Ears

    Cerumen Impaction

• Assesment

  • Check for hearing loss and fullness, and see how much it affects them

• Differentials

  • Cholesteatoma - retracted TM and keratinized collection of epithelial cells in the middle ear or mastoid, can be both congenital and acquired

  • Otitis Externa - redness and swelling of the ear canal

• Treat

  • use caution if they have hx of tympanostomy tubes or ruptured TM

  • Prescribe cerumenolytics (carbamide peroxide) - mineral oil, liquid docusate sodium, and hydrogen peroxide

  • Perform irrigation

  • refer to ENT for refractory cases

Hearling loss

• Assessment

  • Rinne Test

    • compares the air conduction and bone conduction of sound

      • AC>BC indicated normal or sensorial hearing POSITIVE

      • BC>AC indicated conductive hearing loss NEGATIVE

  • Weber test

    • Assessment of lateralization of sound

    • tuning fork is placed on the forehead

    • patient indicated if sound is heard equally in the ears or in the center of the head

    • Lateralization may indicate unilateral hearing loss

  • The whisper test can test acuity

• How to tell what kind of loss is present

  • Conductive hearing loss - typically differentiated by a Weber test and sound lateralization to the affected ear, and a Rinne test showing a positive AC>BC)

  • Sensorineural differentiated by a Weber test showing sound lateralization to the unaffected side and a Rinné test showing BC>AC)

  • Presbycusis (aging) - shows a gradual loss

    
    

    
    

Otitis (Media)

• Redened, bulging tympanic membrane, in severe cases, can even have pus.

• Assessment

  • ask about ear pain, do they have fullness

  • Do an otoscopic exam

    • note a loss of cone light, bulging TM, and inflammation

  • Differentials

    • Otitis media with effusion - temporary conductive hearing loss, effusion on otoscopic exam

    • Bullous myringitis - blisters on the tympanic membrane

    • Otitis media with perforation - mucus-like pus-filled or bloody drainage from the ear

  • Treatment

    • Manage pain

    • amoxicillin, or amoxicillin-clavulanate, beta-lactams

    • treat for 7-10 days

Otitis Externa

• Inflammation and exudates that you can see on the outside of the ear

• Assessment

  • Assess the tenderness of the tragus. This is the key

• Treatment

  • If the tympanic membrane is ruptured, we treat with ofloxacin 5 drops to the affected ear twice daily. Ciprofloxacin with hydrocortisone 3 drops to the affected ear daily

  • If just a mild infection, treat with acetic acid

  • if severe but TM intact, use wick insertion and topical antibiotics like neomycin otic

Cerumen Removal Procedure

• First verify that there is no hx of TM rupture

• apply cerumenolytic for 3-5 days before removing, such as mineral oil, liquid docusate, hydrogen peroxide

Irrigate with water, NS, or a hydrogen peroxide mixture at body temperature with a flexible cath on a syringe or an irrigation device