Ear Disorders

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					    Ear Disorders
         Presented by
      Muhammad H. Shamim
Doctor of Pharmacy Candidate 2005
Anatomy of the Ear

• Prone to moisture collection
• Ideal Environment for bacterial and
  fungal growth
• Loss of skin integrity
• breakdown of natural defenses.
Remember Eight

Attributes While
              Remember !
• 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
  middle ear
     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?
    Assessment Continued…
• Tenderness when you touch the bone behind
  your ear?
• 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
          Ear Wax
• Content
• Appearance
• Color
     Functions of the Cerumen
•   Lubrication
•   Trapping
•   Waterproof barrier
•   Antimicrobial
•   Inhibitory pH
     Causes of excess wax
• Structure of the external auditory canal
• Abnormal cerumen production
• Impaction
Goal of Tx of excessive cerumen

•   Softening
•   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
•   Oil-based
•   surface active agents
•   Bubblers
•   Urea and glycerol
   Only FDA approved OTC for
       cerumen softening
• 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

•   Glycerin
•   Hydrogen peroxide
•   Docusate sodium
•   Remember that they are Not FDA
    approved and there is not enough data
    to say that they are more effective
        Water-clogged ear
• 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
  NonPhamacologic Therapy
• Tilting the effected ear
• Use of blow dryer
    Pharmacologic Therapy
• 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
               Otitis Media
    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
          Meniere’s Disease
•   How Common is the Disease
•   Inner Ear Disorder
•   Chronic Condition
•   A typical Acute Attack
•   Is there a Cure??
          Hearing Impairment
• 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.
  Counseling Hearing-Impaired
• 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
            Summing Up
• Be aware of the common presentations of
  ear disorders
• Recognize when to treat and when to refer
  to GP
• Learn to properly counsel and relate to
  your patients
• Empathize
• Recognize the common barriers to

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