ear we go! john davis rn, msn, fnp-bc. dark night, that does from the eye his function take, the ear...
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Ear we go!John Davis RN, MSN, FNP-BC
Dark night, that does from the eye his function take, the ear the better sense does
make.
-William Shakespeare
“A Midsummer Night’s Dream”
What is the smallest bone in the body?
How to Examine the Ear
O Use the largest speculum that will fit comfortably.
O Hold the otoscope with your thumb and fingers so that the ulnar aspect of your hand makes contact with the patient.
O Pull gently on the auricle/outer ear.O For children- apply traction down and
posterior on the helix/pinna to straighten the canal
O For teenagers/adults- apply traction up and posterior to straighten the canal
Examination of the Tympanic Membrane
O Vary light direction to observe entire membrane and annulus.
O Abnormal:O PerforationO Landmarks not visible
O Normal: O Visible umboO Handle or Manubrium of MalleusO Light reflex
TM Perforation
Note the color and translucency of the TM
O Shiny or Dull (retracted)O Normal is a pinkish/gray colorO BulgingO Red, inflammedO White scarring
Otitis ExternaO Also known as Swimmers Ear.O Caused by excessive moisture
carrying bacteria into the the cerumen of the ear canal, leading to maceration and inflammation.
O Causative organisms:O Pseudomonas species (most
common)O Staphylococcal speciesO Streptococcal speciesO Occasionally fungal infections
Otitis Externa
O Do not shove otoscope in.
O Oral antibiotics generally ineffective.
O Treatment:O Cortisporin Otic
Cerumen ImpactionO Can cause hearing
loss, pain or dizziness.
O Interferes with examination of the tympanic membrane.
O Prevention:O Avoid using cotton
swabs in the external auditory canal.
Cerumen ImpactionO To remove:
O Debrox- OTCO Colace- liquid 1cc 15-30 minutes
before irrigationO 3% Hydrogen Peroxide- fill ear
15-30 minutes before irrigation.O Mineral Oil- 3 drops in to the ear
at bed time for 3 or 4 days.O These treatments should be
avoided in anyone with a suspected breach of the tympanic membrane from previous surgery, insertion of myringotomy tubes, or tympanic membrane perforation.
O Am Fam Physician. 2007 May 15;75(10):1523-1528.
Otitis MediaO Inflammation of the middle earO #1 cause of antibiotic prescription for
children in the developed world.O Results from disruption of eustachian tube
patency.O Commonly after or during an upper
respiratory tract infection (cold)O Can be related to allergic rhinitisO Even positional changes can allow
nasopharyngeal flora to reflux through the eustachian tube and colonize in the middle ear.
Otitis MediaO Risk Factors
O AllergiesO Second hand smoke exposureO Age under 5O Not breastfeedingO Day care or in schoolO Downs syndromeO Cleft Palate
Otitis Media
Otitis MediaO Causes:
O 40-60% ViralO Serous Otitis Media/Otitis Media with Effusion
O Resolves in 4-6 weeksO Bacterial:
O Haemophilus influenzaeO Streptococcus pneumoniaeO Moraxalla catarrhalis
O Treatment:O Spontaneous clinical recovery is observed in more
than 70% of patients with acute otitis media.O Oral AntibioticsO Wait and see- depends on age of patient, medical
history, reliability of follow up.
What vaccine decreases the incidence of otitis media in children?
Eustachian TubeO One way flutter valve that is closed at rest.O Protects middle ear from sound and secretion
of nasopharynx.O Drains secretion from middle ear.O Ventilates middle ear to maintain near
ambient pressure.O When you swallow or yawn, the tubes open
briefly to let air in to make the pressure in the middle ears equal to the pressure outside of the ears.
O Sometimes fluid or negative pressure gets stuck in the middle ear. This causes ear pain and sometimes difficulty hearing.
Eustachian Tube Dysfunction
O Causes:O Cold, sinus
infectionO AllergiesO Changes in
elevation- flying, driving up or down a mountain
O Swimming/ scuba diving
O Pharyngeal flutter valve is held closed
O Treatments:O Yawn or chew
gumO Oral
antihistamine or Intranasal corticosteroid
O Oxymetazoline (Afrin)
O Oral Decongestants
MyringotomyO AKA TM TubesO Made of plastic, metal
or Teflon.O Procedure performed
for chronic / recurrent otitis media, especially if a speech delay is present.
O Usually not done after age 5 as most children will have wider and longer eustachian tubes, thus, allowing for better drainage of fluids from the ear.
Scarring on the Tympanic Membrane
CholesteatomaO Can be a birth defect, but more commonly a
complication of chronic ear infection.O Poor function in the eustachian tube leads to
negative pressure in the middle ear. O This pulls a part of the tympanic membrane
into the middle ear, creating a pocket or cyst that fills with old skin cells and other waste material.
O The cyst may get bigger and break down some of the middle ear bones or other structures of the ear, affecting hearing, balance, and possibly function of the facial muscles.
CholesteatomaO Treatment:
O Surgery to remove cyst.
MastoiditisO Infection of the bony
air cells in the mastoid bone, located just behind the ear.
O Rarely seen in children today because of the use of antibiotics to treat ear infections.
O Emergency treatment and hospitalization necessary because of proximity to the central nervous system.
Thank you!
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