Self Care of Otic Disorders

Epidemiology of Otic Disorders

• Ear disorders affect all ages : accounts for 1,5%
of ambulatory care visits per year
• FDA : Self care with non prescription drugs
should be restricted to external ear disorder
which include disorder of auricle (pinna) and
external auditory canal (EAC)
• EAC disorders : excessive/impacted cerumen
and water-clogged ears
• Cerumen impaction affect up to 10% of
children & more than 50% of elderly : hearing
loss in all ages
 Anatomy & Physiology of The Ear

Lobe
 Physiology of Hearing
• Perception and interpretation of sound depend on a
complex series of steps
• A malfunction at any step can result in some type of
hearing impairment.
 Age-Related Changes
• Skin of the auricle may become dry and wrinkled
• Cerumen production declines; protective wax is
drier
• Hairs in canal coarser/longer, especially in men
• Eardrum thickens; bony joints in middle ear
degenerate
• Degenerative changes: atrophy of the cochlea, the
cochlear nerve cells
• Type of hearing loss associated with age:
presbycusis
 The external ear
• Auricle :
Composed of thin layer of tighly vascular skin covers the
auricle : susceptible to bleeding (by scratch and highly
innervated– otalgia when inflammation
• Lobe : fewer blood vessels, composed of fatty tissue
• External ear canal (EAC) : outer cartilaguious portion, EAC
skin is thicker and contain apocrine & exocrine glands,
dark, warm, moist ideal for fungal & bacterial growth.
• Cerumen : oily secretions from exocrine glands mix with
the milky, fatty fluid from apocrine glands , contain
lysozymes, acidic pH – lubricates the canal, traps, waxy,
waterproof barrier to the pathogen
 Etiology of EAC Disorders :
Breakdown of EAC’s natural defenses
• Local trauma of fingernails, thermal injuries,
sport injuries, ear piercing
• Improperly cleaned ear molds
• Hearing aids
• Dermatologic skin disorders : contact
dermatitis, seborrhea, psoriasis and
malignancies
Excessive/Impacted Cerumen
 Etiology/Patophysiology of EIC
• Abnormally narrow/misshapen EACs
• Excessive hair growth in the canal/ overactive
ceruminous glands
• Hearing aids use, earplugs
• Older : atrophy of ceruminous glands : dried
cerumen –difficult to expel from the ear
Manifestation : inhibit the migration of
cerumen to the outer EACs
 Cerumen Impaction
• Wax is your friend
– Secreted by modified sweat glands
– Creates an acidic environment
– Traps dirt
– Self-cleaning mechanism
• Common condition
– 12 million US/yr
• Contributors
– Narrow ear canal
– Hearing aid use
– Dermatologic conditions
(seborrheic dermatitis, etc) Roland et al. Clinical practice guideline:
Cerumen impaction. Oto HNS 2008.
– Q-tip abuse
 Signs & Symptoms of EIC
• Sense of fullness/pressure in the ear
• Gradual hearing loss
• Dull pain – vertigo
• Tinnitus
• Chronic cough

• Note : Do not remove cerumen with cotton-

tipped applicator cause can force the cerumen
into the inner half of EAC
 Treatment of EIC
Treatment Goal
• Soften cerumen & remove using proper
methods and safe, effective agents
General Treatment Approach
• Gently irrigating ear using an otic bulb syringe
filled with warm water
 Non Pharmacologic Therapy
• Earwax should be removed only when it
migrated to the outer of EACs
• Use wet, wrung-out washcloth draped over a
finger : daily aural hygiene --but not effective if
cerumen becomes impacted
 Ear Candling
• “Complementary” or
“Alternative” medicine
• Used to treat a variety
of ear, nose, and head
complaints
• Meant to draw out the
disease
• Not recommended :
induce ear infection

Roland et al. Clinical practice guideline:

Cerumen impaction. Oto HNS 2008.
 Pharmacologic Therapy
• Carbamide peroxide 6,5% in anhydrous glicerin
 Made from hydrogen peroxide and urea (tissue
debridement) : break down mechanically and
loosen cerumen that exposed to moisture
 Form a nascent oxygen : acts weak antibacterial.
 Used twice daily for up to 4 days
 Side effects : pain, rash, irritation, tenderness,
redness, dizziness
• Mineral oil, olive oil, glycerin, docusate sodium
and dilute hydrogen peroxide
 Water Clogged Ear :
Retaining Water/Excessive Moisture
 Pathophysiology of Water-Clogged Ears

• The shape of the ear canals

• Presence of excessive moisture (cerumen
swell and trapping water) result from hot,
humid climates, sweating, swimming, bathing
• Improper use of aqueous solutions to cleanse
the ear.
 Clinical Presentation
• Feeling of wetness or fullness
• Gradual hearing loss
• Trapped moisture causing maceration , lead
itching, pain, inflammation infection
 Treatment Goals
• To dry using a safe and effective agent
• Prevent recurrence in persons who are prone
to retaining moisture in the ears
• Determine whether a patient has ruptured
tymphanic membrane or not
 Non Pharmacologic Therapy
• Expel excessive water from the ear by tilting
the affected ear downward ; after
swimming /bathing or during periods of
excessive sweating
• Using blow dryer on low setting (not directly
into) the ear immediately after
swimming/bathing
 Pharmacologic Therapy
• Isopropyl alcohol 95% in anhydrous glycerin 5%
• 50:50 mixture of acetic acid 5% and isopropyl
alcohol 95%
For use in adults and children ages 12 years
and older.
Used whenever ears are exposed to water
Medical referral is necessary if symptoms
persist after several days or infection symptoms
 Evaluation Of Patient Outcomes
Consult the primary care provider
• If the symptoms persist or worsen after 4 days
of proper treatment
• Ear pain of discharge develop during
treatment