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2017 HCHB_digital

Ear Conditions Our ears

Ear Conditions Our ears allow us to hear and keep our balance. Each ear consists of three parts: the outer, middle and inner ear. The outer ear collects sounds from the environment and funnels them through the rest of the ear. It is composed of the pinna (the flap of skin that channels sound), the external ear canal, and the tympanic membrane (eardrum). The tympanic membrane separates the outer ear from the middle ear. The middle ear is an oval, air-filled space approximately 2cm 3 in volume that contains three tiny bones (the hammer, anvil and stirrup) that form a chain which conducts sound waves from the tympanic membrane to the inner ear. The inner ear is a complex structure about the size of a pea that is responsible for interpreting and transmitting sound and balance sensations to the brain. The main components of the inner ear are the vestibule, semicircular canals and the cochlea. Ear problems can be caused by a number of different things including: • improper cleaning with cotton buds or other objects that can damage the delicate lining of the ear • ineffective water drainage out of the ear after swimming or showering • inherited structural defects • infections (particularly infections such as tonsillitis and sinusitis) or sensitivity reactions to topical products, ear plugs, jewellery or cosmetics • medicines that may affect balance • wax build-up. Initial assessment Only a visual examination of the outer ear is possible in a pharmacy setting as specialised equipment is needed to look into the ear canal. Therefore treatment is limited to conditions which affect the external ear, such as ear wax, swimmer’s ear, and contact dermatitis from sensitivity reactions (see also Dermatitis/ Eczema). Obtain an accurate description of the problem from your customer and refer those with a "yes" answer to the Refer to Pharmacist questions to a pharmacist. Ear wax (cerumen) Many people do not realise how important ear wax is for helping to maintain the natural function of the ear. It is formed from wax glands in the external ear canal as well as other components, such as dead skin, sweat and oil, and helps to protect the ear from water and infection. Customers should be discouraged from using cotton buds or other devices (hairgrips, pens) to clean the wax out of their ears as this can result in wax impaction and disrupt the thin skin layer that lines the ear, causing infection. In addition, constantly poking things into the ear can actually increase the production of ear wax. The ears are typically self-cleansing and only a few people are genetically more prone to excessive ear wax production. In these people, problematic wax should be removed with drops, by irrigation with warm water, with gentle suction, or by a doctor or audiologist. Preparations available OTC to soften ear wax, or for ear irrigation, work better for people with small to moderate amounts of wax. Ear candles are NOT recommended as there is no evidence that they are effective and the risk of burns is high. TREATMENT OPTIONS Category Examples Comments Ear wax removal drops Ear cleansing products Swimmer’s ear products Natural / herbal products / supplements [GENERAL SALE] eg, Audiclean, Otifleks, NeilMed, Waxsol [PHARMACY ONLY MEDICINE] eg, Auralgan, Cerumol*, Ear Clear* [GENERAL SALE] eg, Audiclean, Ear Clear Ear Cleanser*, Earigate [GENERAL SALE] eg, isopropyl alcohol ear drops (Audiclean Swimmers Ear), propylene glycol/acetic acid (Vosol) eg, ear plugs (Hush A Foam, Macks range) eg, Swim Seal Ear Drops Ear wax removal and swimmer’s ear Warm olive oil (eg, Cerumol Olive Oil) Glue ear Echinacea (eg, Kiwiherb De-Stuff) Tinnitus Gingko biloba (eg, Tebonin EGb 761) Helps soften or loosen ear wax. Warming of drops prior to use may improve effectiveness. Once drops are administered, the patient should lie with the ear containing the solution uppermost for five to 10 minutes. Some drops contain a local anaesthetic to relieve ear pain. Prolonged use of these medicines may lead to hypersensitivity and irritation. Consult a doctor if pain occurs when using these medicines. Contain purified sea water to wash away dirt and excess wax instead of pushing it into the ear canal. These products are safer than cotton buds (cotton buds are not recommended for cleaning out ears). Products may contain acetic acid, propylene glycol or isopropyl alcohol to dry up any water in the ear. These products are usually more effective at preventing rather than relieving swimmer’s ear. Ear plugs help keep water out of the ears during swimming and showering. Swim Seal ear drops contain a mixutre of polysiloxane and tea tree oil that coats the ear canal, providing a barrier against water. Self-removing. Olive oil may help soften wax aiding removal. One drop placed in the ears is also good for relieving an itch and is better than sticking cotton buds or other objects into the ear. Echinacea root preparations may help prevent or relieve upper respiratory tract infections, reducing the risk of otitis media and the development of glue ear. There is no evidence that ear candling is effective and it may leave deposits of candle wax in the ear or burn skin. Ginkgo biloba extract may help with balance and inner ear noise. Cemurol 