Question 20

administer ear drop

Answer 20

1 clean and dry - drying ear drops
2 warm bottle w hand
3 lie down w affected ear up. pull ear backwards & up to open canal (back and down for children)
4 correct number drops, stay in position
5 press ear flap guide drops in canal
avoid touch tip dropper in ear