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
• 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
• 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

• 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
• 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

• 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
• 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
• 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