CERUMEN IMPACTION

CERUMEN NORMALLY ACCUMULATES IN THE EXTERNAL CANAL IN VARIOUS AMOUNTS AND COLORS. ALTHOUGH WAX DOES
NOT USUALLY NEED TO BE REMOVED, IMPACTION OCCASIONALLY OCCURS, CAUSING OTALGIA, A SENSATION OF FULLNESS
OR PAIN IN THE EAR, WITH OR WITHOUTA HEARING LOSS. ACCUMULATION OF CERUMEN IS ESPECIALLY SIGNIFICANT IN THE
GERIATRIC POPULATION AS A CAUSE OF HEARING DEFICIT. ATTEMPTS TO CLEAR THE EXTERNAL AUDITORY CANAL WITH
MATCHES, HAIRPINS, AND OTHER IMPLEMENTS ARE DANGEROUS BECAUSE TRAUMA TO THE SKIN, INFECTION, AND DAMAGE
TO THE TYMPANIC MEMBRANE CAN OCCUR.

MANAGEMENT

CERUMEN CAN BE REMOVED BY IRRIGATION, SUCTION, OR INSTRUMENTATION. UNLESS THE PATIENT HAS A PERFORATED
EARDRUM OR AN INflAMED EXTERNAL EAR (IE, OTITIS EXTERNA), GENTLE IRRIGATION USUALLY HELPS REMOVE IMPACTED
CERUMEN, PARTICULARLY IF IT IS NOT TIGHTLY PACKED IN THE EXTERNAL AUDITORY CANAL. FOR SUCCESSFUL REMOVAL, THE
WATER STREAM MUST flOW BEHIND THE OBSTRUCTING CERUMEN TO MOVE IT fiRST LATERALLY AND THEN OUT OF THE
CANAL. TO PREVENT INJURY, THE LOWEST EFFECTIVE PRESSURE SHOULD BE USED. IF THE EARDRUM BEHIND THE IMPACTION
IS PERFORATED, HOWEVER, WATER CAN ENTER THE MIDDLE EAR, PRODUCING ACUTE VERTIGO AND INFECTION. IF
IRRIGATION IS UNSUCCESSFUL, DIRECT VISUAL, MECHANICAL REMOVAL CAN BE PERFORMED ON A COOPERATIVE PATIENT BY
A TRAINED HEALTH CARE PROVIDER. INSTILLING A FEW DROPS OF WARMED GLYCERIN, MINERAL OIL, OR HALFSTRENGTH
HYDROGEN PEROXIDE INTO THE EAR CANAL FOR 30 MINUTES CAN SOFTEN CERUMEN BEFORE ITS REMOVAL. CERUMINOLYTIC
AGENTS, SUCH AS PEROXIDE IN GLYCERYL (DEBROX), ARE AVAILABLE; HOWEVER, THESE COMPOUNDS MAY CAUSE AN
ALLERGIC DERMATITIS REACTION. USING ANY SOFTENING SOLUTION TWO OR THREE TIMES A DAY FOR SEVERAL DAYS IS
GENERALLY SUFfiCIENT. IF THE CERUMEN CANNOT BE DISLODGED BY THESE METHODS, INSTRUMENTS, SUCH AS A CERUMEN
CURETTE, AURAL SUCTION, AND A BINOCULAR MICROSCOPE FOR MAGNIfiCATION, CAN BE USED.

FOREIGN BODIES

SOME OBJECTS ARE INSERTED INTENTIONALLY INTO THE EAR BY ADULTS WHO MAY HAVE BEEN TRYING TO CLEAN THE
EXTERNAL CANAL OR RELIEVE ITCHING OR BY CHILDREN WHO INTRODUCE THE OBJECTS. OTHER OBJECTS, SUCH AS INSECTS,
PEAS, BEANS, PEBBLES, TOYS, AND BEADS, MAY ENTER OR BE INTRODUCED INTO THE EAR CANAL. IN EITHER CASE, THE EFFECTS
MAY RANGE FROM NO SYMPTOMS TO PROFOUND PAIN AND DECREASED HEARING.

MANAGEMENT

REMOVING A FOREIGN BODY FROM THE EXTERNAL AUDITORY CANAL CAN BE QUITE CHALLENGING. THE THREE STANDARD
METHODS FOR REMOVING FOREIGN BODIES ARE THE SAME AS THOSE FOR REMOVING CERUMEN: IRRIGATION, SUCTION, AND
INSTRUMENTATION.

THE CONTRAINDICATIONS FOR IRRIGATION ARE ALSO THE SAME. FOREIGN VEGETABLE BODIES AND INSECTS TEND TO SWELL;
THUS, IRRIGATION IS CONTRAINDICATED. USUALLY, AN INSECT CAN BE DISLODGED BY INSTILLING MINERAL OIL, WHICH WILL
KILL THE INSECT AND ALLOW IT TO BE REMOVED. ATTEMPTS TO REMOVE ANY FOREIGN BODY FROM THE EXTERNAL CANAL
MAY BE DANGEROUS IN UNSKILLED HANDS. THE OBJECT MAY BE PUSHED COMPLETELY INTO THE BONY PORTION OF THE
CANAL, LACERATING THE SKIN AND PERFORATING THE TYMPANIC MEMBRANE. IN DIFfiCULT CASES, THE FOREIGN BODY MAY
HAVE TO BE EXTRACTED IN THE OPERATING ROOM WITH THE PATIENT UNDER GENERAL ANESTHESIA.

