Ear Health

Question 1

Ear canal (external auditory meatus)
Where is it located?
Identification?
Function?

Answer 1

Location: Starts at the outer ear and ends at the ear drum
Identification: Narrow tube
Function: Collects sound waves and channels them into the ear drum

Question 2

Ear drum
Where is it located?
Identification?
Function?

Answer 2

1. Very end of the ear-canal (middle ear)
2. Thin translucent membrane
3. Vibrates in response to sound waves - vibrations make the tiny bones move - more vibrations are sent to the inner ear

Question 3

Middle ear (consists of 3 bones)
Identification
Function:

Answer 3

.1. Hollow tiny little bones
2. Sound transmission through the bones

Question 4

List the symptoms associated with the external ear

Answer 4

• itch, pain, discharge, deafness

Question 5

List the symptoms associated with the middle ear

Answer 5

1. Pain, discharge, deafness

Question 6

Symptoms associated with the inner ear

Answer 6

1. Deafness, tinnitus, dizziness

Question 7

If patient presents with redness and swelling what condition can it be

Answer 7

Periochondritis

Question 8

If patient presents with discharge what condition can it be

Answer 8

Otitis Externa and Otitis Media

Question 9

A mucinous discharge is a symptom of otitis media. Yes or no. Why is this the case?

Answer 9

Yes. The ear canal (external auditory meatus) has no mucous glands

Question 10

A clear discharge is a symptom of otitis externa. True or false

Answer 10

True

Question 11

Pain in mastoid area (when jaw meets skull - underneat the ear) is a symptom of Otitis Media. True or false

Answer 11

True

Question 12

Pain when pressing tragus or moving pinna is a symptom of Otitis Externa. True or False

Answer 12

True

Question 13

Ear-wax impacted: (high acculamation of wax inside the ear)
1. Signs and symptoms
2. Causative Pathophysiology

Answer 13

1. Earache, blocked ear, ringing in the ears, gradual hearing loss
2. Ear-wax can build up and harden. The 2 main causes:
   - cleaning the ears with ear-buds or “other” items which interrupts the natural processes
   - In elderly patients there is a decrease in cerumen producing glands –> increase in drier earwax

Question 14

Does Ear Wax Impacted self-resolve? If yes, in how many days?

Answer 14

Over 30% of eas impacted with wax will clear in 5 days without any Tx

Question 15

Whats the role of Cerumenolytics?

Treatment for Ear-wax Impacted

Answer 15

Oil-based preparations that soften and disperse wax by emulsification

Question 16

Outline a product used to treat ear-wax Impacted

Question 17

If a patient has earwax impacted it is important to avoid using cotton buds and ear candles. Is this a true statement.

Answer 17

Yes

Question 18

Describe application of ear-drops

Answer 18

1. Warm the bottle to body temperature by holding the bottle in the hands for a few minutes.
2. Lie down or tilt head so the infected ear is facing upwards
3. Place the required number of ear drops into the ear canal
4. Keep the ear facing up for about 5 minutes to allow the medicine to coat the ear canal. [For young children] - who cannot stay still for 5 minutes, try to keep the ear facing up for about 1-2 minutes
5. To keep the medicine as germ-free as possible do not touch the dropper to any surface (including the ear).
6. Close the container tightly after use

Question 19

Otitis Externa (swimmers ear)
1. Identification
2. Signs and symptoms
3. Causative pathology

Answer 19

1. Inflammation of ear canal - A bacterial or fungal infection of the ear canal. Common in children, swimmers and water sports
2. Irritation, itchy ear, pain (worse by movements such as chewing), feeling of pressure, clear discharge, mild hearing loss
3. Trauma, dermatitis, prolonged exposure to moisture, unclean water

Question 20

Outline treatment regimen for otititis externa.
Benefits, Dosage, Non-pharmalogical advice, side effects, precautions

Answer 20

Aqua ear (anti-septic drying agent)
Benefit: restores acidic pH of the external auditory ear canal and inhibits microbial growth
Dosage: 4-6 drops in every ear after swimming or bathing
Non-pharmalogical advice:
* During treatment use cotton balls smeared in vaseline while showering or bathing
* use ear-plugs when swimming
* Keep ear canal dry by meticulous gentle cleansing and drying with tissue spears. Do this 2-4 times a day
* avoid cleaning ears
* Keep ear dry for 2 weeks after treatment
Adequate pain relief (e.g. an NSAID)
Side Effects:

Question 21

When would you refer in the case of otitis externa?

