Ear DisordersEar Disorders

Presented by Presented by Muhammad H. ShamimMuhammad H. Shamim

Doctor of Pharmacy Candidate 2005Doctor of Pharmacy Candidate 2005

Anatomy of the EarAnatomy of the Ear

PathophysiologyPathophysiology

• Prone to moisture collection

• Ideal Environment for bacterial and fungal growth

• Loss of skin integrity

• breakdown of natural defenses.

Remember EightRemember Eight

Attributes While Attributes While AssessingAssessing

Remember !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 PatientAssessing 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…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?

DifferentialDifferential

• Ear wax & excess water

• Water-clogged ear

• Otitis externa

• Otitis media

• Meniere’s disease

• Referred pain

Ear WaxEar Wax

• Content• Appearance

• Color

Functions of the CerumenFunctions of the Cerumen

• Lubrication

• Trapping

• Waterproof barrier

• Antimicrobial

• Inhibitory pH

Causes of excess waxCauses of excess wax

• Structure of the external auditory canal

• Abnormal cerumen production

• Impaction

Goal of Tx of excessive cerumenGoal 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

RememberRemember

• 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 RemoversTypes of Wax Removers

• Oil-based

• surface active agents

• Bubblers

• Urea and glycerol

Only FDA approved OTC for Only FDA approved OTC for cerumen softeningcerumen 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 UsedOther 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 earWater-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 TherapyNonPhamacologic Therapy

• Tilting the effected ear

• Use of blow dryer

Pharmacologic TherapyPharmacologic 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)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 StructureContribution of the Structure

Some Helpful AdvicesSome Helpful Advices

• How to minimize dizziness

• Getting better absorption of the applied medication

• Cleaning and checking for inflammation

Otitis MediaOtitis 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 DiseaseMeniere’s Disease

• How Common is the Disease

• Inner Ear Disorder

• Chronic Condition

• A typical Acute Attack

• Is there a Cure??

Hearing Impairment Hearing Impairment StatisticStatistic

• 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 Counseling Hearing-Impaired PatientPatient

• 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 dropsInstilling 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 UpSumming 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

QuestionsQuestions

And CommentsAnd Comments