EXTERNAL OTITIS

(OTITIS EXTERNA) EXTERNAL OTITIS,OROTITIS EXTERNA, REFERS TO AN INflAMMATION OF THE EXTERNAL AUDITORY CANAL.
CAUSES INCLUDE WATER IN THE EAR CANAL (IE, SWIMMER’S EAR); TRAUMA TO THE SKIN OF THE EAR CANAL, PERMITTING
ENTRANCE OF ORGANISMS INTO THE TISSUES; AND SYSTEMIC CONDITIONS, SUCH AS VITAMIN DEfiCIENCY AND ENDOCRINE
DISORDERS. BACTERIAL OR FUNGAL INFECTIONS ARE MOST FREQUENTLY ENCOUNTERED. (NERD)THE MOST COMMON
BACTERIAL PATHOGENS ASSOCIATED WITH EXTERNAL OTITIS ARE STAPHYLOCOCCUS AUREUS AND PSEUDOMONAS SPECIES.
THE MOST COMMON FUNGUS ISOLATED IN BOTH NORMAL AND INFECTED EARS IS ASPERGILLUS. EXTERNAL OTITIS IS OFTEN
CAUSED BY A DERMATOSIS SUCH AS PSORIASIS, ECZEMA, OR SEBORRHEIC DERMATITIS. EVEN ALLERGIC REACTIONS TO HAIR
SPRAY, HAIR DYE, AND PERMANENT WAVE LOTIONS CAN CAUSE DERMATITIS, WHICH CLEARS WHEN THE OFFENDING AGENT
IS REMOVED.

CLINICAL MANIFESTATIONS THE PATIENT USUALLY REPORTS PAIN, DISCHARGE FROM THE EXTERNAL AUDITORY CANAL,
AURAL TENDERNESS (USUALLY NOT PRESENT IN MIDDLE EAR INFECTIONS), AND OCCASIONALLY FEVER, CELLULITIS, AND
LYMPHADENOPATHY. OTHER SYMPTOMS MAY INCLUDE PRURITUS AND HEARING LOSS OR A FEELING OF FULLNESS. ON
OTOSCOPIC EXAMINATION, THE EAR CANAL IS ERYTHEMATOUS AND EDEMATOUS. DISCHARGE MAY BE YELLOW OR GREEN
AND FOUL SMELLING. IN FUNGAL INFECTIONS, THE HAIRLIKE BLACK SPORES MAY EVEN BE VISIBLE.

MEDICAL MANAGEMENT THE PRINCIPLES OF THERAPY ARE AIMED AT RELIEVING THE DISCOMFORT, REDUCING THE SWELLING
OF THE EAR CANAL, AND ERADICATING THE INFECTION.

PATIENTS MAY REQUIRE ANALGESICS FOR THE fiRST 48 TO 92 HOURS. IF THE TISSUES OF THE EXTERNAL CANAL ARE
EDEMATOUS, A WICK SHOULD BE INSERTED TO KEEP THE CANAL OPEN SO THAT LIQUID MEDICATIONS (EG, BUROW’S
SOLUTION, ANTIBIOTIC OTIC PREPARATIONS) CAN BE INTRODUCED. THESE MEDICATIONS MAY BE ADMINISTERED BY
DROPPER AT ROOM TEMPERATURE. SUCH MEDICATIONS USUALLY COMBINE ANTIBIOTIC AND CORTICOSTEROID AGENTS TO
SOOTHE THE INflAMED TISSUES. FOR CELLULITIS OR FEVER, SYSTEMIC ANTIBIOTICS MAY BE PRESCRIBED. FOR FUNGAL
DISORDERS, ANTIFUNGAL AGENTS ARE PRESCRIBED.

NURSING MANAGEMENT NURSES NEED TO TEACH PATIENTS NOT TO CLEAN THE EXTERNAL AUDITORY CANAL WITH COTTON-
TIPPED APPLICATORS, TO AVOID SWIMMING, AND NOT TO ALLOW WATER TO ENTER THE EAR WHEN SHAMPOOING OR
SHOWER

1800 UNIT 13 SENSORINEURAL FUNCTION

ING. A COTTON BALL CAN BE COVERED IN A WATER-INSOLUBLE GEL SUCH AS PETROLEUM JELLY AND PLACED IN THE EAR AS
A BARRIER TO WATER CONTAMINATION. INFECTION CAN BE PREVENTED BY USING ANTISEPTIC OTIC PREPARATIONS AFTER
SWIMMING (EG, SWIM EAR, EAR DRY), UNLESS THERE IS A HISTORY OF TYMPANIC MEMBRANE PERFORATION OR A CURRENT
EAR INFECTION.

