otic self care

Question 1

background

Answer 1

• self care should be restricted to minor external ear disorders of the auricle and the external auditory canal (EAC)
• FDA approved self care otic conditions: excessive cerumen, water-clogged ears
• water clogged ear is different than externa otitis (Swimmer’s Ear)

Question 2

excessive/impacted cerumen

Answer 2

• cerumen = earwax, a naturally occurring substance that assists in the defense of the external ear canal to clean, protect, and lubricate the EAC
• cerumen impactation = lodged, wedges, or firmly packed cerumen in the EAC

Question 3

factors that can disrupt the normal flow of cerumen toward the outer EAC

Answer 3

• anatomic variability = narrow or irregularly shaped EAC
• atrophy of the ceruminous glands: aging, genetic tendencies
• irritation from foreign objects (hearing aids, ear plugs, or use of cotton-tipped swabs)
• presence of excessive hair

Question 4

excessive/impacted cerumen clinical presentation

Answer 4

• signs/symptoms: sensations of ear fullness, dull pain, itching, discomfort, tinnitus (ringing in ears), dizziness, vertigo, cough, hearing loss, hearing aid malfunction or feedback
• occasionally present: ear discharge and an odor

Question 5

excessive/impacted cerumen clinical impact

Answer 5

• transient hearing loss, especially in the elderly
• inappropriate methods of removal of excessive or impacted cerumen including use of cotton swabs can push wax deeper into the ear or damage the EAC or tympanic membrane, potentially resulting in otitis media

Question 6

excessive/impacted cerumen exclusions for self care

Answer 6

• signs of infection (irritation, rash)
• pain associated with ear discharge
• bleeding or signs of trauma
• presence of ruptured tympanic membrane
• ear surgery within prior 6 weeks
• tympanostomy tubes present
• incapable of following proper instructions
• hypersensitivity to recommended agents
• <12 years of age
• worsening of condition after attempted self care

Question 7

excessive/impacted cerumen treatment goals

Answer 7

• remove cerumen using safe, effective, appropriate products while preventing potential adverse events
• reduce signs/symptoms

Question 8

excessive/impacted cerumen self care

Answer 8

• the use of cerumen-softening agents with or without irrigation
• caution is warranted with patient attempts associated with greater risk of EAC damage
• if presence of excessive cerumen is asymptomatic , active management/removal is optional

Question 9

excessive/impacted cerumen non-pharmacologic treatment

Answer 9

• earwax should only be removed when it has migrated to the outermost portion of the EAC
• don’t insert objects into the ear to remove earwax - may injure the ear canal or push the wax further into the canal
• IMPACTED cerumen removal should only be done by a properly trained PCP
• never use an ear candle to remove earwax

Question 10

excessive cerumen non-pharm treatment methods

Answer 10

• warm water irrigation with a bulb syringe, using sterile water
• use a wet washcloth draped over a finger to remove earwax from the outer canal
• caution against use of Curette (ear cleaning tool), etc.
• home jet irrigation not recommended

Question 11

excessive/impacted cerumen pharmacologic treatment

Answer 11

-currently only FDA-approved nonprescription earwax-softening agent is carbamide peroxide 6.5% in anhydrous glycerin

Question 12

excessive/impacted cerumen special populations

Answer 12

• nonprescription cerumen-softening agents are ONLY approved for patients >12 years old
• no special consideration for use is necessary in pregnant or lactating women or in older adult

Question 13

cerumen-softening products

Answer 13

• carbamide peroxide 6.5% in glycerin
• used alone or in combo with warm water irrigation to remove loosened cerumen
• only for use in ages >12 for OTC use
• other products used off-label products include hydrogen peroxide docusate - NOT RECOMMENDED

Question 14

carbamide peroxide 6.5% in glycerin MOA

Answer 14

• carbamide peroxide: weak antibacterial effect and mechanical loosening of cerumen when carbamide peroxide is exposed to moisture, and hydrogen peroxide and oxygen releases slowly
• anhydrous glycerin: softens and penetrates cerumen to help loosen excessive earwax

Question 15

cerumen softening products administration

Answer 15

-may be administered twice daily for up to 4 days

Question 16

botanical and homeopathic products

Answer 16

• ear candles

- FDA warns AGAINST this method

Question 17

excessive/impacted cerumen: limitations to self care

Answer 17

• pain or bleeding after repeated attempts to remove cerumen from the EAC or if symptoms persist (>4 days of carbamide peroxide use)
• if a rash develops while using carbamide peroxide or if systemic infection is suspected
• patients with previous ear surgery or a suspected tympanic membrane rupture
• severe pain occurs or hearing worsens
• patients younger than 12 years of age with ear symptoms

Question 18

water-clogged ears

Answer 18

• retention of water within the EAC
• treatment: OTC ear drying agent - Isopropyl alcohol 95% in anhydrous glycerin 5% base
• Auro

Question 19

otitis externa (swimmer’s ear)

Answer 19

• inflammation of the external auditory canal (EAC)
• treatment: OTC or RX (depends on severity)
• topical steroids, topical antibiotics, oral antibiotics
• not self care appropriate