Self-Care II Exam 1: Otic Care

BK is a 74 year old male who is a regular at your pharmacy. He comes to the counter with a bottle of acetaminophen and wants to know if this will help with his ear pain. He describes the pain as being dull and is located only in the left ear. He has been slowly losing hearing over the last few weeks despite having a new hearing aid. He denies any recent trauma or surgery and does not have any other symptoms. He is frustrated and says he tries to keep his ears clean with Q-tips regularly, but they seem to be “all clogged up anyway”. He has a lot of hair in his ear, so he is always feeling itchy. He does not have any other complaints today, but does let you know that you can take the sertraline off of his list because he stopped it about 2 weeks ago since he’s feeling better and doesn’t want to take an extra pill. 

PMH:

• Hypertension

• Benign Prostatic Hyperplasia (BPH)

• Depression

Meds:

• Lisinopril/HCTZ 20mg-12.5mg 1 tab daily

• Amlodipine 10mg 1 tab daily

• Finasteride 5mg 1 tab daily

• Sertraline 100mg 1 tab daily

Vitals:  Height 5’10” Weight 162 lbs

Dull one-sided pain

What condition is BK likely suffering from? 

cerumen impaction (buildup of earwax)

BK is a 74 year old male who is a regular at your pharmacy. He comes to the counter with a bottle of acetaminophen and wants to know if this will help with his ear pain. He describes the pain as being dull and is located only in the left ear. He has been slowly losing hearing over the last few weeks despite having a new hearing aid. He denies any recent trauma or surgery and does not have any other symptoms. He is frustrated and says he tries to keep his ears clean with Q-tips regularly, but they seem to be “all clogged up anyway”. He has a lot of hair in his ear, so he is always feeling itchy. He does not have any other complaints today, but does let you know that you can take the sertraline off of his list because he stopped it about 2 weeks ago since he’s feeling better and doesn’t want to take an extra pill. 

PMH:

• Hypertension

• Benign Prostatic Hyperplasia

• Depression

Meds:

• Lisinopril/hctz 20mg-12.5mg 1 tab daily

• Amlodipine 10mg 1 tab daily

• Finasteride 5mg 1 tab daily

• Sertraline 100mg 1 tab daily

Vitals:  Height 5’10” Weight 162 lbs

What risk factors does BK have for this condition?

Elderly, hearing aids, Q-tips, and excess hair

BK is a 74 year old male who is a regular at your pharmacy. He comes to the counter with a bottle of acetaminophen and wants to know if this will help with his ear pain. He describes the pain as being dull and is located only in the left ear. He has been slowly losing hearing over the last few weeks despite having a new hearing aid. He denies any recent trauma or surgery and does not have any other symptoms. He is frustrated and says he tries to keep his ears clean with Q-tips regularly, but they seem to be “all clogged up anyway”. He has a lot of hair in his ear, so he is always feeling itchy. He does not have any other complaints today, but does let you know that you can take the sertraline off of his list because he stopped it about 2 weeks ago since he’s feeling better and doesn’t want to take an extra pill. 

PMH:

• Hypertension

• Benign Prostatic Hyperplasia

• Depression

Meds:

• Lisinopril/hctz 20mg-12.5mg 1 tab daily

• Amlodipine 10mg 1 tab daily

• Finasteride 5mg 1 tab daily

• Sertraline 100mg 1 tab daily

Vitals:  Height 5’10” Weight 162 lbs

Is he a candidate for self-care? If so, what would you recommend for him? (Provide agent brand name, dosing, frequency, duration of use and education points). If not, justify why. 

1. Patient ______ for self-care.

2. Agent Brand Name: ______ 6.% in anhydrous glycerin 

3. Dosing: ______ drops of the solution into affected ear(s)

4. Frequency: ______

5. Duration of use: up to ______ 

6. Education points: 

   1. Medication can be used alone or in conjunction with ______ to remove the loosened cerumen

   2. Prevent applicator tip from entering the ______ and prevent the solution from contacting the ______ 

   3. Solution should remain in the ______ for several minutes for effective softening of excessive earwax

is a candidate, Carbamide Peroxide, 5-10, 2x/day, 4 days, warm water irrigation, EAC, eyes, EAC

BK is a 74 year old male who is a regular at your pharmacy. He comes to the counter with a bottle of acetaminophen and wants to know if this will help with his ear pain. He describes the pain as being dull and is located only in the left ear. He has been slowly losing hearing over the last few weeks despite having a new hearing aid. He denies any recent trauma or surgery and does not have any other symptoms. He is frustrated and says he tries to keep his ears clean with Q-tips regularly, but they seem to be “all clogged up anyway”. He has a lot of hair in his ear, so he is always feeling itchy. He does not have any other complaints today, but does let you know that you can take the sertraline off of his list because he stopped it about 2 weeks ago since he’s feeling better and doesn’t want to take an extra pill. 

