Detection of Common Ear Diseases in the Community SH2030: Secondary Level Training Module.3.1

Objectives To sensitize the trainees regarding the common ear problems faced in the community and their causes. To understand the importance of common ear diseases. To inform them regarding suitable guidance to be given to patients with ear problems. For ease the lecture is divided into two parts: Part 1: dealing with various ear problems Part 2: Dealing with discharging ear SH2030: Secondary Level Training Module.3.1

Common ear problems Pain in the ear Discharge from the ear Heaviness/Blockage in the ear Itching in the ear Hearing Loss (discussed in next lecture) First ask the trainees regarding the ear problems that they have commonly faced within their community or at home and within their family SH2030: Secondary Level Training Module.3.1

Ear Pain Causes: Wax Impacted in the ear Acute infection of the outer part of the ear Acute Infection of the Ear drum and Middle part of the ear. Fluid in the ear Fungal infection of the ear Foreign body in the ear Injury over the ear SH2030: Secondary Level Training Module.3.1

Ear Wax Wax is a normal secretion of the ear. At times, it can accumulate and cause pain hearing loss Sensation of blockage wax is a normal secretion of the ear that can accumulate at times. This accumulation can occur because: certain persons tend to produce more wax than normal and this is not properly cleared out and accumulates. Other persons aid in the wax accumulation by using ear buds etc that pushes the wax deep inside and prevents it from getting cleared out. Alternate text for image: image shows the structure of the ear. The external canal is blocked by a ball of brown wax. SH2030: Secondary Level Training Module.3.1

Ear Wax No role for: Use of ear buds Putting oil in the ear Some amount of wax is normal. Excessive wax should be treated a doctor: Wax softeners (if impacted) to be given two-three times in a day and followed by wax removal No role for: Use of ear buds Putting oil in the ear Persistence of wax in the ear can cause problems as mentioned in the earlier slide, so wherever required, wax must be removed, by a doctor only. Stress to the trainees that the use of ear buds can cause actual harm to the ear. Putting oil in the ear can also be harmful. SH2030: Secondary Level Training Module.3.1

Syringing SH2030: Secondary Level Training Module.3.1 The image in this slide shows a technique known as syringing used by the ENT specialists to remove ear wax from the patients ears. In this technique the doctor injects water with high pressure into the patients ear to remove the wax particles. SH2030: Secondary Level Training Module.3.1

Acute Ear Infections Outer ear Ear drum & Middle ear Infection can involve the outer part of the ear or the middle part of the ear. Both the conditions are extremely painful and require urgent attention. Outer ear Ear drum & Middle ear SH2030: Secondary Level Training Module.3.1

Acute Ear Infections Acute infection of the ear can lead to: Pain in the ear Fever Tenderness on touching the ear a young child with severe ear pain may just cry incessantly and not even complain of ear pain. Early detection and treatment of the acute ear infection is very important. Image: a young girl crying in pain. SH2030: Secondary Level Training Module.3.1

Ear Infections SH2030: Secondary Level Training Module.3.1 These pictures are just meant to stress to the trainees that a normal ear drum (pic1)can become congested and bulge as shown in pics 2,3 . It can even rupture as shown in the last picture. The trainees are not going to be able to make this diagnosis on their own. The pics are only to stress the problem to them. SH2030: Secondary Level Training Module.3.1

If untreated, it can lead to: Rupture of the Ear drum which may cause permanent damage (permanent perforation & Chronic OM). It can lead to discharging ear. If the condition of acute ear infection remains untreated, it can lead to rupture of the ear drum which will cause ear discharge and hearing loss. The perforation in the ear drum may be permanent, at times. Alt text for image: Image 1 shows the structure of the ear. The ear drum and middle ear are red and inflammed. Image 2 shows the ear drum with a perforation in it. Early treatment of acute ear infection can save many children from developing Discharging ears. SH2030: Secondary Level Training Module.3.1

Injury over the ear Slaps over the ear Falls Injury over the ear Can lead to rupture of the ear drum. The Ear drum can be injured (or perforated) if a person falls on his ear or is hit over the ear. This can lead to rupture of the eardrum. This can be PREVENTED SH2030: Secondary Level Training Module.3.1

Foreign body in the EAC Common in children MUST BE REMOVED URGENTLY Educate the children NOT to put anything in their ears, nose or mouth. In case they do, send them to a doctor immediately The picture shows a presence of foreign body in the ear canal. SH2030: Secondary Level Training Module.3.1

Heaviness/Blockage in the ear: Glue Ear/Secretory Otitis Media Is a disease of the ear, wherein there is accumulation of sticky fluid in the middle ear. Image 1 shows the structure of the ear. The middle ear is filled with a fluid. Image 2 is a picture of the tympanic membrane. Fluid and air bubbles are visible behind it. SH2030: Secondary Level Training Module.3.1

Secretory Otitis media (Glue Ear) Such a child may complain of: - Occasional pain in the ear - Heaviness in the ear May have NO complaints, as there may be only mild hearing loss. But This can lead to: - Poor speech development in the child - Poor Performance in school Treatment required may be Medical or Surgical. It can be decided on examination by the doctor. SH2030: Secondary Level Training Module.3.1

Untreated OME Can lead to: Speech problems Poor performance in school Dull child If the child’s speech is not clear or he is not paying attention in school, one possible cause may be mild hearing loss due to OME. It MUST be ruled out. REFER Cartoon 1 in the slide depicts a child sitting silently and looking sad. and poor performance in school. Cartoon 2 shows a child being scolded by the teacher. SH2030: Secondary Level Training Module.3.1

SUSPECT OME if…. The child complains of persistent or recurrent pain or discomfort in the ear. Child is asking to raise the volume of TV etc. Child asks you to repeat your words again & again Child’s academic performance has gone down. Child is not developing clear speech. This slide only stresses the pints that have lready been told in the other slides. Tell them that: REFER all patients with suspicion of Secretory Otitis media to ENT hospital for: Hearing check up Test for confirmation of diagnosis Possible surgical treatment REFER SH2030: Secondary Level Training Module.3.1

Itching in the ear A very common problem in the community. It can be caused by fungal infections of the ear, common during rainy season. In case of persistent itching associated with discharge, pain: REFER for ear check up SH2030: Secondary Level Training Module.3.1