Answer 21

Hearing Impairment
Inflammation of the Pinna
Mucopurulent Discharge
Feeling Unwell

Question 22

Otitis Media
1. Identification
2. Signs and symptoms
3. Causative pathology

Answer 22

1. Inflammation of the middle ear with a build-up of fluid that is common in children
2. Pain (generalised ache in the side of head), sometimes fever, crying, ear-pulling, irritability (particulary in young infants)
3. Bacteria and viruses

Question 23

When should antibiotics be commenced in infants that have otitis media?

Answer 23

If Sx’s are mild - analgesic for 1-2 days
If Sx hasn’t resolved in the 1-2 days then refer them for antibiotics

Question 24

Identify at risk patient groups for otitis Media

Answer 24

• Indigenous Populations
• ottorhea or severe or systematic symptoms
• risk factors for severe complications (e.g. Canofacial abnormality: down syndrome. Cochlear implants or immunocompromised)
  — more listed on another card

Question 25

Outline the most severe form of otitis Media

Answer 25

Supparative Otitis Media 1. Chronically performated eardrum and discharge over several weeks

Question 26

Who are the referral groups for Otitiis Media?

Answer 26

Infants under 6 months, children<2 yrs with bilateral infection, systematically unwell children (lethargic, pale, very irritable), children with ottorhea, Indigenous Populations, immunocompromised

Question 27

Glue ear - Identification - Symptoms

Answer 27

* Chronic Otitis Media that mainly affects children. * Long term build-up of thick sticky fluid in the middle ear behind the ear-drum * Sx: hearing impairment is the only Sx, can delay speech development and make socialisig and learning difficult * Does resolve without any Tx however should be checked to see if Tx is needed

Question 28

What is the Tx regiment for glue ear?

Answer 28

GROMMETS - A very small tube that is inserted surgically into the eardrum to let fresh air into the middle ear - improves hearing immediately Pharmacists role in prevention: ear needs to be kept dry while on grommets 1. ear plugs while swimming supported with a swimming cap --> prevents water from entering the middle ear

Question 29

Ear-drum perforation

Answer 29

Perforation (a tear, or rupture) of the tympanic membrane Symptoms: * hearing loss * pain in the ear- especially linked to trauma or severe otitis media * discharge of fluid - clear, mucopurulent or bloody * Tinnitus or Vertigo * ear ache or pain that suddenly goes away-due to pressure release when the rupture occurs * air coming out of your ear when you blow your nose * fever if there is otitis media Causes: * OtitisMedia * Barotrauma - sudden changes in air pressure (flying, diving * Acoustic trauma-sudden loud noise eg. explosion * Injury: mechanical damage - eg earbud, foreign body * hard blow to head or ear - sports, slap, punch, car accident * Ear syringing (less common) * Eustacian tube disorder (less common) **REFERRAL IS REQUIRED**

Question 30

Periochondritis Identification: Symptoms: Causes:

Answer 30

1. Inflammation of the perichondrium 2. Redness, pain, swelling, fever, pus 3. Causes: Injuries, insect bites, burns, piercings, surgery or boil

Question 31

Treatment regimen for Periochondritis

Answer 31

ADULT+CHILD: Derm-aid cream (hydrocortisone 0.5%). - Apply enough to affected area 1-2 times daily for max 7 days - Reduces inflammation. - SE: stinging or pain upon application Warm compresses for 5-10 minutes 4-5x a day for 7 days - relieves pain If Sx are more than mild: severe pain - affecting sleep and day-today activities - REFERRAL for systematic antibiotics

Question 32

Whats the dosage regimen for Paracetamol? - Adult and Child

Answer 32

Panadol for pain relief - Adult: 0.5–1 g every 4–6 hours; maximum 4 g daily - Child > 1 month: 15 mg/kg every 4–6 hours

Question 33

Ear Piercings

Answer 33

Sx: Piercings cause MILD redness, swelling and crusting as it heals and usually takes up to 6-8 weeks Tx options if Sx are mild: - Wash area twice a day with warm soapy water or Isopropyl Alochol Cold Spray to prevent infection Refer Immediately if: moderate to severe Sx