PMH:

• Hypertension

• Benign Prostatic Hyperplasia

• Depression

Meds:

• Lisinopril/hctz 20mg-12.5mg 1 tab daily

• Amlodipine 10mg 1 tab daily

• Finasteride 5mg 1 tab daily

• Sertraline 100mg 1 tab daily

Vitals:  Height 5’10” Weight 162 lbs

Would you recommend using acetaminophen, why or why not? 

No, because his pain is not severe

BK is a 74 year old male who is a regular at your pharmacy. He comes to the counter with a bottle of acetaminophen and wants to know if this will help with his ear pain. He describes the pain as being dull and is located only in the left ear. He has been slowly losing hearing over the last few weeks despite having a new hearing aid. He denies any recent trauma or surgery and does not have any other symptoms. He is frustrated and says he tries to keep his ears clean with Q-tips regularly, but they seem to be “all clogged up anyway”. He has a lot of hair in his ear, so he is always feeling itchy. He does not have any other complaints today, but does let you know that you can take the sertraline off of his list because he stopped it about 2 weeks ago since he’s feeling better and doesn’t want to take an extra pill. 

PMH:

• Hypertension

• Benign Prostatic Hyperplasia

• Depression

Meds:

• Lisinopril/HCTZ 20mg-12.5mg 1 tab daily

• Amlodipine 10mg 1 tab daily

• Finasteride 5mg 1 tab daily

• Sertraline 100mg 1 tab daily

Vitals:  Height 5’10” Weight 162 lbs

What non-pharmacologic strategies would you recommend to BK to help prevent this in the future?

1. Avoid ______ to prevent increased cerumen impaction with occlusion of the canal 

2. ______ if recurrent

3. Use the ______ properly 

4. Occasional ______ if cerumen builds up

Q-Tips, professional cleaning, hearing aids, softening drops

ZE is a 30 year old male who comes to your pharmacy complaining of really intense right ear pain. He recently went surfing about a week ago and the pain started a day or two after that. He thought he had a swimmer's ear, so he tried Auro-Dri® and followed all of the instructions. It did not provide any relief. He does have some clear liquid coming from the ear, so he thinks the “water might be leaving, but the pain is bad!”. He denies any trauma to the ear. 

Patient age: 30 years, Patient height: 6’2”, Patient weight: 190 lb 

PMH:

• None

Meds/OTC/Herbals

• Green Tea 1 cup daily

• Gingko biloba 1 tab daily

What are common signs of water-clogged ears? 

• ______ in EAC (External Auditory Canal)

• Can cause ______, feeling of ear canal ______

• Sensation of ______

water retention, hearing impairment, fullness, trapped water

ZE is a 30 year old male who comes to your pharmacy complaining of really intense right ear pain. He recently went surfing about a week ago and the pain started a day or two after that. He thought he had a swimmer's ear, so he tried Auro-Dri® and followed all of the instructions. It did not provide any relief. He does have some clear liquid coming from the ear, so he thinks the “water might be leaving, but the pain is bad!”. He denies any trauma to the ear. 

Patient age: 30 years, Patient height: 6’2”, Patient weight: 190 lb 

PMH:

• None

Meds/OTC/Herbals

• Green Tea 1 cup daily

• Gingko biloba 1 tab daily

What would be the most appropriate recommendation for the patient at this time? If recommending self-care, provide dose, frequency, and patient education. If not, justify your recommendation.

Refer because he has intense ear pain and discharge

ZE is a 30 year old male who comes to your pharmacy complaining of really intense right ear pain. He recently went surfing about a week ago and the pain started a day or two after that. He thought he had a swimmer's ear, so he tried Auro-Dri® and followed all of the instructions. It did not provide any relief. He does have some clear liquid coming from the ear, so he thinks the “water might be leaving, but the pain is bad!”. He denies any trauma to the ear. 

Patient age: 30 years, Patient height: 6’2”, Patient weight: 190 lb 

PMH:

• None

Meds/OTC/Herbals

• Green Tea 1 cup daily

• Gingko biloba 1 tab daily

How would you educate ZE regarding the use of Auro-Dri® for the future?

