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Ear care
workshop
AIMS
For the practitioner to be able to confidently
carry out ear examinations, recognise
abnormalities and to carry out appropriate ear
care.
Objectives
• To enhance understanding of basic anatomy and
physiology of the ear.
• Ear examination
• To recognise abnormalities and associated care
• Theory behind cerumen removal and associated
guidelines
• To reflect on accountability, documentation
• Practical session
Basic anatomy and physiology
of ear
Outer (External) ear
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Pinna and external acoustic canal.
• Canal lined with small hairs next to which are
small ceruminous glands
• The Tympanic Membrane
MIDDLE EAR
• Air filled chamber
• Contains 3 smallest
bones in the body –
malleus, incus and stapes
= AUDITORY OSSICLES
• Eustachian tube
• Vibrations – Oval window
- cochlear
Inner ear
• Semi circular canals
and vestibular
apparatus
• The organ of corti is in
the cochlea and is
main organ for hearing
Nerves involved:
• Auditory nerve – inner ear ( CN VIII)
• Facial nerve – middle ear ( CN VII)
• Vagus Nerve - Outer ear
(CN X)
Ear wax - Cerumen
• Not Like paraffin! Made of a lot of different
chemical components
• Testerone control over production of sebum.
• What is its purpose?
People likely to produce excessive wax
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Learning disabilities
Anxious people
High lipid levels
Genetic tendency
Elderly
What issues can wax build
up cause a patient?
Ear Examination
History of presenting condition:
What information would be required here?
History cont……
• PMH - ? Relevant
• Meds
• Allergies
Assessment
• Examine Pina. Outer meatus and adjacent scalp /
mastoid,checking for scars, signs of trauma/
infection
• Is ear inflammed -? Infection/ trauma
• Skin condition – ?seborrhoeic dermatitis/
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Malignancy
• Ear canal discharge?
Identify wax……
• In ear examination discern type of wax, position in
canal and % of occlusion
• Is wax healthy, or bacterial debris, or dry and
crumbly
Assessment cont..
Examine external auditory meatus.
Should be pain free.
What can cause pain?
Furuncle
Trauma
Otitis externa
Fungal infection
Assessment cont….
• Check ear canal and
tympanic membrane
Assessment cont…
• When withdrawing otoscope check external
auditory meatus carefully.
• Document……!
• Document…..!
• Document….!
Ear cleaning / irrigation
Ear Preparation
• If wax hard will require softening for best irrigation results
• Choice of products –
• OTC drops – otex, cerumol – all contain hydrogen
peroxide
• Bicarbonate soda 5% drops – possible irritant
• Olive oil
• Almond oil avoid if nut allergies!
Totally contraindicated in any acute perforated Tympanic
Membrane.
Application of drops
• No formal length of time and number of times a
day
• Advise if using oil not to heat it up – room temp
sufficient
• Not to over oil ears as becomes irritated
Manual removal
• If dry and crusty possibly can be gently
manoeuvred out using Jobson Horne probe –
head light and otoscope
• If too painful discontinue - skin becomes
quickly traumatised
Ear Irrigation
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Equipment required:
Auriscope
Head light / ? Eye protectors/ apron/ gloves
Electronic ear irrigator
Warm water – approx room temp - NOT COLD!!
Noots receiver ( disposable or lined)
Jobson Horne probe/ cotton wool
Tissues, receivers
Waterproof cape / towel
Guidelines:……
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ENSURE – device only used by trained clinician
ENSURE that warnings and cautions are observed
ENSURE patient exhibits NO contra indications
ENSURE the unit been cleaned
Reasons for irrigation
• Remove and Improve!
Principles of ear irrigation
• Facilitate the removal of cerumen and foreign
bodies
• Individual assessment of each patient by
practitioner carrying out procedure.
Possible complications?
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Infection
Perforation
Tinnitus
Vagal nerve stimulation
Dizziness
Irrigation should not be carried out when:
• Informed consent not obtained and NSCP
consent form signed for procedure
• Patient has had previous problems with
procedure in past
• Hx of otitis media in past 6 weeks
• Any form of ear surgery in past 18 months and
NOT been discharged from care of ENT
• Perforation or Hx of mucus discharge in past 12
months
• Cleft palate repaired or not
• Presence of acute otitis externa
Procedure to always be carried out with both
practitioner and patient sitting, patient should be
under direct vision using a headlight throughout.
DOCUMENTATION…….
Record:
• What the patient says
• What you see in BOTH ears
• What you do – including advice given
• Why this treatment – rationale….
NMC record keeping guidelines 2010
Documentation tips…
• Always compare both ears - L=R
• Do not use word “Appears normal” - looks as
though not aware of what you are doing be
definite. – “ Tympanic membrane normal” or
“Tympanic membrane normal features not visible”
• Word “impacted” – to be used if evidence wax
has been pushed down canal with implement
such as cotton bud
• ‘Occluded’ should be used is canal full of wax –
say whether dark and hard, softy and light wax.
• Document advice given to patient written/ verbal
post procedure.
DEAFNESS
3 types:
1. Conductive : Obstruction between external /middle ear
2. Sensori – neural: Obstruction between stapes footplate and the
auditory centres of brain
3. Mixed Deafness: Combination of conductive and sensori – neural
deafness
Practical Time
Hearing Aid Care..
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General
Whistling
Hearing aid controls
Washing the ear mould
Retubing ear mould
Tinnitus
• What is Tinnitis?
• How do you get it?
• Who is likely to get it?
• Hyperacusis
Patient Education
• E – Educate - Why problem there?
• A – Advise – How to prevent recurring
Regular check ups
• R – Resolve – Treat the Problem, applying
clinical judgement and ability
References and acknowledgements
Rogers R, www.earcareservicesuk.com
www.tinnutis.org.uk
www.deafnessresearch.org.uk
Action on ENT Steering Board (2007). Guidance
Document in Ear Care. Primary Ear Care Centre. (http://
www.earcarecentre.com)
• Nursing and Midwifery Council (2006) Record Keeping
Guidance for Nurses. NMC, London.
• Skills for Health :CHS20. Undertake examination of the
external ear: -National Operation Standards:
https://tools.skillsforhealth.org.uk/competence/show/ht
ml/id/350/ (last accessed 11th April 2012)
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