Otitis external notes

1. CONDITIONS OF THE EXTERNAL
EAR
MR C. KAFWANKA
RN/RTN/BSc.NRS

2. External ear infections
• Infection and inflammation of the external ear in
referred to as otitis externa.
• Being covered by the skin, the external ear is
liable to develop conditions just like those of any
other part of the body covered by the skin.
• These include fungal (otomycosis), psoriatic
(eczematoid) and bacterial.
• Common bacterial pathogens that cause otitis
externa are pseudomonal and staphylococcal
species.

3. Predisposing factors
• Common predisposing factors are:-
i. Swimming
ii. Forceful cleaning of the ear
iii. Trauma
iv. Poor hygiene

4. Clinical manifestations
The common clinical manifestations are;
• otorrhoea,
• erythema
• oedema.
• Fever
• Itching
• In severe cases, soft tissue stenosis may be
present.
• Pseudomonal infections produce green or yellow
purulent otorrhoea.

5. Management of external ear infection
• Patients are in most cases managed at OPD
• External ear infections require otoscopic
examination that must be performed in
conjunction with evaluation of related
structures such as the head and neck.
• For example, examine the auricle for swelling,
deformity, and erythema; the face for
evidence of facial nerve paresis or other
cranial neuropathy; and the neck for masses.

6. Cont’d
• Usually a history of preceding ear trauma in
the form of forceful ear cleaning, use of cotton
swabs, or water in the ear canal is important
and ensure that you take such history.
• History of severe throbbing pain with ear
discharge, this can lead to a hearing loss due
to occlusion of the ear canal.

7. Cont’d
Bacterial;
Cloxacillin 250mg – 500mg 6hrly for 5 days
Erythromycin 250mg – 500mg 6hrly for 5 days
Fungal;
Miconazole cream 2% topically twice daily
(continue applying until after 2 weeks when
symptoms clear).
Griseofulvin 500mg once daily P/O up to 2 weeks
after lesions disappear.

8. Cont’d
• Psoriatic;
Zinc oxide cream topically 1-3 times daily after
bathing
Hydrocortizone cream 1% topically twice daily
for 7 days and maintenance once or twice
weekly as required
• Maintain high standards of personal hygiene

9. IMPACTED EAR WAX
• Cerumen or ear wax is produced by glands in
the skin of the outer portion of the ear canal.
• Cerumen impaction, or impacted ear wax, is a
common phenomenon.
• It is the result of mixing skin cells of the outer
ear canal with glandular secretions that
protects the ear against infections by cleaning
and trapping dirt in the ear canal.

10. Cont’d
• Cerumen accumulation can occur if there is an
overproduction of ear wax in response to
infections or loud noise. The amount of ear wax
produced varies by individual. Some individuals
produce very little wax; others overproduce ear
wax to the point that blockage may occur.
• Cerumen normally works itself out of the ear;
however, there are situations when the wax
begins to plug up the outer ear canal resulting in
impaction.

11. Signs and symptoms
Individuals who have impacted ear wax often
complain of;
• hearing loss
• pain in the ear
• a ringing in the ear called tinnitus
• Cough
• vertigo
• itching of the ear.

12. Management
• Normally, ear wax is removed by cleansing the
ear. This is accomplished by wrapping a wet
cloth around the finger and washing around
the outer ear.
• In the case of cerumen impaction, the excess
ear wax may have to be softened using an oil-
based agent (ear drops wax softener), such as
baby oil or olive oil.

13. Cont’d
• Over the counter cerumen – removing agents
such as Debrox and Murine Ear Drops may
also be used in place of oil – based agents to
loosen the wax.
• Another low – cost method of removing ear
wax involves using a 3% Hydrogen Peroxide.
• However, these ear drops may cause irritation
to the ear and result in possible allergic
reactions.

14. IEC
• Excessive ear wax can be very embarrassing, and
can also cause many people to be a little hard of
hearing.
• Therefore, the following should be considered in
the I.E.C:
Do not use cotton swabs and other small objects
to remove earwax as they can cause earwax to
be pushed farther back in the ear, creating more
wax buildup and possibly hearing problems.

15. Cont’d
People should not aim at getting rid of all the
earwax as it protects the ear from infections.
Visit the clinic for ear examination at every 6 –
12 months.
Only use ear drops prescribed by a medical
personnel.
Ear syringing must be done only at the health
centre by a professional.

16. FOREIGN BODIES OF THE EAR
• Majority of objects found in ears are placed
there voluntarily, usually by children, for an
endless variety of reasons.
• A caregiver should not threaten a child when
asking about this possibility, because the child
may deny having put something in the ear in
order to avoid punishment.

17. Cont’d
• This denial could easily result in a delay of its
discovery and increase the risk of complications.
• Insects crawl into the ear, usually when one is
sleeping.
• Therefore, sleeping on the floor or outdoors
would increase the chance of this unpleasant
experience.
• The ear canal, where most objects get stuck, is
very sensitive.

18. Signs and symptoms
• The symptoms of having a foreign body in the ear
largely depend on the size, shape, and substance
involved.
• Occasionally, a foreign body in the ear will go
undetected and can cause an infection in the ear.
• Pain is the most common symptom.
• If the object is blocking most of the ear canal, the
patient may experience a decrease in hearing on
the affected ear.

19. Cont’d
• Ear irritation to the ear canal, this may cause
nausea and vomit.
• Bleeding is also common, especially if the
object is sharp.
• One of the most distressing experiences with
this problem is having a live insect in the ear.
• The insect's movement can cause a buzzing in
the ear and may be quite uncomfortable.

20. Medical/Surgical Care
• Where there is ear infection antibiotic ear drops
can be administered.
• Dripping mineral oil into the affected ear kill the
insect. This is safe as long as there is no hole in
the ear eardrum.
• Urgent removal is also recommended for food or
plant material (such as beans) because these will
swell when moistened.
• Urgent removal is indicated if the object is
causing significant pain or discomfort.

21. Cont’d
• Commonly used techniques include applying
gentle suction to the object, small forceps, or
instruments that have a loop or hook at the
tip are used.
• If the object is metallic, a long instrument may
be magnetized to assist in gently pulling the
object from the ear.
• Another common technique involves irrigating
the ear.

22. Cont’d
• If the eardrum appears intact, warm water can
be gently squirted past the object using a
small catheter as the water will turn around at
the end of the ear canal and often wash the
object out.
• A child with this problem may be sedated to
allow calm and comfortable removal of the
object.

23. ASSIGNMENT
• Draw and label the human ear