Cerumen impaction &Tympanic membrane perforation.pptx

Impacted wax and Tympanic membrane perforation.ENT disorder

1. Impacted wax & Tympanic membrane perforation Presented by Sneha Dutta B.Sc(N) 4 th semester

2. IMPACTED WAX

3. Introduction Cerumen impaction is a condition in which earwax has become tightly packed in the external ear canal to the point that the canal is blocked. It develops when earwax accumulates in the inner part of the ear canal and blocks the eardrum.

4. Definition Earwax is a mixture of secreations of the ceruminous and sebaceous glands of the external ear ,when this blocks the eardrum it is called impacted wax .

5. Earwax pushed forcefully If it is trapped against the eardrum by a hearing aids. Overproduction of earwax. Improper cleaning Abnormally shaped ear canal. Etiology

6. Clinical manifestation Partial loss of hearing Itching Pain Tinnitus Vertigo A sensation of fullness in the ear Discomfort

7. Diagnostic Evaluation It can be diagnosed by looking in the ear with the help of light and otoscope.

8. Complication Swimmer’s ear earache Short term hearing loss Dizziness Eardrum perforation Ringing in the ears Ear bleeding

9. Management Irrigation of the ear or Syringing Removal with curette Suctioning

10. Nursing management Examine the ear Assess the level of impaction Educate the patient Older adults should be examined Eardrops can also be recommended.

11. Prevention Clean the ear with wipe cloth. Do not put any swab into the ear canal. Use drop of mineral oil once a week. Clean the ear while showering.

12. Summarization

13. 1.Cerumen Impaction can lead to which of the following severe types of hearing loss?

A.Severe conductive C.Profound conductive D.Severe sensorineural B.Conductive hearing

14. 2.All are true about ear wax except: A. pH is acidic in normal healthy canals. B. Contains a bactericidal enzyme. C.Is a combination of secretions of sebaceous and apocrine glands. D. Needs to be removed periodically. E. Secreted from outer third of external auditory canal

15. Tympanic membrane perforation

16. Introduction: A perforated eardrum can occur as a result of otitis media, trauma,explosion,noise or surgery Symptoms include sharp ear pain,drainage,ringing in the ear or hearing loss. Tympanic membrane perforation is a rupture or hole of the eardrum. Definition:

17. Types Central perforation : It is dry,no granulation tissue is seen, middle ear mucosa is normal. This perforation usually follows upper respiratory tract infection. Marginal perforation: This is often associated with a cholesteatoma but is usually the result of acute necrotizing otitis media destroying the annulus and mucus membrane.

18. Causes and risk factor Foreign bodies usually pointed objects. Improper curetting or syringing. Infection of the middle ear. Trauma Rapid changes in the atmospheric pressure.

19. Pathophysiology

20. Clinical manifestation Vertigo Hearing loss Episodic ear infection Buzzing sound Facial weakness Disorientation Fullness of ear Pain in the ear Drainage from ear

21. Diagnostic evaluation History taking&Physical examination Tympanogram Otoscopy Audiometry Culture

22. Management: Medical management- Pack the external ear canal with sterile cotton plug. Use systemic antibiotics and decongestant drop. Ear irrigation solution Analgesics such as acetaminophen or ibuprofen Warmth can be applied.

23. Sur gical management: Tympanoplasty Type I Tympanoplasty Type II Tympanoplasty Type III Tympanoplasty Type IV Tympanoplasty Type V Tympanoplasty Myringgoplasty Ossiculoplasty

24. Nursing diagnosis 1.Acute pain related to perforated eardrum as evidenced by dull facial expression 2.Impaired verbal communication related to hearing loss as evidenced by not being able to hear and does not respond when spoken to.

25. Prevention Get treatment for middle ear infection Protects ears during flights Keep ears free of foreign objects Do not dig hardened earwax Guard ear against excessive noise.

26. Summarization

27. 1.Which of the following symptoms is most suggestive that the inner ear has been injured? A.Bleeding from the ear B.Pain C.Tinnitus D.Vertigo

28. 2.If traumatic perforation of the tympanic membrane is diagnosed, which of the following is done before and after treatment to avoid confusion between trauma-induced and treatment-induced hearing loss? B.Irrigation of the ear canal C.Otomicroscopy D.Pneumatic otoscopy A.Audiometric studies

29. 3.A 42-year-old man comes to the hospital because he has had persistent hearing loss during the past 4 months. He says he sustained a perforation of the tympanic membrane 4 months prior when the airbag inflated in his car after a motor vehicle collision. Since that time, he has kept the ear dry and has not experienced any infection in the ear. Which of the following is the most appropriate next step in treatment? A.Prescribe a course of antibiotic ear drops B.Prescribe a course of broad-spectrum oral antibiotics C.Refer for surgical exploration and repair D.No treatment is necessary

30. Conclusion Cerumen impaction can cause symptoms like hearing loss,itching,earpain. Preventive measure should be taken properly to avoid this condition as it has some complications. Tympanic membrane perforation can be caused as a complication of impacted earwax. If not treated well patient with this condition can face a permanent hearing loss.

31. Bibliography Ansari Javed, ”A textbook of Medical Surgical Nursing-II ,Peevee publication,6 th edition, page no-25-41 Kumari MJ,”Adult Health Nursing-II” ,Jaypee brothers,2 nd edition,page no-10-11 https://www.slideshare.net