Ear Ailments
Cerumen mpaction
General—Cerumen (earwax) tightly packed in the external ear canal and blocking the eardrum
Clinical—partial hearing loss, sense of fullness in the ear, itching, tinnitus (ringing in ears), pain
Etiology—usually a result of an individual unintentionally pushing cerumen into his ear
Eardrop treatments (irrigation)
Three percent hydrogen peroxide + water → mix 50% of each solution and apply TID
Carbamide peroxide 6.5% (Debrox) 3 to 5 drops in affected ear BID
Triethanolamine polypeptide oleate condensate (Cerumenex).
Directions for use are as follows
Fill ear canal with solution while having patient’s head at 45 degrees.
Insert cotton plug and allow it to remain in place for 15 to 30 minutes.
Flush with lukewarm water.
Bacterial otitis externa (with intact tympanic membrane [TM])
General—inflammation of the external ear canal with scant white mucus
Clinical—otalgia (pain range: pruritis to harsh), otorrhea (discharge in/from the external ear canal)
Make sure to visualize the TM to rule out otitis media.
Etiology—most common cause is bacterial (Staphylococcus aureus, Pseudomonas), but 10% of cases are fungal.
Risk factors—moisture, mechanical removal of cerumen, insertion of foreign objects into ear, and so on.
Treatment—(recommended that drops be given 3 days after symptoms end; therefore course is 7 days)
Ofloxacin otic (Floxin Otic) 10 drops daily.
Note: If otitis externa is persistent, or if associated with otitis media, then use oral antibiotics (see subsequent text).
Complications
Necrotizing or malignant otitis externa (temporal bone osteomyelitis)
General—life-threatening extension of otitis externa to mastoid or temporal bone
Clinical—Otorrhea with odor
Etiology—Pseudomonas
Risk factors—old age, diabetes mellitus (DM), immunocompromised state (e.g., human immunodeficiency virus [HIV])
Treatment
For mild infections, PO fluoroquinolones × 2 weeks
Get ENT involved; surgical debridement may be needed
Cellulitis of the external ear
Fungal otitis externa (with intact TM)
Clinical—classical result of long-term treatment of bacterial otitis externa; fluffy white discharge
Etiology—Aspergillus (80%-90% of fungal cases), Candida
Treatment—as with bacterial otitis externa, clear the ear canal, thenRelated posts:
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