#413: Common Ear Complaints, Ear Exam 101, Cerumen Remedies, and more! Get an EARful with Dr. Angela Peng!
Oct 23, 2023
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Dr. Angela Peng, an ENT expert, shares valuable insights on common ear complaints. Topics include ear exam skills, safely clearing earwax, Eustachian tube dysfunction, cholesteatoma, malignant otitis externa, and cerumen impaction. The episode also discusses itchy ears and open tympanic membrane treatments.
Thoroughly examine the ear, including outer ear, ear canal, and middle ear, for any abnormalities or signs of infection.
Consider the possibility of otitis externa in patients with outer ear complaints, especially in diabetic patients, and conduct a thorough evaluation to guide appropriate treatment.
Address Eustachian tube dysfunction by opening and stretching the muscles connected to the tube, and consider treatment options such as addressing sinus issues and using nasal sprays.
Deep dives
Approach to Ear Pain: Inner Ear Complaints
When a patient presents with ear pain, it is important to conduct a thorough examination of the ear, including the outer ear, ear canal, and middle ear. Look for any abnormalities or signs of infection, such as redness, swelling, or fluid. Consider other factors that could contribute to ear pain, such as sinus issues or throat infections. If no obvious ear problems are found, explore other potential causes, such as TMJ issues or referred pain from the throat. Referral to an ENT specialist may be necessary if the cause is unclear or if there are recurrent infections.
Approach to Ear Pain: Outer Ear Complaints
For patients with outer ear complaints, such as earache, itchiness, and decreased hearing, consider the possibility of otitis externa, especially in the presence of diabetes. The examination should focus on the ear canal, looking for swelling, redness, and discharge. Fungal infections, more common in humid environments, may present with friable skin, chunky debris, or hyphae. Malignant otitis externa, a severe infection that can involve the bone, should be considered in diabetic patients with significant pain. Thorough evaluation, including cultures, can help guide appropriate treatment.
Treatment Options for Otitis Externa
Treatment for otitis externa may include a combination of approaches. For mild cases, patients can use a mixture of rubbing alcohol and distilled white vinegar, which can be applied as a few drops after swimming. Over-the-counter drops containing antibiotics and steroids are commonly used, but the individual components can be purchased separately to decrease cost. Quinolones, like ofloxacin, can be used as an alternative, but using the ophthalmic formulation rather than the ear-specific product. It is important to note that eye drops can be used in the ear, but ear drops should not be used in the eye. Referral to an ENT specialist should be considered if symptoms persist or if there are severe infections or bone involvement.
Understanding Eustachian Tube Dysfunction
Eustachian tube dysfunction is explained using the analogy of plumbing, where blockage in the tube can cause fluid buildup in the ear. Opening and stretching the muscles connected to the tube can help alleviate the problem, such as chewing gum or swallowing. Diagnosis of Eustachian tube dysfunction involves examining the eardrum for signs of inflammation, negative pressure, or scarring. Treatment options include addressing sinus issues, using nasal sprays, and considering allergy shots.
Management and Prevention of Ear Wax and Ear Infections
To remove ear wax, mineral oil is recommended to loosen and help it naturally come out of the ear. Irrigation is discouraged due to the risk of water getting trapped behind the wax. Hydrogen peroxide and alcohol-based solutions are not as effective. For itchy ears, a mixture of fluocinolone oil can help with lubrication and anti-inflammatory effects. Prevention involves avoiding Q-tips and using mineral oil once a week to maintain ear cleanliness. Other common ear conditions and risks, such as barotrauma and dermatitis, are discussed.
Diagnosing and Treating Otitis Media and Other Ear-related Issues
Otitis media, including acute or chronic infections, is one of the common diagnoses for ear discomfort. Treatment involves appropriate antibiotics, topical drops, and nasal sprays to address inflammation and promote drainage. The use of ear drops containing acetic acid and hydrocortisone oil, or prescriptions like ofloxacin, may be effective. Ear irrigation and instrumenting the ear are advised against, especially for those with perforations. Tips for preventing ear wax buildup and managing itchy ears due to conditions like eczema are also provided.
Producer, Writer, Show Notes, Cover Art and Infographics: Isabel Valdez, PA-C
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
Reviewer: Leah Witt, MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Angela Peng, MD
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