Phar 362 - Ear Disorders

Front 1

What are three tissue layers of the Auricle (Pinna)-Earlobe?

Back 1

1) Cartilage

2) Perichondrium

3) Thin Vascularized Skin

Front 2

Where is the tragus located?

Back 2

Auricle (Pinna) Earlobe

Front 3

What are the components of the External Auditory Ear Canal (Meatus)? (3)

Back 3

1) Skin lined cul-de-sac

2) Isthmus: narrowing of the canal

3) S-Shaped:

(Upward and backward traction for adults) (Downward and backward traction for Kids)

Front 4

What are the two parts of the External Auditory Ear Canal?

Back 4

1) Outer 1/3 - Mobile Cartilage

2) Inner 2/3 - Rigid Bone

Front 5

What is the normal pH of Cerumen (Earwax)?

Back 5

5.0-7.2

Front 6

What is the role of Cerumen (Earwax)?

Back 6

Lubricates skin and traps foreign material

Front 7

What are the conditions of the Auricle (Earlobe)? (5)

Back 7

1) Lacerations: Cuts and Scrapes

2) Hematomas: Painful Bruises

3) Frostbite: Damaged Blood Vessels [first appears white & hard then red & swollen]

4) Bacterial Infections

5) Dermatitis

Front 8

What are the conditions of the External Auditory Canal? (5)

Back 8

1) Impacted Cerumen

2) Furunicles (Boils)

3) Acute Otitis Externa

4) Malignant Otitis Externa

5) Acute Otitis Media

Front 9

What is a Hematoma of the Auricle (Earlobe)?

Back 9

Accumulation of blood or serous fluid between cartilage and perichondirum

Front 10

"If hematoma of the Auricle(Earlobe) is not aspirated then it can result in _____"

Back 10

Cauliflower Ear

Front 11

What are the different types of Dermatitis of the Auricle (Earlobe)? (3)

Back 11

1) Seborrheic Dermatitis (yellow greasy scales)

2) Allergic (Atopic/Contact) Dermatitis (small, red itchy weeping lesions)

3) Psoriasis (Silver Scales on pink-red base)

Front 12

What are the risk factors of Impacted Cerumen? (4)

Back 12

1) Excessive secretions of ear

2) Abnormal shaped ear canal

3) Mixture of long hairs

4) Use of cotton tipped applicators

Front 13

What are the risk factors of Acute Otitis Externa? (4)

Back 13

1) Trauma

2) Diabetes

3) Dermatitis

4) Prolonged exposure to water

Front 14

What are the risk factors of Malignant Otitis Externa? (3)

Back 14

1) Elderly

2) Diabetes

3) Immunocompromised

Front 15

What is the general name of "Acute Otitis Externa" ?

Back 15

"Swimmer's Ear"

Front 16

What are the symptoms of Impacted Cerumen? (3)

Back 16

1) Fullness

2) Deafness

3) Tinnitus

Front 17

What are the symptoms of Furuncles (Boils)? (2)

Back 17

1) Pain exacerbated with chewing

2) Hearing may be impaired

Front 18

What are the symptoms of Acute Otitis Externa? (6)

Back 18

1) Pain (otalgia) (worse when moving ear)

2) Itching/Pruritis

3) Fullness

4) Otorrhea (discharge)

5) Swollen Ear Canal

6) Los of Hearing

Front 19

What are the symptoms of Malignant Otitis Externa? (2)

Back 19

Same as Acute Otitis Externa.

1) Fever

2) Pain in bone and movement

Front 20

What are the symptoms of Acute Otitis Media? (3)

Back 20

1) Eardrums are red, bulging /perforated

2) Fever

3) Hearing is always decreased

Front 21

What are the associated seasons of Acute Otitis Externa?

Back 21

Summer (because of more common swimming)

Front 22

Does Acute Otitis Externa have pain on movement of Tragus?

Back 22

yes

Front 23

Is the Ear Canal swollen with Acute Otitis Externa?

Back 23

Swollen

Front 24

How does the Eardrum present with Acute Otitis Externa?

Back 24

Normal (maybe slightly red)

Front 25

Is there discharge with Acute Otitis Externa?

Back 25

Yes (pus and other stuff)

Front 26

Are Nodes present with Acute Otitis Externa?

Back 26

Frequent

Front 27

Is Fever present with Acute Otitis Externa?

