AIMS For the practitioner to be able to confidently carry out ear examinations recognise abnormalities and to carry out appropriate ear care Objectives To enhance understanding of basic anatomy and physiology of the ear ID: 537744
Download Presentation The PPT/PDF document "Ear care workshop" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Ear care workshopSlide2
AIMS
For the practitioner to be able to confidently carry out ear examinations, recognise abnormalities and to carry out appropriate ear care.Slide3
Objectives
To enhance understanding of basic anatomy and physiology of the ear.
Ear examination
To recognise abnormalities and associated care
Theory behind
cerumen
removal and associated guidelines
To reflect on accountability, documentation
Practical session Slide4
Basic anatomy and physiology
of ear
Outer (External) ear
Pinna and external acoustic canal.
Canal lined with small hairs next to which are small
ceruminous
glands
The Tympanic MembraneSlide5
MIDDLE EAR
Air filled chamber
Contains 3 smallest bones in the body – malleus, incus and stapes = AUDITORY OSSICLES
Eustachian tube
Vibrations – Oval window - cochlearSlide6
Inner ear
Semi circular canals and vestibular apparatus
The organ of corti is in the cochlea and is main organ for hearing Slide7
Nerves involved:
Auditory nerve – inner ear ( CN VIII)
Facial nerve – middle ear ( CN VII)
Vagus Nerve - Outer ear (CN X)Slide8
Ear wax - Cerumen
Not Like paraffin! Made of a lot of different chemical components
Testerone control over production of sebum.
What is its purpose?Slide9
People likely to produce excessive wax
Learning disabilities
Anxious people
High lipid levels
Genetic tendency
ElderlySlide10Slide11
What issues can wax build up cause a patient?Slide12
Ear Examination
History of presenting condition:
What information would be required here?Slide13
History cont……
PMH - ? Relevant
Meds
AllergiesSlide14
Assessment
Examine Pina. Outer meatus and adjacent scalp / mastoid,checking for scars, signs of trauma/ infection
Is ear inflammed -? Infection/ trauma
Skin condition – ?seborrhoeic dermatitis/
Malignancy
Ear canal discharge?Slide15Slide16
Identify wax……
In ear examination discern type of wax, position in canal and % of occlusion
Is wax healthy, or bacterial debris, or dry and crumblySlide17
Assessment cont..
Examine external auditory meatus
.
Should be pain free.
What can cause pain?
Furuncle
Trauma
Otitis
externa
Fungal infectionSlide18
Assessment cont….
Check ear canal and tympanic membraneSlide19
Assessment cont…
When withdrawing otoscope check external auditory meatus carefully.
Document……!
Document…..!
Document….!Slide20Slide21
Ear cleaning / irrigationSlide22
Ear Preparation
If
wax hard will require softening for best irrigation results
Choice of products –
OTC drops – otex, cerumol – all contain hydrogen peroxide
Bicarbonate soda 5% drops – possible irritant
Olive oil
Almond oil avoid if nut allergies!
Totally contraindicated in any acute perforated Tympanic Membrane.Slide23
Application of drops
No formal length of time and number of times a day
Advise if using oil not to heat it up – room temp sufficient
Not to over oil ears as becomes irritatedSlide24
Manual removal
If dry and crusty possibly can be gently manoeuvred out using Jobson Horne probe – head light and otoscope
If too painful discontinue - skin becomes quickly traumatisedSlide25Slide26
Ear Irrigation
Equipment required:
Auriscope
Head light / ? Eye protectors/ apron/ gloves
Electronic ear irrigator
Warm water –
approx
room temp - NOT COLD!!
Noots
receiver ( disposable or lined)Jobson Horne probe/ cotton wool
Tissues, receivers
Waterproof cape / towelSlide27
Guidelines:……
ENSURE – device only used by trained clinician
ENSURE that warnings and cautions are observed
ENSURE patient exhibits NO contra indications
ENSURE the unit been cleanedSlide28
Reasons for irrigation
Remove and Improve!Slide29
Principles of ear irrigation
Facilitate the removal of cerumen and foreign bodies
Individual assessment of each patient by practitioner carrying out procedure.Slide30
Possible complications?
Infection
Perforation
Tinnitus
Vagal nerve stimulation
DizzinessSlide31
Irrigation should not be carried out when:
Informed consent not obtained and NSCP consent form signed for procedure
Patient has had previous problems with procedure in past
Hx
of otitis media in past 6 weeks
Any form of ear surgery in past 18 months and NOT been discharged from care of ENT
Perforation or
Hx
of mucus discharge in past 12 months
Cleft palate repaired or notPresence of acute otitis
externaSlide32
Procedure to always be carried out with both practitioner and patient sitting, patient should be under direct vision using a headlight throughout.Slide33
DOCUMENTATION…….
Record:
What the patient says
What you see in BOTH ears
What you do – including advice given
Why this treatment – rationale….
NMC record keeping guidelines 2010Slide34
Documentation tips…
Always compare both ears - L=R
Do not use word “Appears normal” - looks as though not aware of what you are doing be definite. – “ Tympanic membrane normal” or “Tympanic membrane normal features not visible”
Word “impacted” – to be used if evidence wax has been pushed down canal with implement such as cotton bud
‘Occluded’ should be used is canal full of wax – say whether dark and hard, softy and light wax.
Document advice given to patient written/ verbal post procedure.Slide35
DEAFNESS
3 types:
1. Conductive : Obstruction between external /middle ear
2. Sensori – neural: Obstruction between stapes footplate and the auditory centres of brain
3. Mixed Deafness: Combination of conductive and sensori – neural deafness
Practical TimeSlide36Slide37
Hearing Aid Care..
General
Whistling
Hearing aid controls
Washing the ear mould
Retubing ear mouldSlide38
Tinnitus
What is
Tinnitis
?
How do you get it?
Who is likely to get it?
HyperacusisSlide39
Patient Education
E
– Educate - Why problem there?
A
– Advise – How to prevent recurring
Regular check ups
R
– Resolve – Treat the Problem, applying
clinical judgement and abilitySlide40
References and acknowledgements
Rogers R, www.earcareservicesuk.com
www.tinnutis.org.uk
www.deafnessresearch.org.uk
Action on ENT Steering Board (2007). Guidance Document in Ear Care. Primary Ear Care Centre. (http:// www.earcarecentre.com)
Nursing and Midwifery Council (2006) Record Keeping Guidance for Nurses. NMC, London.
Skills for Health :CHS20. Undertake examination of the external ear: -National Operation Standards: https://tools.skillsforhealth.org.uk/competence/show/html/id/350/ (last accessed 11th April 2012)