13/9/02 10:12 AM Page 1 Products with an asterisk have a detailed listing in the Ear Conditions section of OTC Products, starting on page 235. ® CERUMOL “I said, you need Cerumol ear wax remover.” For the easy removal of ear wax Contains: Chlorbutal 5% w/v; Ortho-dichlorobenzene 14% w/v; Para-dichlorobenzene 2% w/v; and Arachis Oil 57% w/v; Contra-indications; Otitis Externa, Seborrhoeic Dermatitis and Eczema affecting the external ear. * Fraser JG: Jouirnal of Larying and Otol. 1970;34: 1055-64 Page 62 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Swimmer’s ear (otitis externa) Swimmer’s ear is a condition of the outer ear canal that commonly occurs in swimmers. Water, humidity, heat and moisture can cause the thin layer of skin that lines the ear canal to soften and swell, making it prone to infection by bacteria. Early symptoms include an itching within the ear and a slight redness of the ear canal. Pain and drainage of fluid suggest infection. Attempts to remove water or scratch inside the ear with cotton buds or other objects may cause further disruption to the skin lining and make the condition worse. Referral to a doctor for antibiotics is often necessary. Swimmer’s ear is best prevented by drying the ears thoroughly after exposure to water and using a product containing a water-evaporating agent (see Treatment options: swimmer's ear) to remove any moisture collected within the external ear canal. People prone to swimmer’s ear should also wear ear plugs during swimming or showering. Otitis media Otitis media is inflammation of the middle ear, causing a build-up of fluid, with or without infection. If there is an infection it is often viral. Many children have several bouts of otitis media before they are seven years old. Symptoms include crying, ear-pulling, mild fever and irritability. It is important for children to see a doctor, who will investigate ear pressure since chronic unrelieved pressure within the ear may result in glue ear. Antibiotics are not necessarily prescribed routinely for otitis media, but paracetamol or ibuprofen may be given to help relieve pain. Glue ear Glue ear is a type of chronic otitis media. Long-term build-up of thick or “sticky” fluid in the middle ear, behind the eardrum, causes hearing loss, which may affect socialisation skills and/or learning ability, especially if hearing loss is not recognised in early childhood. Any suspicion of hearing impairment in a child, such as inattention at school, lack of response to instructions, apparent disobedience or wanting the television very loud, should be checked by a doctor. Advice for customers • Cotton buds or other devices should not be used for cleaning ears since they can result in the wax becoming more deeply impacted. • For people prone to ear wax impaction, regular ear wax removal by a doctor every six to 12 months is recommended. • Check any suspected hearing loss, especially in children. »» Free ear checks are available for preschool children up until the age of five. »» Children aged five to 16 with suspected hearing loss may be entitled to a free hearing assessment through a hospital audiology clinic. »» Free hearing checks are available for New Zealanders over the age of 16 Cemurol 13/9/02 10:12 AM Page 2 through Life Unlimited Hearing Therapy Services (0800 008 011). Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes, is pregnant)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications) that may be possibly associated with the ear condition (eg, tinnitus and salicylates)? • Is the customer a child? • Was there any trauma to the ear preceding the current problem (eg, insertion of a cleaning tool), or could the eardrum be perforated? • Is there any pain or discharge (eg, pus or blood)? • Did any neck or head injury occur before the ear pain started? • Is the customer experiencing any middle-ear pain, tinnitus (ringing in the ear), and/or dizziness? • Is there any unusual growth visible (especially in elderly people)? • Is the customer feeling generally unwell or has a fever? • Is hearing acutely impaired or has it been gradually deteriorating? • Is it possible a foreign object may be lodged in the ear? • Have the symptoms persisted despite treatment, or has the ear become itchy with treatment? • Does the person have any allergies to topical medicines? • Constant low noise, eg, lawn mowing, may impair hearing long term. Use ear protectors if working in a noisy environment, including the home environment. • Ensure correct nose-blowing technique. Regular blowing (instead of sniffing) may help prevent glue ear incidence in children. is the easy way to remove ear wax. Clinical trials confirm that CCerumol is efficient and reliable and is especially effective in softening and removing hard wax.* Cerumol is so easy to use, patients can administer it themselves. The loosened wax may clear from the ear after the application of five drops of Cerumol; otherwise, after 10 to 30 minutes, the softened wax can be removed by gentle syringing. Proven effective and easy to use for over 40 years, Cerumol is the treatment you can recommend with confidence. For further information please contact: BDM Grange Limited PO Box 40-147, Glenfield, Auckland Tel: (09) 443 9300 Fax: (09) 443 9301 TAPS PP2836 Page 63

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