• Auro-Dri is an ear-drying agent and is NOT for the prevention of ______ accumulation or ______ treatment. Keep the product away from ______ sources (______) and avoid contact with eyes. If pain, burning, or irritation occurs with application or if symptoms persist after several days of use, a ______ is indicated. Do NOT use for swimmer’s ears + for infections.

moisture, inflammation, fire, flammable, medical referral

Nonpharmacologic (Non-Drug) Therapy for Excessive/Impacted Earwax

Recommended Methods

• Use a ______/ear-cleaning tool only at the ______ entrance

• Warm sterile water irrigation with a bulb syringe may help

• Examples of curettes:

  • ______ (ages 12+)

  • ______ (ages 16+)

• Methods NOT Recommended

  • Cotton-tipped swabs (Q-tips)

  • Oral jet irrigators/water flossers

  • Inserting objects deep into the ear canal

  • These methods may worsen impaction or cause (STUDY):

    • Infection

    • Vertigo

    • Tinnitus (ear ringing)

    • Eardrum perforation

    • Pain or Bleeding

• Patients should seek medical care if symptoms persist or if ______ occurs.

curette, outer ear canal, Clinere, Ototek Loop, pain/bleeding

Pharmacologic (Drug) Therapy for Excessive/Impacted Earwax

The only FDA-approved nonprescription earwax softener is:

• ______ 6.5% in anhydrous glycerin

• ______ hardened earwax

• Has mild ______ effects

• Can be used alone or with warm water irrigation

How to Use Carbamide Peroxide

• Instill ______ into the affected ear

• Leave in for ______

• May be used ______ for up to ______

• Remaining wax can be removed with gentle warm-water irrigation

Approved for:

• ______

• Children ≥______

Possible SEs: Pain, Irritation, Rash, Redness, Dizziness, and Ear discharge

Patients should contact a healthcare provider if symptoms continue after ______ or signs of infection develop.

Carbamide Peroxide, softens and loosens, antibacterial, 5-10 drops, several mins, 2x/day, 4 days, adults, 12 y/o, 4 days

Nonpharmacologic (Non-Drug) Treatment for Water-Clogged Ears

Recommended Measures

• Tilt head downward and gently pull the earlobe to drain water

• Dry the outer ear with a towel

• Use a blow dryer on low heat and speed (not directly into the ear)

• Wear molded earplugs or a bathing cap during prolonged water exposure

Water Protection

• Molded earplugs provide the best protection

• Petroleum jelly–coated cotton balls may help for short exposure (<15 mins)

Water-Absorbing Products

Examples:

• AquaEars

• BioEars

• ClearEars

ClearEars earplugs absorb trapped water and are left in the ear for 5–10 minutes.

KNOW

Key Counseling Points for Ear Disorders

Excessive/Impacted Earwax

• Recommended

  • Use ______ (Debrox Earwax Removal Aid, Murine Ear Wax Removal)

  • Use ______ drops ______ for up to ______

  • Allow drops to stay in ear for ______

• Avoid

  • Cotton swabs/Q-tips

  • Ear candles

  • Inserting objects into the ear canal

• Seek Medical Care If

  • ______ occurs

  • Hearing worsens

  • Symptoms continue after ______

  • <______

carbamide peroxide with glycerin, 5-10, 2x/day, 4 days, 5 mins, severe pain, 4 days, 12 y/o

KNOW IMAGE

Water Clogged Ears Exclusions (same as cerumen but w/dizziness):

• Signs of infection (irritation or rash)

• Pain associated with ear discharge

• Dizziness

• Bleeding or signs of trauma

• Presence of ruptured tympanic membrane

• Ear surgery within 6 weeks prior

• Tympanostomy tubes present

• Incapable of following proper instructions

• Hypersensitivity to recommended agents

• Worsening of condition after attempted self-treatment

KNOW

Excessive/Impacted Cerumen Exclusions

(same as water clogged but w/o dizziness and w/<12 y/o):

• Signs of infection (irritation or rash)

• Pain associated with ear discharge

• Bleeding or signs of trauma

• Presence of ruptured tympanic membrane

• Ear surgery within 6 weeks prior

• Tympanostomy tubes present

• Incapable of following proper instructions

• Hypersensitivity to recommended agents

• <12 years old

• Worsening of condition after attempted self-treatment

KNOW