Muhammad H. Shamim
Doctor of Pharmacy Candidate 2005
Anatomy of the Ear
• Prone to moisture collection
• Ideal Environment for bacterial and
• Loss of skin integrity
• breakdown of natural defenses.
• It is important to establish that the patient
really is in pain and not just discomfort.
The presence of severe pain requires
referral in all cases
• Pain or Drainage from the ear may mean
an infection, but pain in or around the
ear isn’t always an infection from the
Assessing your Patient
• Do you have a fever?
• Do you have pain deep in the ear?
• Do you have thick drainage from the ear
canal that started after pain?
• Do you have drainage from the ear canal,
redness, swelling of the ear and the
• Do you have pain behind your ear?
• Tenderness when you touch the bone behind
• Pain when ear or ear lobe is pulled?
• Fluid in ear, or feeling of pressure or stuffiness
that can’t be cleared by coughing, yawing, or
• Tooth pain?
• Pain after airplane?
• Pimple in the ear?
• Child with hearing problem?
• Ear wax & excess water
• Water-clogged ear
• Otitis externa
• Otitis media
• Meniere’s disease
• Referred pain
Functions of the Cerumen
• Waterproof barrier
• Inhibitory pH
Causes of excess wax
• Structure of the external auditory canal
• Abnormal cerumen production
Goal of Tx of excessive cerumen
• Use of proper agent
• Use of safe agent
• Use of an effective agent
• Restore hearing loss and other associated
• No Q-tips
• Keys are for starting the car or
for opening the doors only
• Pens and pencils are learning
tools, not the cleaning tools
Types of Wax Removers
• surface active agents
• Urea and glycerol
Only FDA approved OTC for
• Carbamide peroxide 6.5 % in anhydrous
• Mode of action
• Who should use it?
• How often should it be used?
• When to refer to MD?
Other Products Commonly Used
• Hydrogen peroxide
• Docusate sodium
• Remember that they are Not FDA
approved and there is not enough data
to say that they are more effective
• Not the same as Swimmer’s Ear (Otitis
• Some people are more prone to retaining
• Signs and symptoms
• Treatment goals
• Exclude these before you recommend
• Tilting the effected ear
• Use of blow dryer
• Isopropyl alcohol 95% in anhydrous
glycerin 5%...Only FDA approved therapy
• 50:50 mixture of acetic acid 5% (white
vinegar) and isopropyl alcohol 95%
• why alcohol , glycerin, or acetic acid?
• Use of boric acid and precautions
Acute Otitis Externa (AOE)
• Also Called Swimmer’s Ear
• Combination of Inflammation and
• Two Most Common Precipitants
• Common Symptoms
• What should be Avoided
Contribution of the Structure
Some Helpful Advices
• How to minimize dizziness
• Getting better absorption of the applied
• Cleaning and checking for inflammation
One of the most common childhood illnesses.
Approximately $3 billion in healthcare costs were
attributed to >5 million cases in 1995
• Three out of 4 children experience ear infection
(otitis media) by the time they are 3 years old.
• Acute otitis media Vs otitis media with
• Most commonly reported symptoms
• How Common is the Disease
• Inner Ear Disorder
• Chronic Condition
• A typical Acute Attack
• Is there a Cure??
• Hearing Loss is greater in men
• One in every ten (28 million) Americans has
hearing loss. As baby boomers reach retirement
age starting in 2010, this number is expected to
rapidly climb and nearly double by the year
• Among seniors, hearing loss is the third most
prevalent, but treatable disabling condition,
behind arthritis and hypertension.
• Only 5% of hearing loss in adults can be
improved through medical or surgical treatment.
• Get the Pt’s Attention Before You Speak
• Do Not Put Obstacles in Front of Your
• No Chewing Gum
• Use Facial Expressions and Gestures
• Don’t Shout
• Be Patient, Relaxed, and Positive
Instilling ear drops
• Washing hands before and after
• Avoiding dizziness
• Hold the dropper tip down all of the time
• Proper technique for adults and children
• Be aware of the common presentations of
• Recognize when to treat and when to refer
• Learn to properly counsel and relate to
• Recognize the common barriers to