Otitis external presentation notes for medical students

Otitis external notes

1. CONDITIONS OF THE EXTERNAL EAR MR C. KAFWANKA RN/RTN/BSc.NRS

2. External ear infections Infection and inflammation of the external ear in referred to as otitis externa . Being covered by the skin, the external ear is liable to develop conditions just like those of any other part of the body covered by the skin. These include fungal (otomycosis), psoriatic (eczematoid) and bacterial . Common bacterial pathogens that cause otitis externa are pseudomonal and staphylococcal species .

3. Predisposing factors Common predisposing factors are:- Swimming Forceful cleaning of the ear Trauma Poor hygiene

4. Clinical manifestations The common clinical manifestations are; otorrhoea , erythema oedema . Fever Itching In severe cases, soft tissue stenosis may be present. Pseudomonal infections produce green or yellow purulent otorrhoea.

5. Management of external ear infection Patients are in most cases managed at OPD External ear infections require otoscopic examination that must be performed in conjunction with evaluation of related structures such as the head and neck. For example, examine the auricle for swelling, deformity, and erythema; the face for evidence of facial nerve paresis or other cranial neuropathy; and the neck for masses .

6. Cont’d Usually a history of preceding ear trauma in the form of forceful ear cleaning, use of cotton swabs, or water in the ear canal is important and ensure that you take such history. History of severe throbbing pain with ear discharge, this can lead to a hearing loss due to occlusion of the ear canal.

7. Cont’d Bacterial; Cloxacillin 250mg – 500mg 6hrly for 5 days Erythromycin 250mg – 500mg 6hrly for 5 days Fungal; Miconazole cream 2% topically twice daily (continue applying until after 2 weeks when symptoms clear). Griseofulvin 500mg once daily P/O up to 2 weeks after lesions disappear.

8. Cont’d Psoriatic; Zinc oxide cream topically 1-3 times daily after bathing Hydrocortizone cream 1% topically twice daily for 7 days and maintenance once or twice weekly as required Maintain high standards of personal hygiene

9. IMPACTED EAR WAX Cerumen or ear wax is produced by glands in the skin of the outer portion of the ear canal. Cerumen impaction, or impacted ear wax, is a common phenomenon. It is the result of mixing skin cells of the outer ear canal with glandular secretions that protects the ear against infections by cleaning and trapping dirt in the ear canal.

10. Cont’d Cerumen accumulation can occur if there is an overproduction of ear wax in response to infections or loud noise. The amount of ear wax produced varies by individual. Some individuals produce very little wax; others overproduce ear wax to the point that blockage may occur. Cerumen normally works itself out of the ear; however, there are situations when the wax begins to plug up the outer ear canal resulting in impaction.

11. Signs and symptoms Individuals who have impacted ear wax often complain of; hearing loss pain in the ear a ringing in the ear called tinnitus Cough vertigo itching of the ear.

12. Management Normally , ear wax is removed by cleansing the ear. This is accomplished by wrapping a wet cloth around the finger and washing around the outer ear. In the case of cerumen impaction, the excess ear wax may have to be softened using an oil-based agent (ear drops wax softener), such as baby oil or olive oil.

13. Cont’d Over the counter cerumen – removing agents such as Debrox and Murine Ear Drops may also be used in place of oil – based agents to loosen the wax. Another low – cost method of removing ear wax involves using a 3% Hydrogen Peroxide. However, these ear drops may cause irritation to the ear and result in possible allergic reactions.

14. IEC Excessive ear wax can be very embarrassing, and can also cause many people to be a little hard of hearing. Therefore, the following should be considered in the I.E.C: Do not use cotton swabs and other small objects to remove earwax as they can cause earwax to be pushed farther back in the ear, creating more wax buildup and possibly hearing problems .

15. Cont’d People should not aim at getting rid of all the earwax as it protects the ear from infections. Visit the clinic for ear examination at every 6 – 12 months. Only use ear drops prescribed by a medical personnel. Ear syringing must be done only at the health centre by a professional.

16. FOREIGN BODIES OF THE EAR M ajority of objects found in ears are placed there voluntarily, usually by children, for an endless variety of reasons. A caregiver should not threaten a child when asking about this possibility, because the child may deny having put something in the ear in order to avoid punishment.

17. Cont’d This denial could easily result in a delay of its discovery and increase the risk of complications. Insects crawl into the ear, usually when one is sleeping. Therefore, sleeping on the floor or outdoors would increase the chance of this unpleasant experience. The ear canal, where most objects get stuck, is very sensitive.

18. Signs and symptoms The symptoms of having a foreign body in the ear largely depend on the size, shape, and substance involved. Occasionally , a foreign body in the ear will go undetected and can cause an infection in the ear. Pain is the most common symptom. If the object is blocking most of the ear canal, the patient may experience a decrease in hearing on the affected ear .

19. Cont’d Ear irritation to the ear canal, this may cause nausea and vomit. Bleeding is also common, especially if the object is sharp. One of the most distressing experiences with this problem is having a live insect in the ear. The insect's movement can cause a buzzing in the ear and may be quite uncomfortable.

20. Medical/Surgical Care Where there is ear infection antibiotic ear drops can be administered. Dripping mineral oil into the affected ear kill the insect. This is safe as long as there is no hole in the ear eardrum. Urgent removal is also recommended for food or plant material (such as beans) because these will swell when moistened. Urgent removal is indicated if the object is causing significant pain or discomfort.

21. Cont’d Commonly used techniques include applying gentle suction to the object, small forceps, or instruments that have a loop or hook at the tip are used. If the object is metallic, a long instrument may be magnetized to assist in gently pulling the object from the ear. Another common technique involves irrigating the ear.

22. Cont’d If the eardrum appears intact, warm water can be gently squirted past the object using a small catheter as the water will turn around at the end of the ear canal and often wash the object out. A child with this problem may be sedated to allow calm and comfortable removal of the object .

23. ASSIGNMENT Draw and label the human ear