Earwax: symptoms, Types, Diagnosis, management, Complications

Ear Wax:

 

Earwax is otherwise called as cerumen

 

1.     It is the soft, brownish, yellow, waxy secretion of the ceruminous gland of the external auditory means.

 

2.     It usually gets impacked due to use of Cotton swabs to clean ears, and may be a problem for some people while playing with sand.

 

Signs and symptoms:

 

1.     Cerimen usually builds up over period of time and causing slighty decreased hearing activity and feeling the ear is plugged.

 

2.     Pain severe and drainage may occur

 

Management :

 

1.     Accumulated cerimen (earwax) need not be removed unless it becomes impacked with hearing defict by irrigating ear canal.

 

2.     Foreign bodies may be removed by instrumentation or irrigation.

 

3.     Insects : Treatment by instilling oil drops

 

4.     Vegetable Foreign bodies (eg Peas): It can' t be removed by irrigation and it is removed skillfully with instruments

5.     If the victims very young general anesthesia is required.

 

6.     Teach proper ear hygiene especially not to put any thing in ears.

Ear Infections:

 

A. External Otitis Media:

 

Inflammation of the external ear is called external otitis media, which may involve the pinna and also the epidermal layer of tympanic membranes.

 

Types :

 

It can be divided into two types

 

1.     Acute external otitis media

 

2.     chronic external otitis media

 

Etiology :

 

1.     They are usually common in the summer and winter.

 

2.     It is caused by eczematous dermatitis fungus and bacterial infection. And also caused by trauma or the result of primary invasion of organism.

 

Sign and symptoms :

Acute E.O.M.

Feeling of hot burning sensation in the ear

Small amount of oozing will be present

Meatal line becomes inflamed and swollen

 

Chronic E.O.M

Severe itching due to irritated feeling

Oozing turns into crust.

Swollen meatus becomes dry and scally and has a feeling of impaired loss in hearing.

Management :

 

1.     Local treatment may include application of medication ointment or powders.

2.     Compresses to provide heat, soften crusts or supply medication. (Eg warm glycerin can be applied over swalling

 

3.     Cool application to lesson inflammation and relieve discomfort.

 

4.     Analgesics and antibiotic may also be ordered.

 

5.     Ointment is avoided with acute external otitis. Barrow' s solution (Aluminium aceste solution ) often is used for its astringent action which has cooling and sooring effect.

 

6.     In caring for person with either chronic or acute external otitis it is important to avoid further infection thus had washing is important.

 B.Serous Otitis Media

 

Inflammation of the middle ear. Serous (catarnal) otitis media is a condition in which serum is present in the middle ear and interferes with hearing.

 

Types:

 

They are two main types.

 

1.     Acute sapurative otitis media

 

2.     Chronic sapurative otitis media.

 

Etiology :

 

1.     Streptococous

 

2.     Pneumocous

 

Signs and symptoms :

 

1.     It may last for a few days or to years.

 

2.     The patient may complain of a sense of fullness or blockage in the ear.

 

3.     Hearing loss

 

4.     A low pinched tinnitus

 

5.     A severe ear ache

 

6.     Loss of appetite and Insomnia

 

Raise of body temperature

Treatment :

 

1.     Gentle aspirate the fluid and clean the ear

 

2.     Antipyretics, Antibiotics and analgesics are prescribed with multivitamin tables.

 

3.     Mild Sedatives and ear drops are administered.

 

C. Otosclerosis

 

Otosclerousis is a progressive condition in which the normal bone of the inner ear is replaced by abnormal osseous tissue leads to progressive deafness.

 

Etiology:

 

The cause of otosclerosis is not known as predisposing factors and are

 

1.     Hereditary

 

2.     Vitamin deficiency

 

3.     Calcium and metabolic disorders

 

4.     In some women pregnancy may be precipitating factor

 

Signs and symptoms:

 

1.     Deafness

 

2.     Trinities and depression

 

3.     Loss of appetite

 

4.     Patient hears better in noisy place

 

5.     Tympanic membrane will be bluish in colour

 

Management :

 

The Treatment for hearing loss due to otosclerosis is stapedectomy

 

Surgical management:

 

Surgery is for removing the stapes and replacing it with some types of prosthesis.

 

Nursing management :

 

Provide bed rest and reduce anxiety.

Administer, Analgesics, antibiotics, ant emetics and multivitamin tables as prescribed

 

Instruct the patient to keep the operated ear away from the bed side to prevent dislodgement.

 

Educate the patient not to blow the nose and prevent cold and cough, not to swimming and shampoo bath is avoided.

 

 D.Mastiditis

 

Inflammation of the mastoid results from the middle ear infection.