MALIGNANT EXTERNAL OTITIS

A MORE SERIOUS, ALTHOUGH RARE, EXTERNAL EAR INFECTION IS MALIGNANT EXTERNAL OTITIS (IE, TEMPORAL BONE
OSTEOMYELITIS). THIS IS A PROGRESSIVE, DEBILITATING, AND OCCASIONALLY FATAL INFECTION OF THE EXTERNAL AUDITORY
CANAL, THE SURROUNDING TISSUE, AND THE BASE OF THE SKULL. (NERD)PSEUDOMONAS AERUGINOSA IS USUALLY THE
INFECTING ORGANISM IN PATIENTS WITH LOW RESISTANCE TO INFECTION (EG, PATIENTS WITH DIABETES). SUCCESSFUL
TREATMENT INCLUDES CONTROL OF THE DIABETES, ADMINISTRATION OF ANTIBIOTICS (USUALLY INTRAVENOUSLY), AND
AGGRESSIVE LOCAL WOUND CARE. STANDARD PARENTERAL ANTIBIOTIC TREATMENT INCLUDES THE COMBINATION OF AN
ANTIPSEUDOMONAL AGENT AND AN AMINOGLYCOSIDE, BOTH OF WHICH HAVE POTENTIALLY SERIOUS SIDE EFFECTS.
BECAUSE AMINOGLYCOSIDES ARE NEPHROTOXIC AND OTOTOXIC, SERUM AMINOGLYCOSIDE LEVELS AND RENAL AND
AUDITORY FUNCTION MUST BE MONITORED DURING THERAPY. LOCAL WOUND CARE INCLUDES LIMITED DÉBRIDEMENT OF
THE INFECTED TISSUE, INCLUDING BONE AND CARTILAGE, DEPENDING ON THE EXTENT OF THE INFECTION.

MASSES OF THE EXTERNAL EAR EXOSTOSES ARE SMALL, HARD, BONY PROTRUSIONS FOUND IN THE LOWER POSTERIOR BONY
PORTION OF THE EAR CANAL; THEY USUALLY OCCUR BILATERALLY. THE SKIN COVERING THE EXOSTOSIS IS NORMAL. MANY
PEOPLE THINK EXOSTOSES ARE CAUSED BY AN EXPOSURE TO COLD WATER, AS IN SCUBA DIVING OR SURfiNG. THE USUAL
TREATMENT, IF ANY, IS SURGICAL EXCISION. MALIGNANT TUMORS ALSO MAY BE FOUND IN THE EXTERNAL EAR. MOST
COMMON ARE BASAL CELL CARCINOMAS ON THE PINNA AND SQUAMOUS CELL CARCINOMAS IN THE EAR CANAL. IF
UNTREATED, SQUAMOUS CELL CARCINOMA MAY SPREAD THROUGH THE TEMPORAL BONE, CAUSING FACIAL NERVE
PARALYSIS AND HEARING LOSS. CARCINOMAS MUST BE TREATED SURGICALLY.
MANAGEMENT

IF THE CAUSE OF EXOSTOSIS IS A SURFERS EAR, A SURGEON CAN REMOVE THE BONE IN ORDER TO GIVE YOU MORE COMFORT
AND RESTORĒ HEARING.

GAPPING EARRING PUNCTURE

GAPPING EARRING PUNCTURE RESULTS FROM WEARING HEAVY PIERCED EARRINGS FOR A LONG TIME OR AFTER AN
INFECTION, OR AS A REACTION FROM THE EARRING OR OTHER IMPURITIES IN THE EARRING. ONE OR MORE GAPPING
PUNCTURES MAY RESULT FROM WEARING MORE THAN ONE EARRING. WHATEVER ITS CAUSE, THIS DEFORMITY CAN ONLY BE
CORRECTED SURGICALLY. THE EDGES OF THE PERFORATIONS ARE EXCISED ON THE LATERAL AND MEDIAL SURFACES OF THE
EARLOBE. NEXT, THE ENTIRE TRACT IS REMOVED, JOINING THE ABOVE TWO INCISIONS AND RESULTING IN A MUCH LARGER
DEFECT THAT IS CLOSED SEPARATELY ON EACH SURFACE. THEN, AN ANTIBIOTIC DRESSING IS APPLIED.

MANAGEMENT

 DEFORMITY CAN ONLY BE CORRECTED SURGICALLY.

 EDGES OF PERFORTIONS ARE EXCISED ON THE LATERAL AND MEDIAL SURFACES OF THE EARLOBE
 NEXT, ENTIRE TRACT IS REMOVED, JOINING THE ABOVE TWO INCISIONS AND RESULTING IN A MUCH LARGER DEFECT
IS DOSED SEPARATELY ON EACH SURFACE.
 ANTIBIOTIC DRESSING IS APPLIED.