1 / 22

Blocked or painful ears Wax and otitis media

Blocked or painful ears Wax and otitis media. Mike Smith ENT Consultant Hereford County Hospital and Worcester Royal Hospital UK. 2009. Ear canal: 2-3cm long. Cerumen In hair follicles. Thin sweat like secretion. Long coiled tubes with muscle walls.

arama
Download Presentation

Blocked or painful ears Wax and otitis media

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Blocked or painful earsWax and otitis media Mike SmithENT ConsultantHereford County HospitalandWorcester Royal Hospital UK 2009

  2. Ear canal:2-3cm long

  3. CerumenIn hair follicles.Thin sweat like secretion.Long coiled tubes with muscle walls. SebumIn hair follicles.SecreteOily fluid. Epithelial debris HairsShed, and mat with secretions. Dust, sand, f.b.’s etc What is wax?

  4. Waterproofing layer Protective layer from trauma Cleansing by migration outward with dust, foreign material (e.g. sand, grommets) Acid pH is antiseptic Contains antibacterial agents Functions of wax

  5. Canal Skin Migration • Squamous epitheliumand keratin / dead skinMoves from drum centre along canal to meet the secretions in outer canal • Keratosis ObturansFailure of migration. Epithelial build up and canal expansion. Rare.

  6. Health education • Harmful :ScratchingCotton buds(‘Nothing smaller than elbow’) • False :‘Wax is dirty and must be removed’‘Wax often causes reduced hearing’ • Ear ‘candling’ and other gadgets

  7. Hearing lossNon-obstructivewax (no loss)Apparent total obstruction (hearing loss 5dB)Totally obstructedcanal (conductive hearing loss 45dB) Otitis ExternaDamp, itchy Hearing aid Problems with wax?

  8. Treatment options • Solvent drops • Manual Syringe • Electric pulsed irrigation • Aural speculum and loops/hooks • Microscopic suction

  9. Effectiveness ?Exterol ++++Cerumol +++Oil ++Waxsol ++Bicarbonate + Cost Irritation Wax Solvent Drops

  10. Ear Syringing • MethodSolvent beforehandStraighten canal (Pull up and back)Water at 37-38 deg. CBrace nozzle with hand on headPoint syringe up and back • After syringingcheck canal/drum (Dr?)

  11. Indications for syringing • Total occlusion • Examination of obscured tympanic membrane • Otitis Externa ( if other cleansing not available) • Foreign body

  12. Contra-indications to syringing • Normal wax (be more selective of patients) • Past ear disease or surgery (thin drum) • Perforation(may force debris into middle ear, dislocate ossicle, damage oval/round window, or infect middle ear) • Only hearing ear(no risks) • Recurrent Otitis Externa(keep dry) • Anti-coagulant(care to avoid trauma) • Vegetable f.b.’s(swell)

  13. Perfs and pockets

  14. Risks of syringing • Complications requiring specialist referral in 1:1000 e.g. pain, dizziness, bleeding, infection, perforation, tinnitus, hearing loss

  15. Rupture of ear drum by syringingStudy by Sorenson et al 1995 • Tested on 10-48 hr post mortem cadavers • Large variations in pressure needed to rupture, but well above that generated by syringing (if TM not atrophic)

  16. Otitis externaprompt treatmentrefer if canal occluded by debris or oedema Perforationspecialist referral(it usually heals) Canal wall bleedingbicarbonate dropsfollow up to ensure clot clears Acute sensori-neural hearing loss or vertigoUrgent referral Refer early if in any doubt. Do not blindly reassure the patient, check Treatment of complications

  17. Acute Otitis Media • Acute otitis media<3yrs-70% at least one episode • VarietiesAOM with dischargeAOM with complicationsResistant AOMRecurrent AOMAOM on ME EffusionChronic MEE/Glue ear • TreatmentAnalgesiaAntibiotics?Prophylaxis?GrommetsAdenoidectomyPrevention: parental smoking, pre-schoolRhinitisImmunity

  18. Grommet With Discharge • Grommets/T-tubesCommonest operation~20% discharge • AcuteOrganisms same as AOM • ChronicOften Pseud. Or Staph.Biofilms? • Treatment Oral antibiotic? Drops? Water prevention? Tube removal? Adenoids Allergy Immunity IV antibiotics Surgery

  19. Ear drops and ototoxicity • Ototoxicity Ototoxicity of the infection itself. Inflammation acts as barrier to RW membrane. Vestibulo-toxicity also an issue. Familial trait / genetic susceptibility. Use endorsed for infected perfs by Am. Acad. of ORL, H & N and ENT-UK Alternatives (ciprofloxacin unlicensed as ear drop in UK so far, but widely used)

  20. Complications of AOM • Perforation and otorrhoea • Hearing loss • Glue ear • Mastoiditis • Facial palsy • Meningitis • Chronic Suppurative Otitis Media (CSOM)

  21. CSOM • MucosalSafe?Active/InactiveDischarge character • TreatmentNoneMedicalSurgical SquamousPockets/atelectasisCholesteatomaDischarge character TreatmentStable pocketUnstable pocketEstablished cholesteatoma

  22. Thankyou

More Related