Ear Conditions

Question 1

List some protective purposes of earwax

Answer 1

Mechanical protection
Slightly acidic = protect against bacterial and fungal infection
Traps dirt, repels water
Aids removal of organisms
Lubricate ear canal

Question 2

What are the symptoms of earwax?

(I think they mean excessive, idk)

Answer 2

Discomfort (blocked/full)
Can be itchy
Gradual reduction in hearing
Dizziness, tinnitus (less common)

Question 3

What contributes to excessive earwax?

Answer 3

Overactive ceruminous glands
narrow ear canal, large amount of hair in canal
Insufficient talking/chewing
Age - earwax becomes drier and harder

Question 4

Outline the steps for ear examinations

Answer 4

1) Take history, 2) wash hands, 3) inspect external ear for redness/swelling 4) apply pressure to mastoid area directly behind pinna, 5) move pinna up and down, manipulate the tragus, 6) examine the EAM

Question 5

What questions can you ask to identify excessive earwax?

Answer 5

Can you describe your symptoms? How did they develop?

How painful is it on a scale from 0 to 10?

Have you experienced this before? If so, how did you manage it? Did it work?

Is there a history of trauma to your ear?

What medicines do you take?

Question 6

Name some differential diagnoses for earwax (compaction??)

(they’re not very clear on the slides…)

Answer 6

Otitis externa = inflammation/infection of outer ear (redness/inflamm, itch)

Otitis media = middle ear infection (pain, fever, history of cold)

Inner ear = dizziness, tinnitus

Trauma to ear canal = laceration of the ear canal after cleaning with pens, cotton buds

Foreign bodies = similar symptoms as ear wax initially, discharge and pain over time, common in children.

Question 7

What are the goals of treatment for earwax

Answer 7

Relieve symptoms/ improve quality of life, reduce risk/prevent complications

Soften and aid removal of ear wax

Manage with evidence based treatment

Question 8

How is wax impaction treated?

Answer 8

> 30% clear in 5 days without treatment

Avoid cotton bud and ear candle use

Ear syringe by doctor is effective = flush ear with warm water or saline
- can be done prior or after earwax softeners

Question 9

Comment on the use of Cerumenolytics in earwax compaction

Answer 9

Able to loosen/soften wax to aid removal, all have similar efficacy.

Safe in children and no medicine interactions

ADRs = few, local irritation, brief deafness inc

Precautions = peanut or almond oil allergy, irritation or rash occurs

Contraindication = inflammation in ear canal, perforation of eardrum

Question 10

What medications can be used in treatment of external ear conditions? (e.g. earwax compaction/earwax)

Answer 10

Carbamide peroxide (ear clear)

Dichlorobenzene with chlorbutol (cerumol)

Docusate (waxol)

Question 11

Instructions of use and notes for carbamide peroxide (Ear clear) use

Answer 11

Adults + children >12 y/o

5-10 drops, up to 4 days. DO NOT plug ear

Mild temporary effervescence

Question 12

Instructions of use and notes for Dichlorobenzene with chlorbutol (cerumol) use

Answer 12

No age limit, contains arachis oil (peanut allergy?)

Up to 5 drops twice daily, few days

Plug ear with ear-drop moistened cotton plug

Question 13

Instructions of use and notes for docusate (waxol) use

Answer 13

Fill ear for 2 consecutive nights

Question 14

When to refer for ear wax conditions?

Answer 14

Signs of middle ear involvement (e.g. pain, fever, malaise)

Signs of inner ear involvement (e.g. dizziness, tinnitus)

Pain beyond discomfort, medication not working/making it worse

Potential trauma or foreign body

Question 15

Provide useful patient information about earwax

Answer 15

Wax keeps ears clean/protective function

Wax build up/impaction generally harmless and will resolve

Talking/chewing helps earwax move out

Avoid cleaning ears with cotton buds (best prevention)

Question 16

What is otitis externa?

Answer 16

Inflammatory condition of external ear canal (can inc. pinna or ear drum)
- cellulitis of skin and subdermis of external ear canal

Breakdown of skin integrity, less cerumen, or blockage with cerumen predisposing

Typically acute, can become chronic in kids >3 months

Question 17

What are some causes of otitis externa?

