Conditions of the Ear

TREATMENT—If the loss is the result of ex- cessive noise, a change of the working or living environment is indicated. Sound suppressors and hearing protection devices should be employed. If the loss is due to an underlying cause such as impacted cerumen or infection, treat the cause. Perforated Tympanic Membrane Although this condition may occur spon- taneously, it is normally a result of trauma. SYMPTOMS—There may be pain, discharge, hearing loss, and a blowing sensation in the ear. TREATMENT—If the perforation is small, no treatment is necessary. Unless the perforation is due to infection, do not instill medications in the ear. A light cotton pledget may be used to prevent dirt or water from entering the ear. For more serious perforations, refer the patient for treatment. Acute External Otitis (Swimmer’s Ear) This is an acute infection in the ear canal, which sometimes involves the auricle and often occurs after swimming. SYMPTOMS—There is usually severe pain and enlarged lymph nodes, and there may be a discharge. Fever is normally present. TREATMENT—Place a wick in the ear canal for 48 hours. The wick should be moistened with aluminum acetate solution every 3 hours. Follow- ing this, instill topical antibiotics and steroids. Treat other symptoms symptomatically. Aural Furunculosis This condition is the result of a furuncle involving the auricle and external ear canal. SYMPTOMS—Impaired hearing, feelings of fullness in the ear, swelling, pain, fever, redness, and lymphadenopathy are common. TREATMENT—Furuncles on the auricle should be treated in the same manner as furuncles elsewhere on the body (see Common Dermatological Conditions in this chapter). When the furuncle is in the external canal, insert a wick moistened with aluminum acetate solution into the ear canal. Application of heat packs may help to bring the infection to a point. I&D after fluctuation. Administer systemic anti- biotics. Otomycosis This is a fungous infection of the external ear resulting from poor hygiene, swimming, and favored by warm, moist climates. SYMPTOMS—These include itching, pain, a possible discharge, a stinging sensation, and the appearance of “salt and pepper” particles (i.e., dirty gray or black exudate resulting from pro- longed scratching). TREATMENT—Remove debris with a solu- tion of acetic acid and aluminum acetate. Dry the ear with alcohol, and perform a smear to identify specific fungus. Treat with the appropriate topical antifungal agent. Acute Otitis Media This is an infection of the middle ear that is usually the result of bacterial origin. It normally follows URI and is more common in children. SYMPTOMS—It is characterized by pain, deafness, fever, chills, and sensations of fullness or pressure. The tympanic membrane is red and bulging and rupture is common. Visualization of normal landmarks is impeded and often impossible due tos welling. Hearing tests show a conductive loss. TREATMENT—Administer decongestants to help promote drainage. Bed rest and analgesics are indicated. Start systemic anti- biotic therapy and maintain it until the eardrum appears normal and other symptoms subside. Labyrinthine Disease This is a suppurative inflammation of the inner ear that may be caused by chronic otitis media, allergies, trauma, blood dyscrasias, and cardiovascular disease. SYMPTOMS—These include deafness, tin- nitus, vertigo, nystagmus, nausea, vomiting, a staggering gait, and a tendency to fall toward the affected side. 2-19