DISORDERS OF THE EXTERNAL EAR
ORTITIS EXTERNA
Definition
Refers to an infection of the ear canal, the tube leading from the outside opening of the ear in towards the ear drum.
Pathophysiology
Is a painful condition caused when irritating or infective agents come into contact with the skin of the external ear.
The result is either an allergic response or inflammation with or without infection.
An inflammation and infection of the external auditory canal
Signs and symptoms
A discharge of liquid or pus from the ear
Ear canal -erythma and edema
Purulent exudate common
Pain, tenderness or pulling of the pinna, redness and itching of the skin lining of the ear
Some degree of temporary hearing loss
Causes
Polluted water
Mechanical trauma
Middle ear infection- discharge produced by an infection deeper in the ear can sometimes lead to otitis extena
Nursing care plan
Nursing interventions
Dry swabbing- this gentle mops out earwax from your ear canal
Gentle remove any discharge, earwax or debris from your outer ear using a twist of cotton wool
Warm the ear drops by holding them in your hands for a new minutes, as cold ear drops can make you feel dizzy
Teach the patient to avoid getting your affected ear wet
Give antibiotic ear drops-this can treat an underlying bacterial infection
Perichondritis
Definition
Inflammation of the perichondrium
Pathophysiology
Perichondritis is an infection of the perichondrium,a tough ,fibrous tissue layer that surrounds the cartilage and shapes the pinna
This tissue supplies blood to the ear cartilage.Infection can be caused by opening an area of pus or localized infections
Signs and symptoms
Derfomation of the ear structure (in severe cases)
Redness
Swelling of the pinna
Pain
Fever(in severe cases)
Abscess may be formed
Sudden hearing loss
Causes :
Trauma
Insect bites
Ear piercing through the cartilage
Systematic inflammatory conditions (eg.vasculitides,such as granulomatosis with polyangitis ,relapsing polychondritis)
Incision of superficial infections of the pinna
Poorly treated otitis externa(swimmer's ear
Nursing intervention
Inform the patient about the the disease process and possible outcomes
A wide incision is made and suction drainage is used to remove pus and other fluid
Always wash your hands
Application of soothing heat
Refer the patient to speech and hearing therapy if there is loss of hearing
Promote comfort,offer emotional support and involve the patient's family and significant others
Ear abscess/funculosis
Definition
This is a localised form of infection that usually occurs following the infection of a hair follicle
Pathophysiology
A boil, also called a furuncle, is a deep folliculitis, infection of the hair follicle. It is commonly caused by the bacterium staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue
Causes
The trauma that may be caused by pricking the ear with a sharp object e.g. match stick which causes break in the skin
Water may be trapped during swimming and may change the flora of the external canal to produce infection
The warm , dark environment of the ear canal provides good medium for the growth of macro-organisms.
Signs and symptoms
Bumpy, red, pus-filled lumps around a hair follicle
Severe pain and hearing loss
Fever
Swollen lymph nodes
Fatigue
Tender,warm, and very painful
Nursing interventions
Drainage
Administer antibiotics as prescribed according to the culture result
Wound care should be done
Relieve enxiety by explaining the disease process and outcomes
Cerumen imperfection
Definition
A condition in which earwax has become tightly packed in the external ear canal to the point that the canal is blocked
Pathophysiology
Cerumen is the most common cause of an impacted canal. A canal can also become impacted as a result of foreign bodies that can enter or be placed in the external ear canal.
Causes
Use of Q tips and other pins which remove superficial wax but also pushes the rest of the wax deeper into the ear canal
Hearing aid and earplug users are also more prone to earwax blockage
Signs and symptoms
Fullness in the ear with or without hearing loss
Ear pain
Itching
Dizziness
Bleeding from the ear
Tinnitus, which is a ringing or buzzing in the ear
Nursing interventions
Soften the ear wax by instilling prescribed drops
Teach a patient not to try and clean the ear with cotton wool buds, as it impact the wax further.
Teach the patient to avoid getting water into the ear during swimming
Assess the tympanic membrane perforation