Answer 17

Trauma (scratching)

High humidity, swimming (x5 more likely)

Skin conditions (dermatitis, seborrheoic dermatitis)

Allergy (e.g. antibiotic ear drops)

Chemical irritants

Question 18

Who can be affected by otitis externa?

Answer 18

All ages, common 7-12 y/o; women up to 65y/o

less common in >50 y/o

Narrow ear canals pre-disposes

Question 19

What time of year is otitis externa commonly seen?

Answer 19

End of summer, increased humidity and after swimming

Question 20

What are the symptoms of otitis externa?

Answer 20

Sudden onset (w/in 48 hrs), acute onset of ear pain

Discomfort (blocker/full feeling), itchy (could be scratching w/ cotton bud)

Reduced hearing (due to swelling)

Pinna, tragus can be tender/painful if pull on ear

Swollen ear canal or discharge (on otoscopic examination)

Question 21

Questions to ask when assessing otitis externa

Answer 21

Describe symptoms? How did they develop/when did you first notice them?

How painful is it on a scale from 0 to 10?

What have you done to manage this? Has it worked?

Is there a history of trauma to the ear? something stuck in the ear?

Any other medical conditions/medications?

What have you been doing? Swimming?

Question 22

What are some differential diagnoses for otitis externa?

Answer 22

Otitis externa chronic = inflammation/infection of outer ear, discharge, itch
otitis media = children 3-6, pain predominant feature, fever, history of cold
inner ear = dizziness, tinnitus
contact dermatitis = much less likely, allergic reaction
furunuclosis = localised infection and pain of hair follicle on outer ear
dermatitis= itch, unlikely symptoms would be elsewhere

trauma to ear canal, foreign bodies,

viral/cancer = severe pain, taste disturbances, no relief with treatment

Question 23

What are the goals of treatment for otitis externa?

Answer 23

Relieve pain, treat infection
reduce risk of complications

prevent recurrence
manage with evidence-based treatment = pharmacy medicine, prescription only medicine

Question 24

Generally, how is otitis externa managed?

Answer 24

Uncomplicated otitis externa can resolve irrespective of treatment, limited OTC options available

Eardrop choice determined by = patient preference, managing risk factors, likelihood of effective use of medicines, severity

Pain management = simple analgesics

For infection = antibiotic eardrops w/ or w/out corticosteroid more effective than acetic acid

Used acidifying agent in fungal infection

Question 25

How can you prevent otitis externa?

Answer 25

Maintain skin integrity, avoid risk factors, avoid trauma caused by ear cleaning, manage skin conditions, avoid triggers of contact dermatitis

Avoid water accumulation in ear, use acidifying ear drops after swimming

use mouldable silicone ear plugs when swimming

Question 26

Name some drugs used to treat otitis externa

Answer 26

Acetic acid + isopropyl alcohol (aqua ear), glycerol plus isopropyl alcohol + propyl glycol diacetate (audiclean)

Auralgan = benzocaine and phenazone

Paracetamol/Ibuprofen

Antihistamines

Question 27

Considerations/use for Audiclean and Aqua Ear in Otitis externa treatment

Answer 27

Any age = 4-6 drops each ear after swimming/bathing

Used for prevention of swimmer’s ear

ADR = transient stinging/burning when used

Contraindicated with discharge grommets/ear drum rupture

Question 28

What drugs can you use to relieve ear pain for otitis externa?

Answer 28

Auralgan (benzocaine and phenazone)

Paracetamol/Ibuprophen

Question 29

Considerations/use for Auralgan in treatment of otitis externa

Answer 29

pain reliever

There is a potential for sensitisation/allergy

Question 30

When should you refer a patient with otitis externa/ear pain?

Answer 30

Signs of middle ear involvement (pain, fever, malaise)

Signs of inner ear involvement (dizziness, tinnitus), infection (fever, nausea, vomiting), itching/discharge inside ear canal

infant <6month, symptoms >4 days or recurrent

Inflammation of pinna

Slow growing growth on ear in elderly, history/sus of perforated ear drum

persistent/sever hearing loss

pain beyond discomfort

Question 31

What else can you tell people with otitis externa?

Answer 31

Avoid water during initial treatment, avoid water accumulation in ear

avoid swimming in polluted water

use ear plugs when swimming, shower caps for bathing, dry ears thoroughly after swimming/ bathing

Fill ear canal with drops, massage pinna

Avoid cleaning ears with cotton buds