1. Ear Disorders Presented by Muhammad H. Shamim Doctor of Pharmacy Candidate 2005

2. Anatomy of the Ear

3. Pathophysiology Prone to moisture collection Ideal Environment for bacterial and fungal growth Loss of skin integrity breakdown of natural defenses.

4. Remember Eight Attributes While Assessing

5. Remember ! It is important to establish that the patient really is in pain and not just discomfort. The presence of severe pain requires referral in all cases Pain or Drainage from the ear may mean an infection, but pain in or around the ear isn’t always an infection from the middle ear

6. Assessing your Patient Do you have a fever? Do you have pain deep in the ear? Do you have thick drainage from the ear canal that started after pain? Do you have drainage from the ear canal, redness, swelling of the ear and the surrounding? Do you have pain behind your ear?

7. Assessment Continued… Tenderness when you touch the bone behind your ear? Pain when ear or ear lobe is pulled? Fluid in ear, or feeling of pressure or stuffiness that can’t be cleared by coughing, yawing, or swallowing? Tooth pain? Pain after airplane? Pimple in the ear? Child with hearing problem?

8. Differential Ear wax & excess water Water-clogged ear Otitis externa Otitis media Meniere’s disease Referred pain

9. Ear Wax Content Appearance Color

10. Functions of the Cerumen Lubrication Trapping Waterproof barrier Antimicrobial Inhibitory pH

11. Causes of excess wax Structure of the external auditory canal Abnormal cerumen production Impaction

12. Goal of Tx of excessive cerumen Softening Use of proper agent Use of safe agent Use of an effective agent Restore hearing loss and other associated symptoms

13. Remember No Q-tips Keys are for starting the car or for opening the doors only Pens and pencils are learning tools, not the cleaning tools

14. Types of Wax Removers Oil-based surface active agents Bubblers Urea and glycerol

15. Only FDA approved OTC for cerumen softening Carbamide peroxide 6.5 % in anhydrous glycerin Mode of action Who should use it? How often should it be used? When to refer to MD?

16. Other Products Commonly Used Glycerin Hydrogen peroxide Docusate sodium Remember that they are Not FDA approved and there is not enough data to say that they are more effective

18. Water-clogged ear Not the same as Swimmer’s Ear (Otitis externa) Some people are more prone to retaining water Signs and symptoms Treatment goals Exclude these before you recommend OTC

19. NonPhamacologic Therapy Tilting the effected ear Use of blow dryer

20. Pharmacologic Therapy Isopropyl alcohol 95% in anhydrous glycerin 5%...Only FDA approved therapy 50:50 mixture of acetic acid 5% (white vinegar) and isopropyl alcohol 95% why alcohol, glycerin, or acetic acid? Use of boric acid and precautions

21. Acute Otitis Externa (AOE) Also Called Swimmer’s Ear Combination of Inflammation and Infection Two Most Common Precipitants Common Symptoms What should be Avoided

22. Contribution of the Structure

23. Some Helpful Advices How to minimize dizziness Getting better absorption of the applied medication Cleaning and checking for inflammation

24. Otitis Media One of the most common childhood illnesses. Approximately $3 billion in healthcare costs were attributed to >5 million cases in 1995 Three out of 4 children experience ear infection (otitis media) by the time they are 3 years old. Acute otitis media Vs otitis media with effusion Most commonly reported symptoms

25. Meniere’s Disease How Common is the Disease Inner Ear Disorder Chronic Condition A typical Acute Attack Is there a Cure??

26. Hearing Impairment Statistic Hearing Loss is greater in men One in every ten (28 million) Americans has hearing loss. As baby boomers reach retirement age starting in 2010, this number is expected to rapidly climb and nearly double by the year 2030. Among seniors, hearing loss is the third most prevalent, but treatable disabling condition, behind arthritis and hypertension. Only 5% of hearing loss in adults can be improved through medical or surgical treatment.

27. Counseling Hearing-Impaired Patient Get the Pt’s Attention Before You Speak Do Not Put Obstacles in Front of Your Face No Chewing Gum Use Facial Expressions and Gestures Don’t Shout Be Patient, Relaxed, and Positive www.shhh.org

28. Instilling ear drops Washing hands before and after Avoiding dizziness Hold the dropper tip down all of the time Proper technique for adults and children

29. Summing Up Be aware of the common presentations of ear disorders Recognize when to treat and when to refer to GP Learn to properly counsel and relate to your patients Empathize Recognize the common barriers to counseling

30. Questions And Comments