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PHAM01 > Wk 15: Ear disorders > Flashcards

Wk 15: Ear disorders Flashcards

1
Q

What do you examine for in the outer ear?

A
  • Redness
  • Inflammation
  • Discharge
  • Bleeding
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2
Q

What do you examine for in the pinna?

A
  • Dermatitis
  • Ulcers/blistering
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3
Q

What doing you examine for in the mastoid area?

A

Apply pressure behind ear, if tender = mastoiditis (infection of mastoid bone)

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4
Q

How do you inspect the ear canal in adults + children?

A
  • Adult - hold top of ear, pull up + back
  • Child - pull lobe down + back
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5
Q

What substances are usually found in the outer ear?

A
  • Cerum: wax like substance prod in external auditory canal by ceruminous glands
  • Earwax: cerumen, sebum, dead skin cells, sweat, hair + foreign matter
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6
Q

What affects the consistency + colour of earwax?

A
  • Asian: dry + grey
  • White + africans: moist + brown
  • Children: soft
  • Adults: hard
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7
Q

What affects the excessiveness of earwax?

A
  • Lots of hair
  • Narrow ear canals
  • Hearing aids/ear plugs
  • Age
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8
Q

What is the cleaning process of the ear?

A
  • Conveyor belt
  • Cells formed in tympanic membrane migrate outwards
  • Accelerate towards ear canal entrance
  • Cerum carried outwards
  • Earwax removed if symptomatic
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9
Q

What are examples of cerumenolytics?

A

Water based:
- Urea hydrogen peroxide 5% (otex)

  • Docusate sodium 0.5% (waxol)

Oil based:
- Almond

  • Olive
  • Arachis/chlorobutanol
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10
Q

What are the counselling points for cerumenolytics?

A
  • 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
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11
Q

How do you use ear drops?

A
  • 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
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12
Q

When do you not use cerumenolytics?

A
  • Perforation of tympanic membrane
  • Previous middle ear/mastoid surgery
  • Recurrent otitis externa/chronic middle ear disease
  • Dizziness/tinnitus
  • Nut allergy: arachis/almond oil
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13
Q

What are examples of outer ear disorders?

A
  • Dermatitis
  • Contact dermatitis
  • Seborrhoeic dermatitis
  • Otitis externa
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14
Q

What is dermatitis + how is it treated?

A
  • Dry, itchy, irritation of pinna/ear canal
  • Tx: emollient
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15
Q

What is contact dermatitis + how is it treated?

A
  • Sensitivity to earrings, plugs, aids
  • Tx: topical HC + avoid nickel earrings
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16
Q

What is seborrhoeic dermatitis + how is it treated?

A
  • Affect ear in isolation/scalp dandruff/eyebrow scaling
  • Eczematous reaction: yeast
  • Tx: antifungal shampoo (ketoconazole)
  • Tx: steroid drops/creams
17
Q

What is otitis externa?

A
  • Swimmers ear
  • Inflammation of pinna/external ear canal
18
Q

What are predisposing external factors of otitis externa?

A
  • Ear trauma
  • Cotton buds
  • Syringing
  • Excessive moisture
  • Humid env
  • Shampoo/hair dye
19
Q

What are the types of otitis externa?

A
  • 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
20
Q

What are the symptoms of acute otitis externa?

A
  • Pain in ear canal
  • Itching
  • Impaired hearing
  • Fowl smelling discharge
  • Red ear
  • Swollen/scaly ear
21
Q

What are the POM treatment for acute otitis externa?

A
  • Corticosteroid drops: inflammation
  • Topical ABx drops: infection
  • No more than 7 days
22
Q

What is the OTC treatment for acute otitis externa?

A

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
23
Q

When do you refer outer ear disorders?

A
  • Internal ear pain
  • Foreign body
  • Otitis media: ear pain, eardrum perforated, purulent smelly discharge
  • Mastoiditis: unwell, hearing loss, mastoid swelling
  • Barotrauma: divers/flown
24
Q

What are the examples of middle ear disorders?

A
  • Otitis media
  • Otitis media w/ effusion
  • Glue ear
25
Q

What is otitis media?

A
  • Middle ear inflammation: btw tympanic membrane + inner ear
  • Cause of otalgia
  • Preceded by: upper respiratory symptoms cough + rhinorrhoea
  • Most likely in children
26
Q

What causes otitis media?

A

Middle ear acutely infection, pressure builds up behind eardrum = intense pain, fever + hearing loss

27
Q

How does suppurative otitis media occur?

A

Tympanic membrane perforate (otorrhoea)

28
Q

What are the signs of acute otitis media?

A
  • Pulling ear
  • Sleeplessness
  • Irritability
  • Fever
  • Ear drum perforation
29
Q

What is the treatment for otitis media?

A

Analgesics

30
Q

What is otitis media with effusion?

A
  • Glue ear inflammation w/ fluid accumulation + blockage of eustachian tube
  • Spontaneous resolution
  • speech/behaviour affected
  • Result in conductive hearing loss
31
Q

What are the risk factors of glue ear?

A
  • Males
  • Tobacco smoke
  • Young children
  • Formula feeding
  • Winter
  • Sibling Hx G ear
  • Gastric reflux
32
Q

What are examples of inner ear disorders?

A
  • Tinnitus
  • Meniere’s disease
  • Vertigo
  • Hearing impairment
33
Q

What is tinnitus?

A
  • Sound in absence of stimuli
  • Buzzing, ringing, whistling, hissing
  • Intermittent, continuous, pulsatile
34
Q

What is inner ear disorders associated with?

A
  • Hearing impairment
  • Impacted wax
  • Head injury
  • Toxicity
  • Meniere’s disease
  • Male + age
35
Q

What is meniere’s disease?

A
  • Progressive disorder of inner ear
  • Fluid build up
  • 30-60yrs old
  • Attack: 20 mins - hrs
36
Q

What are the symptoms of meniere’s disease?

A
  • Vertigo
  • Dizziness
  • N + V
  • Dulled hearing/tinnitus
  • Headache
37
Q

What are the causes of vertigo?

A
  • Viral infection
  • Brain stem ischaemia
  • Eustachian tube dysfunction
  • Chronic otitis media
  • Epilepsy
38
Q

What is the management for meniere’s disease?

A

Acute
- Prochlorperazine 5mg TDS 7/7 (POM)

  • Cinnarizine 30mg TDS 7d (OTC)

Prophylactic
- Betahistine 24-48mg OFD w/ food (POM)

39
Q

What are the ototoxic drugs that cause hearing impairment?

A
  • Chemo therapy: cisplatin
  • ABx: aminoglycosides
  • Loop diuretics: furosemide
  • Antimalarials: mefloquine
  • NSAID: aspirin

PHAM01 (47 decks)

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