Download Ear Disorders - Dr Ted Williams

Ear Disorders
Presented by
Muhammad H. Shamim
Doctor of Pharmacy Candidate 2005
Anatomy of the Ear
Pathophysiology
• Prone to moisture collection
• Ideal Environment for bacterial and
fungal growth
• Loss of skin integrity
• breakdown of natural defenses.
Remember Eight
Attributes While
Assessing
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 isn’t always an infection from the
middle ear
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?
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 can’t be cleared by coughing, yawing, or
swallowing?
• Tooth pain?
• Pain after airplane?
• Pimple in the ear?
• Child with hearing problem?
Differential
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Ear wax & excess water
Water-clogged ear
Otitis externa
Otitis media
Meniere’s disease
Referred pain
Ear Wax
• Content
• Appearance
• Color
Functions of the Cerumen
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Lubrication
Trapping
Waterproof barrier
Antimicrobial
Inhibitory pH
Causes of excess wax
• Structure of the external auditory canal
• Abnormal cerumen production
• Impaction
Goal of Tx of excessive cerumen
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Softening
Use of proper agent
Use of safe agent
Use of an effective agent
Restore hearing loss and other associated
symptoms
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
Types of Wax Removers
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Oil-based
surface active agents
Bubblers
Urea and glycerol
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?
Other Products Commonly Used
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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
Water-clogged ear
• Not the same as Swimmer’s Ear (Otitis
externa)
• Some people are more prone to retaining
water
• Signs and symptoms
• Treatment goals
• Exclude these before you recommend
OTC
NonPhamacologic Therapy
• Tilting the effected ear
• Use of blow dryer
Pharmacologic Therapy
• Isopropyl alcohol 95% in anhydrous
glycerin 5%...Only FDA approved therapy
• 50:50 mixture of acetic acid 5% (white
vinegar) and isopropyl alcohol 95%
• why alcohol , glycerin, or acetic acid?
• Use of boric acid and precautions
Acute Otitis Externa (AOE)
• Also Called Swimmer’s Ear
• Combination of Inflammation and
Infection
• Two Most Common Precipitants
• Common Symptoms
• What should be Avoided
Contribution of the Structure
Some Helpful Advices
• How to minimize dizziness
• Getting better absorption of the applied
medication
• Cleaning and checking for inflammation
Otitis Media
One of the most common childhood illnesses.
Approximately $3 billion in healthcare costs were
attributed to >5 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
Meniere’s Disease
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How Common is the Disease
Inner Ear Disorder
Chronic Condition
A typical Acute Attack
Is there a Cure??
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.
Counseling Hearing-Impaired
Patient
• Get the Pt’s Attention Before You Speak
• Do Not Put Obstacles in Front of Your
Face
• No Chewing Gum
• Use Facial Expressions and Gestures
• Don’t Shout
• Be Patient, Relaxed, and Positive
• www.shhh.org
Instilling ear drops
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Washing hands before and after
Avoiding dizziness
Hold the dropper tip down all of the time
Proper technique for adults and children
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
Questions
And Comments