Back 27

No

Front 28

Is hearing impaired with Acute Otitis Externa?

Back 28

Normal (sometimes impaired)

Front 29

What are the associated seasons of Acute Otitis Media?

Back 29

Winter (because usually follows viral infections)

Front 30

Does Acute Otitis Media have pain on movement of Tragus?

Back 30

No

Front 31

Is the Ear Canal swollen with Acute Otitis Media?

Back 31

Normal

Front 32

How does the Eardrum present with Acute Otitis Media?

Back 32

Red, Bulging or Perforated

Front 33

Is there discharge with Acute Otitis Media?

Back 33

Not Normally (only if perforated)

Front 34

Are Nodes present with Acute Otitis Media?

Back 34

Less Frequent

Front 35

Is Fever present with Acute Otitis Media?

Back 35

Yes

Front 36

Is hearing impaired with Acute Otitis Media?

Back 36

Always decreased

Front 37

What are the appropriate questions to assess a given patient's ear problem? (9)

Back 37

1) Do you have an earache? (how long, pain, what makes it worse)?

2) Have you had a cold or flu?Fever?

3) Have you been swimming in the past few days or tried to clean your ears?

4) Have you travelled in an airplane recently? 5) Do you have ear discharge? How does it appear?

6) Is your ear itchy?

7) Are you taking any medications?

8) What medical conditions do you have?

9) What have you done to treat the symptoms

Front 38

When do you refer ear conditions to a physician? (11)

Back 38

1) Hematoma on Auricle

2) Fever

3) Discharge

4) Bacterial Infections

5) Malaise

6) Progressing Ear Pain/Severe stabbing pain

7) Furnucles (boils)

8) Bleeding 9) Hearing Loss

10) Loose Dentures 11) Itchy/Redness

Front 39

What is the recommended treatment plan for Lacerations of Auricle?

Back 39

No treatment needed, because heals spontaneously with good blood supply

Front 40

What is the recommended treatment plan for Hematomas of Auricle?

Back 40

Refer to MD for drainage

Front 41

What is the recommended treatment plan for Frostbite of Auricle?

Back 41

Warm the area and then follow with cool compress (repeat multiple times).

Front 42

What is the recommended treatment plan for Perichondritis of Auricle?

Back 42

Refer to MD for Antibiotics and Drainage

Front 43

What is the recommended treatment plan for Furnucles (Boils) of Auricle?

Back 43

1) Treat with hot compress

2) Lidosporin can be given for pain

3) Refer to MD for Antibiotics and Drainage

Front 44

What is the recommended treatment plan for Seborrhetic Dermatitis of Auricle?

Back 44

Head and Shoulders Shampoo

Front 45

What is the recommended treatment plan for Atopic Contact Dermatitis of Auricle?

Back 45

Hydrocortisone 1/4 -1% Cream

Front 46

What is the recommended treatment plan for Psoriasis of Auricle?

Back 46

Hydrocortisone 1/4 - 1% Cream

Front 47

What is the recommended treatment plan for Impacted Cerumen of Auricle?

Back 47

1) Solvents (e.g. Olive Oil, Mineral Oil, Hydrogen Peroxide) used BID for 2-3 days before syringing (pre-syringing)

2) Syringing ear canal by trained personnel (don't aim at center of canal)

3) Cerumenex (equally as effective as olive oil)

Front 48

What is the recommended treatment plan for General Otitis Externa?

Back 48

1) Cleanse Ear Canal: Irrigate with warm water, cotton wick soaked w/Burrows solution drops q3hrs to keep moist

2) Relieve Pain: Oral Acetaminophen, ASA, Ibuprofen. OR Local Heat & Hygroscopic Vehicles (e.g Glycerin) {Avoid Swimming for 7-10 days}

Front 49

What is the recommended treatment plan for Bacterial Otitis Externa?

Back 49

1) Antibacterial Ear Drops [Acetic Acid, Gramicidin, Polymyxin B] (2-4 gtt TID-QID x7-14 days)

2) Corticosteroids are used when there is excessive swelling

{Should see effect in 2-3 days, stop if no resolution by 7th day}

Front 50

What is the recommended treatment plan for Fungal Otitis Externa?

Back 50

1) Clotrimazole 1% Solution

2) Vosol

3) Salicylic Acid 2% in Alcohol

4) Locacorten -Vioform

[BID x 7days]

Front 51

What is the recommended treatment plan for Viral Otitis Externa?

