Otic Disorders

Question 1

Refer the Following Patients to an Primary Care Provider

Answer 1

1. Pts who appear incapable of following proper instructions
2. Bleeding or discharge from the ear
3. Presence of otalgia (>dull pain)
4. Ruptured tympanic membrane
5. Ear surgery in the past 6 weeks
6. Signs of infection or trauma
7. Unexplained dizziness, tinnitus, hearing loss, pruritis
8. Children <12 years old
9. OTC treatment ineffective after 4 days
10. Tympanostomy tubes

Question 2

Cerumen Impaction

Answer 2

• Cerumen removal is the most common ENT procedure performed in primary care
• Asymptomatic, but when impacted it can cause hearing loss, pain, tinnitus, dizziness, and chronic cough, otitis externa.
• Coughing or even cardiac depression can accompany

Question 3

Etiology

Answer 3

Physiologic anomalies

• Abnormally narrow or misshapen EAC’s
• Excessive hair growth in the canal (both disrupt the normal migration of cerumen to the outer EAC)
• Overactive cerumen glands
• Hearing aids, ear plugs, sound attenuators (prevent migration and cause wax buildup)

Advanced age

• Atrophy of ceruminous glands
• Drier cerumen, more difficult to expel from the ear

Question 4

Cerumen (Ear wax)

Answer 4

• Oily secretions from the exocrine gland mix with milky, fatty fluid from the apocrine glands form cerumen
• Cerumen lubricates the ear canal, traps dust and foreign materials
• Provides a waterproof barrier to the entry of pathogens
• Also contains many antimicrobial substances such as lysozymes and exhibits an acidic pH, which inhibits bacterial and fungal growth

Question 5

Non-pharmacological Therapy

Answer 5

• Earwax should only be removed if it has migrated to the outmost portion of EAC
• The only non-pharmacological method of removing cerumen is to use a wet, wrung out washcloth draped over the finger, (although this method is not effective once cerumen becomes impacted)

Question 6

Guidelines for removing Excessive/Impacted Cerumen

Answer 6

1. Place 5 to 10 drops into the ear canal and allow it to remain for at least 10 minutes
2. Prepare a warm solution of plain water or other solution (8 oz of soln sufficient)
3. To catch the returning solution, hold a container under the ear being cleaned. An emesis basin is ideal because it fits the contour of the neck. Tilt the head down slightly on the side where the ear is being cleaned.
4. Gently pull the earlobe down and back to expose the ear canal.
5. Place the open end of the syringe into the ear canal with the tip pointed slightly upward toward the side of the ear canal, as shown in the drawing. Do not aim the syringe into the back of the ear canal. Make sure the syringe does not obstruct the outflow of solution.
6. Squeeze the bulb gently to introduce the solution into the ear canal and to avoid rupturing the eardrum.
7. If pain or dizziness occurs, remove the syringe and do not resume irrigation until a doctor is consulted.
8. Make sure all water is drained from the ear to avoid predisposing to infection from water-clogged ears.
9. Rinse the syringe thoroughly before and after each use, and let it dry.
10. Do this procedure twice daily for no longer than 4 consecutive days.

Question 7

Water-Clogged Ears

Answer 7

• Tilting the affected ear downward and gently manipulating the auricle can expel excessive water from the ear.
• Using a blow dryer on a low setting immediately after swimming or bathing may help to dry the ear canal.

Pharm

• Isopropyl alcohol in anhydrous glycerin
• Acetic acid, 95% iso alc 5% aa
• Boric acid

(Ear drying agents 12+)

Question 8

Pathophysiology of Otic Disorders

Answer 8

1. Improper fitting, or unclean ear molds or hearing aids.
2. Warm moisture environment.
3. Local trauma from fingernail, cotton-tipped swabs or other items inserted into the ear canal.
4. External trauma from thermal injuries, sports injuries, ear piercing.
5. Dermatological skin disorders contact dermatitis, seborrhea, psoriasis, and malignancies.

Question 9

Contact Dermatitis

Answer 9

• Condition where skin = red, sore, or inflamed after direct contact with a substance (irritant or allergic)
• Use Al acetate soln or Domeboro

Question 10

Boils

Answer 10

• A skin infection involving an entire hair follicle and nearby skin tissue
• Boils are usually self limiting
• Warm compresses followed by a topical antibiotic, such as bacitracin, are often recommended
• Antibiotics do not readily penetrate boils; therefore, incision and drainage by a primary care provider may be required
• Multiple boils, boils that do not respond rapidly to topical treatment, or boils in the EAC should be referred to a primary care provider

Question 11

Psoriasis of Ear

Answer 11

• Causes skin redness and irritation. Most people with psoriasis have thick, red skin with flaky, silver- white patches called scales.
• Treating the scalp with anti-seborrheic shampoos (coal tar) often relieves the symptoms of the disorder.
• Topical hydrocortisone 1% is also useful in treating these disorders twice daily
• Moderate to severe cases refer to PCP