Ear Wax and Otitis Externa Quiz

Ear wax

• Cerumen (ear wax) is produced by sebaceous and apocrine glands in the ear canal, combining with skin cells to create a protective layer
• Cerumen is naturally moved outward by jaw movement, and removed by washing
• Excessive cerumen can build up, creating a plug that affects hearing and causes discomfort
• Cerumenolytics are used to soften ear wax and make it easier to remove
• Cerumenolytics are unlikely to dissolve a compacted wax plug on their own
• Cerumenolytics may include: fixed and volatile oils, glycerol, docusate, urea, hydrogen peroxide and paradichlorobenzene

Otitis Externa

• Inflammation of the external auditory canal
• Commonly caused by bacteria, but can also be fungal or viral
• Chronic form is eczematous and may be atopic or a contact dermatitis
• Symptoms include: ear pain worse with chewing, feeling of fullness and hearing loss

Treatment of Otitis Externa

• Adequate cleaning of the canal by a physician
• Hydrocortisone cream for mild eczematous otitis externa affecting the pinna
• Aluminium acetate is astringent and hygroscopic (absorbs water)
• Acetic acid has antibacterial activity and is available as a 2% pump-action spray for adults and children over 12 years old
• Use acetic acid spray 3-8 times a day until two days after symptoms disappear, for max 7 days
• Discontinue use and seek medical advice if symptoms do not improve within 48 hours of starting treatment

How to administer ear drops

• Warm drops slightly by holding in hands for a few minutes
• Patient lays on a flat surface with affected ear uppermost
• Lift auricle upwards and backwards in adults, downwards and backwards in children
• Instill drops
• Gently press tragus once or twice to assist drops down the ear canal
• Patient remains with head down for at least 5 minutes
• Place a cotton-wool plug moistened with drops into the ear

Minor Eye Conditions

• Conditions that can be treated with nonprescription medication include:
  • Bacterial and allergic conjunctivitis
  • Styes
  • Sore and tired eyes
  • Dry eyes
  • Blepharitis

Bacterial Conjunctivitis (Pinkeye)

• Infectious condition affecting one or both eyes
• Most often caused by Staphylococcus aureus
• Feels itchy or gritty with discharge
• Vision may be blurred due to discharge
• Viruses are also common causes of infective conjunctivitis
• OTC antibacterial treatment is considered appropriate, as it may prevent secondary bacterial infection

Styes

• Infection of the lash follicle of the eyelid
• Most commonly caused by S. aureus
• Creates pustules

Non-Pharmacological Therapy for Bacterial Conjunctivitis and Styes

• Warm compresses for 10-15 min 3-4 times daily for 2 days
• Hard boiled egg wrapped in a compress is a convenient method to apply heat to the eyelid

Tear Substitutes (Artificial Tears)

• Hypromellose, carmellose, polyvinyl alcohol, carbomer 940, sodium hyaluronate
• Hydrophobic ocular lubricants
• In severe cases, use oral pilocarpine, topical acetylcysteine, methylprednisolone, cyclosporine, and estradiol

Blepharitis

• Inflammation of the margins of the eyelids, often accompanied by crusting
• Many cases are unknown cause, but may be associated with seborrhoea
• Symptoms include: irritation and itching of the lid margin, foreign-body sensation, sandy or gritty sensation worse upon awakening

Non-Pharmacological Therapy for Blepharitis

• Melt solidified material in the gland through:
• Warm compresses for 5-10 min
• Gentle scrubbing with warm water and a commercial eyelid scrub (e.g Eye scrub®, lid-care® or Blepharoshampoo®)
• Drops of baby shampoo in warm water

Treatment for Blepharitis

• Topical antibiotics such as Bactracin and Erythromycin following eyelid cleansing
• Ointments on the lid margins are preferred to drops
• If associated with seborrhoea, treat the scalp with antidandruff shampoo containing pyrithione zinc, selenium sulphide or ketoconazole

Administering Eye Drops and Ointments

• Wash hands thoroughly
• Tilt head backwards
• Gently pull lower eyelid away from the eye
• Place dropper or ointment tube over the eye
• With drops:
  • Look up before applying
  • Look down after applying
  • Release eyelid slowly
  • Keep eyes closed for 1-2 minutes
  • Press over the opening of the tear duct
  • Blot excess liquid
• With ointment:
  • Insert ointment inside the lower lid
  • Release eyelid slowly
  • Keep eyes closed for 1-2 minutes
  • Blot excess ointment

Oral Thrush (Oral Candidiasis)

• Caused by Candida albicans
• Common in newborn babies
• Can also be contracted by users of inhaled corticosteroids or following antibiotic treatment
• May indicate reduced immune status
• Symptoms include: creamy white patches on the oral mucosa that are difficult to remove and may bleed

Treatment of Oral Thrush

• Miconazole oral gel is effective for infants and adults
• Refer patient to physician if:
  • Patient is an infant or elderly
  • History of receiving:
    • Broad spectrum antibiotics
    • Inhaled corticosteroids
    • Chemo- or radiation-therapy
  • Has:
    • Malignancy
    • Diabetes
    • Nutritional deficiency
    • Immunosuppression
    • Terminal illness

Prevention of Oral Thrush

• Prevent dry mouth
• Keep mouth clean, especially for denture wearers
• Rinse mouth with water after using inhaled corticosteroids and use a spacer

Canker Sore (Mouth Ulcers)

• Common condition of the oral mucosa
• Affects adults and children
• 75% of cases are minor aphthous ulcers that are self-limiting within 7-14 days
• Painful, shallow ulcers occurring singly or in groups on the tongue and mucosal surfaces
• The cause is unknown, but may be related to: stress, trauma, infection, vitamin B or iron deficiency, hormonal changes, drugs

Treatment of Canker Sores

• Treatment is symptomatic
• Anti-inflammatories (including corticosteroids) are most effective
• Wide range of products containing local anaesthetics, antiseptics and astringents are available
• Hydrocortisone sodium succinate is an effective treatment
• Benzydamine hydrochloride (NSAID) is available as an oral rinse and spray
• Chlorhexidine gluconate (antimicrobial) is also used

Referral to Physician for Canker Sores

• If sore is still there after 14 days
• If it has gotten larger or more have developed
• If pain is not controlled by medications
• If there is:
  • Fever
  • Pain in joints
  • Watery bowel movements
  • Irritated eyes
  • Difficulty in chewing or swelling

Test your knowledge on ear wax (cerumen) and otitis externa. This quiz covers the production, implications, and treatment of cerumen, as well as the causes and symptoms of otitis externa. Learn about the medical approaches to treating ear conditions effectively.