Back 51

1) Keep Canal Dry

2) Anesthetic Ear-drops may provide some relief (DOC is Lidocaine)

Front 52

What are some complications of Otitis Externa? (5)

Back 52

1) Cellulitis

2) Perichondritis

3) Nectrotizing Otitis Externa (i.e. Malignant OE) in Diabetic

Front 53

What should you do if a Diabetic patient comes in with Swimmer's Ear?

Back 53

They require prescription antibiotics and close monitoring

Front 54

What are the non drug measures for Acute Otitis Externa? (5)

Back 54

1) Avoid using cotton swabs, hairpins in ear canal

2) Avoid getting water into ear canal

3) Cleanse Ear Canal: Irrigate with warm water, 4) Cotton wick soaked w/burrows solution q3hrs to keep moist

5) Local Heat & Hygroscopic vehicles

Front 55

What are the common antibacterials used for Ear infections? (4)

Back 55

1) Polymyxin B Sulfate + Gramicidin

2) Aluminum Acetate (I.e. Burrows Solution) [1:20 - 1:40 astringent]

3) Acetic Acid 1-5% (Household Vinegar 5%)

4) Propanediol Diacetate (Acetic Acid + Propylene Glycol)

Front 56

What are the common Analgesics/Local Anesthetics used for Ear Infections? (3)

Back 56

1) Lidocaine 1-5% (Amide Type)

2) Benzocaine (Ester Type)

3) Antipyrine (Auralgin)

Front 57

"Antipyrine (Auralgan) is not used in anything else other than Otic products due to systemic toxicity issues" True or False?

Back 57

TRUE

Front 58

What are the common Cerumenolytics used to remove Ear Wax? (3)

Back 58

1) Hydrogen Peroxide 3% mix 1:1 with water-mechanical cleansing with O2

2) Carbamide Peroxide 6.5% (urea + hydrogen peroxide)

3) Triethanolamine Polypeptide Oleate Condensate 10%

Front 59

What are the common Humectants & Solvents for Ear Conditions? (2)

Back 59

1) Glycerin: Prevents Bacterial Growth by absorbing moisture from mucous membranes

2) Propylene Glycol: Good inhibitor of mold growth and is useful for poorly water soluble drugs

Front 60

What are the common Emollients used to soften Ear Wax? (3)

Back 60

1) Olive Oil

2) Sweet Almond Oil

3) Urea 5%

Front 61

Which products can cause ringing ears(i.e.Ototoxic Drugs) ?

Back 61

Salicylates, Furosemide, Aminoglycosides, Quinine, Alcohol, Nicotine

Front 62

What are the advantages of 2% Acetic Acid Solution?(3)

Back 62

1) Inexpensive

2) effective against most infections

3) without causing sensitization

Front 63

What are the advantages of Neomycin Otic Preperations?(2)

Back 63

1) Effective

2) Inexpensive

Front 64

What are the advantages of Polymyxin B alone?(1)

Back 64

1) Avoid potential neomycin sensitization

Front 65

What are the advantages of Aminoglycoside Ophthalmic Solutions?(1)

Back 65

1) Less locally irritating than 2% acetic acid solution, neomycin or polymyxin B alone

Front 66

What are the advantages of Quinolone Otic and Ophthalmic Solutions?(3)

Back 66

1) Highly effective without causing local irritation or sensitization.

2) No risk of ototoxcitiy.

3) Only twice daily dosing.

Front 67

What are the disadvantages of 2% Acetic Acid Solution?(2)

Back 67

1) Can be irritating to inflamed external auditory canal;

2) possibly ototoxic

Front 68

What are the disadvantages of Neomycin Otic Preparations?(2)

Back 68

1) Can be a potent sensitizer, causing contact dermatitis in 15% of patients.

2) Ototoxic.

Front 69

What are the disadvantages of Polymyxin B alone? (1)

Back 69

1) No activity against Staphylococcus and other gram positive microorganisms

Front 70

What are the disadvantages of Aminoglycoside Ophthalmic Solutions?(2)

Back 70

1) Potential ototoxicity.

2) Moderately expensive.

Front 71

What are the disadvantages of Quinolone Otic and Ophthalmic Solutions? (3)

Back 71

1) Expensive.2) Increased Community exposure of an important class of antibiotics. 3) Potential for causing resistance.