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IOS 9 Exam 2
Otics
| Question | Answer |
|---|---|
| Pathophysiology of excessive/impacted cerumen | May be the result of 3 events: physical structure of the external auditory canal 2. excessive cerumen production or abnormal secreetions (softer drier) 3 Impaction due to repeated attempts to remove it with Q-tip (Can lead to otitis media |
| Excessive /impacted cerumen treatment | Weak antibacterial +tissue debridement + softening |
| Function of cerumen | Lubrication of external auditory canal, trap dust and provide waterproof barrier |
| Tympanic membrane function | Seperates outer ear from the middle war, transmits sound waves and protection |
| Factors that compromise protective barrier | External auditory canal is a dark and moist area, Lipid layer (protection) could be removed via Q-tip, dermatologic skin disorders, viral illness such as UTi |
| Protective barriers of external auditory canal | Hairs lining outer half of EAC, Acidic pH, cerumen coating (lyzomes), natural cleansing as cerumen migrates outward |
| Risk Factors for excessive/impacted cerumen | Abnormally narrow EAC, excessive hair, overactive cerumnous glands, hearing aids, ear plugs, atrophy of cerumen gland (stay inside) |
| Signs and symptoms of excessive/impacted cerumen | sense of fullness or pressure in the ear, gradual hearing loss, vertigo, dull pain |
| Treatment for excessive/impacted cerumen | Carbamide peroxide 6.5% in glycerin BID for up to 4 days or mineral oil, or dilute hydrogen peroxide |
| MOA of Carbamide peroxide in glycerin | weak antibacterial+ tissue debridement +softening must irrigate |
| Mineral oil or Docusate sodium MOA | Mineral oil softens and eleviates itching docusate more effective |
| Hydrogen peroxide MOA | weak antibacterial can be used to flush after softening method |
| Contraindication to treat excessive/impacted cerumen | Perforated typmanic membrane, otitis media |
| Excessive/ Impacted cerumen triethanolamine polypeptide oleate condensate treatment | RX indicated for exam drop in 15 minutes before and flush with buld syringe |
| Water Clogged ears etiology | Excessive moisture in the ears due to moisture sports or misshapen ears |
| Risks for water clogged ears | Misshapen ears, excessive cerumen, hot, humid weather, sweating, swimming, improper use of aqueous cleansing solutions |
| Non-pharm prevention for water clogged ears | Tilt ear downward and gently manipulate auricle to expel excessive water, blow dry on low setting immediately after swimming, use ear plugs when swimming (petroleum jelly in cotton wool) |
| Signs and symptoms of water clogged ears | Wetness or fullness in ears (#1), gradual hearing loss, itching, otalgia |
| Treatment for water clogged ears OTC | 95% isopropyl alcohol in 5% anhydrous glycerin or compounded with 5% acetic acid to prevent bacterial growth |
| MOA of 95% isopropyl alcohol in anhydrous glycerin to treat water clogges ears | Acts as a drying agent and skin disinfectant to prevents over drying |
| Contraindications of treating water clogged ears | Perforated tympanic membrane and otitis media |
| Acute Otitis Externa etiology | Called swimmers ear, usually a bacterial infection caused by P. Aeruginosa or S. aureus or Aspergillus |
| Risk factors for Acute Otitis Externa | Trauma to the external ausitory canal(Q-tip), moisture (swimming, perspiration), bacteria contaminated water (P. aeruginosa), Hot weather, hearing aids, chronic dermatologic disease |
| Signs and symptoms of acute otitis externa | Symptoms: Rapid onset (48hrs), Otalgia (70%), itching (60%), fullness (20%), hearning loss (30%) Signs: Tenderness, traga/pinna or edema/erythema, otorrhea, lymphadentis, pinna cellulitis |
| Acute Otitis Externa evaluation | Necessary to distinguish from other causes verify that patient does not have perforated TM (PCP) |
| Acute Otitis Externa symptomatic treatment | 1. AUral toilet (water,saline, H2O2), APAP, NSAID |
| Acute otitis externa RX treatment | Antimicrobials/corticosteroids, antimicrobials, acetic acid |
| Rx antimicrobial/corticosteroid for acute otitis externa | Neomycin/hydrocortisone/polymixin given TID-QID should give the suspension to decrease burning |
| Rx antimicrobial/corticosteroid for acute otitis externa | Ciprofloxacin/hydrocortisone suspension or ciprofloxacin and dexamethasone (better efficacy)BID or Oflaxacin (most prescribed) QD |
| Acetic acid products for acute otitis externa | acetic acid and propylene glycol but can cause stinging (cotton wick) |
| acute otitis externa antifungal therapy | Clotrimazole or tollnafate solution |
| 9 Patient counseling points | Clean and dry ear prior to instilling drops, warm ear drops by holding hands, shake suspension, tilt head pull ear backward, avoid touching dropper to canal, administer correct drops, gently press flap over ear , keep head or cotton, wick if thick |
Created by:
liza001
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