Otic disorders Flashcards
Differentiate otic disorders based on
etiology, loss of hearing, pain, etc
Ruptured tympanic membrane
Etiology: otitis media or trauma to the ear such as sharp blows, diving into water, forceful irrigation of ear Pain: brief, severe Itching: none Loss of hearing: abrupt Discharge: associated with otitis media
External otitis
Etiology: local trauma to external auditory canal caused by excessive moisture or abrasions, subsequent fungal/bacterial infections
Pain: acute onset, varies from mild to severe, increases with movement of tragus or auricle
Itching: yes
Loss of hearing: occasional
Discharge: occasionally, clear discharge changing to seropurulent
Other: swollen ear canal, stuffiness, discharge, swollen lymph nodes, fever, often occurs in summer or humid climates
Otitis media
Etiology: bacterial infection of middle ear, usually follows upper respiratory infection
Pain: sharp, steady, frequently unilateral, does NOT increase with mvmt of tragus or auricle
- Itching: NO
- Loss of hearing: hearing sometimes decreased
- Discharge: possible exudate through perforated ear drum
Other: dizziness, fever, occurs in winter, sometimes swollen lymph nodes, perforated or bulging ear drum
Excessive/impacted cerumen
- Etiology: overactive ceruminous glands, obstructed migration of cerumen
- Pain: rare, dull if present
- Itching: NO
- Loss of hearing: often
- Discharge: NONE
- Other: sense of fullness or pressure in ears
Water-clogged ears
- Etiology: excessive moisture in external auditory canal
- Pain: NONE
- Itching: NO
- Loss of hearing: often
- Discharge: NONE
- Other: sense of fullness or wetness
Excessive/impacted cerumen symptoms
- pain in ear
- feeling of fullness
- constant ringing
- hearing reduction
- cough
- dizziness
Excessive/impacted cerumen causes
- advanced age
- keratotis and other skin disorders (produce too much ear wax)
- use of hearing aids
- narrow/abnormal ear canals
- incorrect use of cotton swabs
Excessive/impacted cerumen Exclusions for self-care
- signs of infection
- pain associated with discharge (always refer with discharge)
- bleeding/trauma
- ruptured tympanic membane
- ear surgery within prior 6 weeks
- tympanostomy tubes
- cannot follow paper instructions
- hypersensitivity to recommended agents
- under 12 years of age
Excessive/impacted cerumen pharmacologic tx
- carbamide peroxide 6.5% (Debrox): mechanically breaks down and loosens cerumen, acts as weak antibacterial, up to BID for 4 days
Docusate sodium: emollient that can soften wax, varying results, can cause superficial erythema - Gycerin: can soften cerumen
- H2O2: weak antibacterial, flushes canal, overuse can predispose to infection
- Olive oil: emollient, alleviates itching
- only approved if over 12 y/o
Excessive/impacted cerumen goals of tx
to soften and remove cerumen; to avoid temporary hear loss and other sx
Excessive/impacted cerumen NON-pharmacologic tx
- use wet washcloth draped over finger to remove wax from external canal
- remove wax if it can be clearly seen by: warm water irrigation, suction, instruments (PCP only)
Excessive/impacted cerumen common ear drop names
- auro ear drops (Carbamide peroxide 6.5%, glycerin)
- Debrox (carbamide peroxide 6.5%, glycerin)
- auro-dri drops (isopropyl alcohol 95%, glycerin)
- swim ear drops (isopropyl alcohol 95%, glycerin)
- most drops used for 14 days –> longer = refer
Administering ear drops
- wash hands and ear, dry
- warm drops to body temp in hands
- shake if indicated
- do not put dropper in canal or allow to touch
- pull ear up and back, or back and down for under 3
- tilt head for 3-5 min
- if repeating in other ear, wait 10-15 min
Water-clogged ears goals of tx
- dry affected ears
- prevent recurrences
