ear conditions - week 5

healthy ear

• The good condition of the skin in the ear canal

• Translucent and healthy tympanic membrane (ear drum)

• You can see some of the ossicles (small bones of the ear from previous diagram)

• White ‘Triangle’ of light shining back showing the drum is the correct convex shape

ear wax blockage

This Ear canal is blocked with wax

• The old impacted wax is black – and surprisingly hard to see as absorbs
  all light. Looks more like a ‘hole’ very often.

• First line treatment is Olive Oil ear drops to soften wax, dissolve it and
  allow its removal.

• Second choice is hydrogen peroxide. This can give a faster break down
  of wax, but much more likely to irritate / damage skin or eardrum. Must
  be avoided when risk of damage to any tissue.

• Can be treated OTC

otitis externa

This is how otitis externa (often called eczema of the ear) can present through
an otoscope.

• Skin of the ear canal is damaged

• Can involve eardrum

• Not necessarily infected, but is always at risk of infection.

• Usually requires treatment with prescription eardrops

• These normally contain combination of steroids (for inflammation) and/or
  anti infection agents.

• Pharmacy treatments via PGD (patient group directions) are new and
  emerging

otitis media

This condition is infection / inflammation of the middle ear

• Outer ear often not involved at all – therefore eardrops of very
  limited (if any) use

• You can see here the build-up of purulent fluid behind the ear
  drum.

• The only normal passage of escape for this fluid is the Eustachian
  tube which has become blocked.

• Treatments can include systemic antibiotics if appropriate.

• Treatments should include advice / medication to clear eustachian
  tube such as decongestants. Some of which is available OTC.

• It is likely hearing will be impaired if pressure has built up behind
  the eardrum

otitis media - more severe

This are examples of more severe otitis media

• The fluid and pressure has built up here to the point that the
  eardrum is beginning to bulge.

• Risk of perforation imminent (you can see the beginning of a
  perforation in the lower picture.

• The eardrum bulges in a ‘doughnut’ shape because the eardrum is
  connected to the Malleus (small ‘hammer’ bone) in the centre.

• This eardrum will not be functional and hearing will be impaired.

• These cases should be referred.

perforated eardrum

This is an example of a perforated eardrum through the otoscope

• Uncomplicated perforations normally heal themselves.

• ENT specialists in hospital can apply patch treatments to assist
  their healing.

• Ear drops should not be applied to these cases.

• Currently no pharmacy treatments are available and these cases
  should be referred.

ear grommets

This is what ear grommets look like through the Otoscope

• Children are very prone to blocked eustachian tubes.

• This is because the face structure is not fully formed yet and
  essentially the eustachian tube is cramped whilst they are still
  growing.

• This makes pressure build up behind the ear a common problem,
  and common cause of hearing difficulties.

• A grommet makes an artificial tube through the ear drum, allowing
  air though from the middle ear out of the canal.

• This allows the pressure to equalise even if the eustachian tube is
  blocked.

• This treatment can restore total hearing loss in severe cases.

• OTC drops should not be used.

• Ear is always more at risk of infection, care should be taken, and
  any complications referred.