 

Signs and symptoms :

 

Severe pain, fever, headache, loss of weight Tenderness, swelling, insomnia, loss of apposite etc.

 

Management :

 

Surgical Management :

 

Mastoidectomy

 

Medical management :

 

Analgesics and antibiotics

 

Nursing management :

 

Same as post stapidectomy patient

Complication :

Meningitis

 

Facial palsy

 

Brain abscess

 

Hearing loss

E. Menier' s disease

 

It is an inner ear disease characterised by vertigo, dizziness and with pathological distension of endolympatic system.

 

Etiology :

 

The cause of menier' s disease is unknown. But it appears to be related to dysfunction of the autonomic nervous system.

Signs and symptoms:

 

i.       Severe vertigo some times unable cross the road.

 

ii.     Pain,  Headache, loss of hearing.

 

iii.  Sensation of dizziness severe tinnites (dinging sensation in the ears )

 

iv.  Nauses and vomiting and loss of appetite.

 

v.     May be irritable and shows loss of interest in activity

 

vi.  Profuse perspiration and nystagmus.

 

Investigation :

 

i.       Autoscope, Audiogram (Audiometry)

 

ii.     The Caloric test

 

iii.  The glycerin test (1.5ml / of glycard is mixed with equal amount of water and given to the patient. So that it reduce inflammation and it has dehydrating agent.

 

iv.  Electro nystagmography

 Management :

1. No medical treatment for menier' s disease has proved successful.

2. To reduce endolymphatic hypertension, fluid intake may be limited and diuretic drugs such as Diruil and Diamox may be ordered.

3. A low salt diet may be helpful.

4. Other medications include histamine

Surgical management :

1. Conservative : The tube is introduced to the labryinsh in to the endolymphatic sac to drain the excess endolympic fluid.

2. Destructive labynthectomy: In this the labyrinth is exercised and removed surgically.

Nursing care:

 

1.     Reassure the patient

 

2.     Give comfortable bed to prevent fall (put side rails)

 

3.     Monitor vital signs

4.     Assist the patient in all simple axes.

 

5.     Restrict the intake of sodium and water to reduce odema.

 

6.     Arrange for pleasant music to overcome tannitis

 

7.     Health education regarding

 

                                                             i.      Advise to stop smoking

 

                                                           ii.      Avoid allergic food

 

                                                        iii.      Intake the medicine is an appropriate way

 

                                                        iv.      Control of environmental factors.

 

8.     Follow up care.

General terms :  :  absence of odour of smell

Anosmia 

Hyperosmia  :  increased sense of smell

Hyposmedia  :  decreased sense of smell

Cachosmia  :  perspiration of bad odour

Perosmia  :  wrong odour

E. Tonsilitis:

 

It is an acute or generalized inflammation of the mass of the tonsil caused by straptococus or staphylococcus.

Etiology :

 

Caused by bacterial or viral organism

 

1.     It is common in children

 

2.     More among the person who' s resistance is low.

 

Signs and symptoms:

 

1.     Onset is Sudden

 

2.     Sorethroat pain on swallowing

 

3.     Fever, Chills generlised muscle acting a malaise.

 

4.     Tonsils appear red and peritonsillar tissue are swollen

 

Diagnosis:

 

1.     Throat examination and appropriate cultures to determine the presence of source of infection.

 

2.     Blood studies.

Management :

 

Pre-operative management :

 

a.     Adequate bed rest

 

b.     Diet should consist of large amount of fluids and

 

c.      Soft cool, non-irritating foods.

 

d.     Antibiotic penicillin should be given.

 

e.      Must be kept free from upper respiratory truck infections.

 

f.       Explain the procedure and keep nothing by mouth

 

g.     Discourage coughing

 

h.     Acetylsalisilic acid and sometimes iodine sulphate may be ordered to relieve pain and discomfort.

 

i.       Ice color may be applied to neck.

 

j.       If temperature 39oC - Alcholic sponge bath may be given.

 

Surgical management :

 

Chronic tonsillitis may lead to tonsillectomy

 

Indication for tonsilectomy :

 

Repeated attacks of tonsillitis

 

Paritonsillar  abcess (quinsy)

 

The sleep apnea syndrome

 

Post operative nursing care : -

 

Post operative care should be directed in preventing hemorrhage the most common complication.

 

The nurse must watch the vomiting substances, amount , frequency and nature of vomit.

 

The patient should be ensured for side lying position

 

Vital signs must be watched carefully.

 

Airway must be maintained because swelling may occlude it.

 

Fluid  must  be  encouraged  orally by swallowing  clear

fluids and straw should be privded.