Otic & Vestibular Disorders Flashcards
Clinical Thresholds that are a sign you need to refer the patient:
- Fever > 103
- Sys BP < 100
- RR >25
- Unintentional weight loss
- Foreign object in ear
- N/V for > 24 hours
- Sudden Hearing loss
- Blood from ear canal
- Fall caused by dizziness
T/F: You can recommend a OTC drop to relieve ear pain
FALSE; may use systemic pain relievers
What are common ear symptoms patients report?
Pain: aching, throbbing, stabbing
Fullness, heaviness, clogged feeling, pressure
Itching, burning
What is the role of cerumen?
Cerumen = ear wax
- Lubricates and keeps skin soft
- Traps or slows foreign objects
- Hydrophobic barrier
T/F: You should clean your ear canal with a washcloth instead of a Q-tip.
False! Only clean pinna and outer ear with washcloth.
Never insert anything into ear canal
- “Nothing smaller than your own elbow”
Why do patients feel pressure in their ears?
- Excessive ear wax
- Atmosphere changes
- Impacted ear wax
- Water in the ear
How can you reduce the amount of ear wax in the ear?
Warm water irrigation
Ceruminolytics:
- Carbamide peroxide or hydrogen peroxide and rinsing after
a) Warn patient of bubbling/fizzing for hours after use - Sweet oil - aka olive oil
How can you combat ear pressure issues when flying or scuba diving?
Topical decongestant
A patient complains that their excessive sweating while running results in ear pressure. What can you recommend to help?
- Swim-Ear OTC to help dry out ear
2. Isopropy alcohol + glycerin to dry out and protect skin
T/F: The best treatment for Swimmer’s Ear is the OTC product Swim-Ear!
FALSE; do not use as Swimmer’s ear is an infection of the ear, not just water causing pressure
Which household ingredients do people often use to help dry out their ears? Is there any concern?
- White Vinegar = safe but may burn broken skin
2. Borax solutions = TOXIC to kiddos and not safe in humans
List 4 ways to avoid getting water in the ear that causes pressure issues.
- Gravity
- “Palm vacuum”
- Ear plugs
- Blow dryer on lowest setting
What is Swimmer’s Ear and how do you treat it?
It is a bacterial infection of the skin in the outer ear
- Treat with Antibiotics + Steroid ear drops
No OTC product available
What are possible causes of Swimmer’s Ear?
- Sticking objects in ear
- Frequent H20 exposure causing softening or breaking down of skin (maceration)
- Swimming in poor quality water with infectious agents
A mom brings her 10 year old into the pharmacy asking what she can use to help her son’s itchy, painful ear. He recently came back from summer camp where they did a lot of swimming, hiking and biking.
What can you recommend?
Most likely = Swimmer’s Ear
Patient should take be taken to the PCP for antibiotics and steroid ear drops
Discuss treatment for dermatologic conditions of the ear
Treat like other skin issues
- Wet a dry lesion
- Dry a wet lesion
- Use Crisco to moisten/protect skin
An older gentleman comes into your pharmacy asking about lipoflavonoids.
What is he likely going to use this for and what can you tell him about the product? What else could you recommend?
Used for tinnitus: Ringing in the ears
Product has not been proven to be effective, but is fairly safe to use (Expensive though!).
May recommend:
- White noise creator
- looking over his drug profile to see if it is a side effect of one of his medications
- Treating hearing loss - hearing aids
What two medications may be prescribed to alleviate tinnitus for patients?
gabapentin or dexamethasone
What is Meniere’s Disease? Signs and Symptoms?
Too much fluid is located in the cochlea resulting in over stimulation
- Vertigo
- Hearing loss - Lowest pitch 1 (different from age-related)
- Pressure or fullness
- Tinnitus
What is Vertigo?
A feeling of spinning when you are sitting down
- Motion sickness
How do patients describe motion sickness?
- Unsteadiness or disequilibrium - sense of imbalance
- Lightheadedness - feeling as if you are about to faint
- Dizziness - Any of the above
- Vertigo = feeling of spinning when you are sitting down
What are possible causes of vertigo?
Migraine
Ischemic Stroke
Multiple Sclerolsis
Drugs-induce: alcohol, lithium, anti-HTNs, sedatives, anticonvulsants, aminoglycosides
Who is most likely to experience vertigo?
Children age 2 to 12, pregnant females or those who suffer from migraines
What are Pharmcological therapies used to treat or prevent vertigo?
- Acupressure: Sea bands = Prophylaxis
- Antihistamines = Prophylaxis
- Scopolamine patch = Prophylaxis
- Phenothiazines “Antipsychotics” - Treat vomiting only
- Metoclopramide = N/V treatment
- Cannabinoids = nausea treatment
What is the concern of using Compazine for vertigo treatment?
Extrapyramidal side effects, although less likely with compazine than phenergan
What is the proper way to place ear drops?
< 3 y.o. = Pull ear down and back
3+ y.o. = Pull ear UP and BACK
Do not touch dropper to ear
Stay in position for 2 minutes to allow absorption for each ear!
List possible causes of hearing loss
- Noise Exposure
- Trauma/Infection
- Aging
- Meniere’s Disease
- Congential - structural or maternal infection
Which drugs are associated with hearing loss?
Aminoglycosides
- Genta > Tobra > Amikacin > Neomycin
Cancer Chemotherapy
Asprin > 6 gm/day = tinnitus symptom
Vancomycin, tetracycline & erythromycin
How can we treat hearing loss?
- Get rid of drug causing the problem
- Cochlear Implants
- Hearing Aids
Which health precautions should patients take if they have a cochlear implant?
- Pneumococcal pneumonia vaccine
- Meningococcal vaccine
- Haemophilus Influenzae vaccine
- Influenza vaccine - NOT FLUMIST
