Ear Wax and Otitis Externa Quiz

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

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

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

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

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

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

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

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

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

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

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

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

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 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