Ear Disorders

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Ear Disorders

• Presented by
• Muhammad H. Shamim
• Doctor of Pharmacy Candidate 2005

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Anatomy of the Ear
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Pathophysiology

• Prone to moisture collection
• Ideal Environment for bacterial and fungal growth
• Loss of skin integrity
• breakdown of natural defenses.

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Remember Eight

• Attributes While Assessing

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Remember !

• It is important to establish that the patient
  really is in pain and not just discomfort. The
  presence of severe pain requires referral in all
  cases
• Pain or Drainage from the ear may mean an
  infection, but pain in or around the ear isnt
  always an infection from the middle ear

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Assessing your Patient

• Do you have a fever?
• Do you have pain deep in the ear?
• Do you have thick drainage from the ear canal
  that started after pain?
• Do you have drainage from the ear canal, redness,
  swelling of the ear and the surrounding?
• Do you have pain behind your ear?

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Assessment Continued

• Tenderness when you touch the bone behind your
  ear?
• Pain when ear or ear lobe is pulled?
• Fluid in ear, or feeling of pressure or
  stuffiness that cant be cleared by coughing,
  yawing, or swallowing?
• Tooth pain?
• Pain after airplane?
• Pimple in the ear?
• Child with hearing problem?

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Differential

• Ear wax excess water
• Water-clogged ear
• Otitis externa
• Otitis media
• Menieres disease
• Referred pain

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Ear Wax

• Content
• Appearance
• Color

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Functions of the Cerumen

• Lubrication
• Trapping
• Waterproof barrier
• Antimicrobial
• Inhibitory pH

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Causes of excess wax

• Structure of the external auditory canal
• Abnormal cerumen production
• Impaction

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Goal of Tx of excessive cerumen

• Softening
• Use of proper agent
• Use of safe agent
• Use of an effective agent
• Restore hearing loss and other associated symptoms

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Remember

• No Q-tips
• Keys are for starting the car or for opening the
  doors only
• Pens and pencils are learning tools, not the
  cleaning tools

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Types of Wax Removers

• Oil-based
• surface active agents
• Bubblers
• Urea and glycerol

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Only FDA approved OTC for cerumen softening

• Carbamide peroxide 6.5 in anhydrous glycerin
• Mode of action
• Who should use it?
• How often should it be used?
• When to refer to MD?

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Other Products Commonly Used

• Glycerin
• Hydrogen peroxide
• Docusate sodium
• Remember that they are Not FDA approved and there
  is not enough data to say that they are more
  effective

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Water-clogged ear

• Not the same as Swimmers Ear (Otitis externa)
• Some people are more prone to retaining water
• Signs and symptoms
• Treatment goals
• Exclude these before you recommend OTC

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NonPhamacologic Therapy

• Tilting the effected ear
• Use of blow dryer

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Pharmacologic Therapy

• Isopropyl alcohol 95 in anhydrous glycerin
  5...Only FDA approved therapy
• 5050 mixture of acetic acid 5 (white vinegar)
  and isopropyl alcohol 95
• why alcohol , glycerin, or acetic acid?
• Use of boric acid and precautions

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Acute Otitis Externa (AOE)

• Also Called Swimmers Ear
• Combination of Inflammation and Infection
• Two Most Common Precipitants
• Common Symptoms
• What should be Avoided

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Contribution of the Structure
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Some Helpful Advices

• How to minimize dizziness
• Getting better absorption of the applied
  medication
• Cleaning and checking for inflammation

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Otitis Media

• One of the most common childhood illnesses.
  Approximately 3 billion in healthcare costs were
  attributed to gt5 million cases in 1995
• Three out of 4 children experience ear infection
  (otitis media) by the time they are 3 years old.
• Acute otitis media Vs otitis media with effusion
• Most commonly reported symptoms

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Menieres Disease

• How Common is the Disease
• Inner Ear Disorder
• Chronic Condition
• A typical Acute Attack
• Is there a Cure??

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Hearing Impairment Statistic

• Hearing Loss is greater in men
• One in every ten (28 million) Americans has
  hearing loss.  As baby boomers reach retirement
  age starting in 2010, this number is expected to
  rapidly climb and nearly double by the year 2030.
  
• Among seniors, hearing loss is the third most
  prevalent, but treatable disabling condition,
  behind arthritis and hypertension.
• Only 5 of hearing loss in adults can be improved
  through medical or surgical treatment.

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Counseling Hearing-Impaired Patient

• Get the Pts Attention Before You Speak
• Do Not Put Obstacles in Front of Your Face
• No Chewing Gum
• Use Facial Expressions and Gestures
• Dont Shout
• Be Patient, Relaxed, and Positive
• www.shhh.org

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Instilling ear drops

• Washing hands before and after
• Avoiding dizziness
• Hold the dropper tip down all of the time
• Proper technique for adults and children

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Summing Up

• Be aware of the common presentations of ear
  disorders
• Recognize when to treat and when to refer to GP
• Learn to properly counsel and relate to your
  patients
• Empathize
• Recognize the common barriers to counseling

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Questions

• And Comments