Wk 15: Ear disorders Flashcards
What do you examine for in the outer ear?
- Redness
- Inflammation
- Discharge
- Bleeding
What do you examine for in the pinna?
- Dermatitis
- Ulcers/blistering
What doing you examine for in the mastoid area?
Apply pressure behind ear, if tender = mastoiditis (infection of mastoid bone)
How do you inspect the ear canal in adults + children?
- Adult - hold top of ear, pull up + back
- Child - pull lobe down + back
What substances are usually found in the outer ear?
- Cerum: wax like substance prod in external auditory canal by ceruminous glands
- Earwax: cerumen, sebum, dead skin cells, sweat, hair + foreign matter
What affects the consistency + colour of earwax?
- Asian: dry + grey
- White + africans: moist + brown
- Children: soft
- Adults: hard
What affects the excessiveness of earwax?
- Lots of hair
- Narrow ear canals
- Hearing aids/ear plugs
- Age
What is the cleaning process of the ear?
- Conveyor belt
- Cells formed in tympanic membrane migrate outwards
- Accelerate towards ear canal entrance
- Cerum carried outwards
- Earwax removed if symptomatic
What are examples of cerumenolytics?
Water based:
- Urea hydrogen peroxide 5% (otex)
- Docusate sodium 0.5% (waxol)
Oil based:
- Almond
- Olive
- Arachis/chlorobutanol
What are the counselling points for cerumenolytics?
- 7 days to achieve
- To soften hard wax
- Syringing CI: perforation of tympanic membrane, unilateral deafness + Hx recurrent otitis externa
- Drop earwax initially swells: temp deafness
How do you use ear drops?
- Warm bottle
- Draw liquid into dropper
- Lie on side/tilt head
- Pull lobe upwards + away
- Squeeze + tilt for 5 mins
- Wipe away excess
- Replace cap + complete course
- Discard drops left over
When do you not use cerumenolytics?
- Perforation of tympanic membrane
- Previous middle ear/mastoid surgery
- Recurrent otitis externa/chronic middle ear disease
- Dizziness/tinnitus
- Nut allergy: arachis/almond oil
What are examples of outer ear disorders?
- Dermatitis
- Contact dermatitis
- Seborrhoeic dermatitis
- Otitis externa
What is dermatitis + how is it treated?
- Dry, itchy, irritation of pinna/ear canal
- Tx: emollient
What is contact dermatitis + how is it treated?
- Sensitivity to earrings, plugs, aids
- Tx: topical HC + avoid nickel earrings
What is seborrhoeic dermatitis + how is it treated?
- Affect ear in isolation/scalp dandruff/eyebrow scaling
- Eczematous reaction: yeast
- Tx: antifungal shampoo (ketoconazole)
- Tx: steroid drops/creams
What is otitis externa?
- Swimmers ear
- Inflammation of pinna/external ear canal
What are predisposing external factors of otitis externa?
- Ear trauma
- Cotton buds
- Syringing
- Excessive moisture
- Humid env
- Shampoo/hair dye
What are the types of otitis externa?
- Infective (discharge): bacterial, viral, fungal, prolonged use of topical c. steroid + ABx
- Reactive: atopic/contact
- Furuncle (boil like): s.a, severe pain, small red swelling, Tx flucloxacillin
What are the symptoms of acute otitis externa?
- Pain in ear canal
- Itching
- Impaired hearing
- Fowl smelling discharge
- Red ear
- Swollen/scaly ear
What are the POM treatment for acute otitis externa?
- Corticosteroid drops: inflammation
- Topical ABx drops: infection
- No more than 7 days
What is the OTC treatment for acute otitis externa?
Acetic acid 2% spray
- > 12 yrs old
- 1 spray TDS- til 2 days after symptoms resolved
- Max freq. 1 spray every 2-3 hrs
- Max 7 days
- May cause: burning/irritation
- Don’t clean ear canal w/ fingers or cotton buds, may push dirt further
- Stop soap/shampoo w/ vaseline or ear plugs
When do you refer outer ear disorders?
- Internal ear pain
- Foreign body
- Otitis media: ear pain, eardrum perforated, purulent smelly discharge
- Mastoiditis: unwell, hearing loss, mastoid swelling
- Barotrauma: divers/flown
What are the examples of middle ear disorders?
- Otitis media
- Otitis media w/ effusion
- Glue ear
What is otitis media?
- Middle ear inflammation: btw tympanic membrane + inner ear
- Cause of otalgia
- Preceded by: upper respiratory symptoms cough + rhinorrhoea
- Most likely in children
What causes otitis media?
Middle ear acutely infection, pressure builds up behind eardrum = intense pain, fever + hearing loss
How does suppurative otitis media occur?
Tympanic membrane perforate (otorrhoea)
What are the signs of acute otitis media?
- Pulling ear
- Sleeplessness
- Irritability
- Fever
- Ear drum perforation
What is the treatment for otitis media?
Analgesics
What is otitis media with effusion?
- Glue ear inflammation w/ fluid accumulation + blockage of eustachian tube
- Spontaneous resolution
- speech/behaviour affected
- Result in conductive hearing loss
What are the risk factors of glue ear?
- Males
- Tobacco smoke
- Young children
- Formula feeding
- Winter
- Sibling Hx G ear
- Gastric reflux
What are examples of inner ear disorders?
- Tinnitus
- Meniere’s disease
- Vertigo
- Hearing impairment
What is tinnitus?
- Sound in absence of stimuli
- Buzzing, ringing, whistling, hissing
- Intermittent, continuous, pulsatile
What is inner ear disorders associated with?
- Hearing impairment
- Impacted wax
- Head injury
- Toxicity
- Meniere’s disease
- Male + age
What is meniere’s disease?
- Progressive disorder of inner ear
- Fluid build up
- 30-60yrs old
- Attack: 20 mins - hrs
What are the symptoms of meniere’s disease?
- Vertigo
- Dizziness
- N + V
- Dulled hearing/tinnitus
- Headache
What are the causes of vertigo?
- Viral infection
- Brain stem ischaemia
- Eustachian tube dysfunction
- Chronic otitis media
- Epilepsy
What is the management for meniere’s disease?
Acute
- Prochlorperazine 5mg TDS 7/7 (POM)
- Cinnarizine 30mg TDS 7d (OTC)
Prophylactic
- Betahistine 24-48mg OFD w/ food (POM)
What are the ototoxic drugs that cause hearing impairment?
- Chemo therapy: cisplatin
- ABx: aminoglycosides
- Loop diuretics: furosemide
- Antimalarials: mefloquine
- NSAID: aspirin
