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November 23, 2020 09:45pm
This is the time of year when more patients present with vagueâ€”and annoyingâ€”otic complaints.
This is the time of year when more patients present with vague—and annoying—otic complaints. They use words like clogged, blocked, popping, or wet, and also may report noises in their ears or hearing loss. These symptoms indicate eustachian tube issues. In addition, earwax buildup in the external auditory canal or foreign bodies in the ear can cause fullness, fluid sensations, or unusual noises.
Cerumen (earwax) buildup is easy to identify with an otoscope. Retail healthcare providers have several options for removing cerumen. Softening the cerumen with ceruminolytic drops is a first step. Carbamide peroxide is generally the go-to earwax softener. Used twice daily for up to 4 days, it's a combination of hydrogen peroxide and urea, and it effervesces to break down cerumen mechanically. Mineral oil, olive oil, docusate sodium, glycerin, sodium bicarbonate, dilute hydrogen peroxide, and many alternative or complementary products are also marketed as cerumen-softening agents.
Once the cerumen is soft, healthcare providers can irrigate the ear. Most clinicians use sterile water (not tap water) with some peroxide warmed to body temperature, but if the patient is immunocompromised, plain sterile water is preferred. Place a disposable collection tray under the ear. Using a 20- to 30-cc syringe for children or a 50- to 60-cc syringe for adults, apply slow, gentle pressure on the syringe plunger. Direct the liquid stream at the roof or side wall of the canal. This reduces pressure on the tympanic membrane. The irrigation fluid will carry loose earwax into the collection tray.
After irrigating, dry the ear carefully using a wash cloth, and examine it for trauma. The ear canal will usually look red or inflamed due to irrigation, the syringe, or the patient's previous manipulations to remove wax. If the skin becomes abraded, it creates a potential risk for infection. If the ear canal is excoriated, instilling antibiotic drops for 3 to 5 days will prevent infection.
Retail healthcare providers should avoid ear canal irrigation if they see or suspect tympanic membrane perforation; the patient has a myringotomy tube, a previous tympanic membrane rupture, or a history of ear surgery; the presence of foreign bodies (beans, peas, hearing aid batteries); or purulent exudate in the canal.
The ear canal's shape or excessive cerumen can trap water in the external auditory canal. Excessive sweating, swimming, and high humidity also increase the likelihood of water in the ears. Water can also build behind hearing aids and earpieces. Patients report a wet feeling or fullness in the ear. Untreated, water accumulation can cause tissue maceration, leading to inflammation and infection of the external auditory canal (external otitis media, or swimmer’s ear).
Several OTC products contain the FDA-approved ingredients isopropyl alcohol 95% in anhydrous glycerin 5% for patients 12 years and older (and note that the FDA prohibits OTC manufacturers from labeling nonprescription medicinals as preventive). In addition, some clinicians recommend a 50:50 mixture of acetic acid and isopropyl alcohol 95% to help dry water-clogged ears.
Nonpharmacologic measures often work well. Suggest patients tilt the affected ear to drain excess water, or use a hair dryer on the low setting to dry the ear canal. Patients should be advised, however, never to blow air directly into the ear canal. People who swim often might find Mack’s Ear Dryer (McKeon Products, Inc) helpful.
Pressure problems are usually related to the eustachian tube and a pressure differential. This condition is called baropressure or barotrauma. Most people experience air pressure differences during altitude changes (eg, in airplanes, while scuba diving). The middle ear, an air-filled chamber, is connected to the back of the nose via the 1.5-inch eustachian tube. Under normal conditions, the inner ear adjusts its pressure every time a person swallows, yawns, or blows his nose, and patients may intuitively use these to relieve pressure. In addition, chewing gum can often relieve pressure.
Anything that causes havoc in or near the eustachian tube can cause hearing changes. When patients report barotrauma, which can be very uncomfortable and at times painful, the best approach is to look for an underlying cause. Medical causes include enlarged adenoids, tumors, inflammation, allergies, and the common cold.
Often, decongestants or antihistamines can restore balance to the eustachian tube.
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