Student.Handout.HEENT (2)

Tears and cold compresses 2 2 recommend using

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tears and cold compresses. 2. 2. Recommend using naphazoline ophthalmic drops for 3 Recommend using naphazoline ophthalmic drops for 3 days and if symptoms persist, contact his pediatrician. days and if symptoms persist, contact his pediatrician. 3. 3. It is likely bacterial conjunctivitis. Instruct the mother to It is likely bacterial conjunctivitis. Instruct the mother to take her child to the pediatrician as soon as possible as take her child to the pediatrician as soon as possible as he may require antibiotics he may require antibiotics 4. 4. The ocular discharge is likely related to an allergic The ocular discharge is likely related to an allergic response – recommend a ketotifen fumarate 0.025% response – recommend a ketotifen fumarate 0.025% ophthalmic solution. ophthalmic solution.
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38 Otic Disorders
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39 Anatomy of the Ear Photo adopted from: http://www.biographixmedia.com/human/ear-anatomy.html
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40 Otic Disorders Accounts for 1.5% of physician visits per year Increased risk Children and elderly patients Current viral illness Limit self-treatment to external ear disorders External auditory canal (EAC) Auricle (pinna) Minor symptoms such as sense of fullness, pressure, or wetness in the ears
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41 Immediate Referral Signs / symptoms of infection present Ear drainage or discharge Moderate to severe ear pain and vertigo Fever Recent ear surgery ≤ 6 weeks Bleeding or signs of trauma Tympanostomy tubes present No improvement within 7 days or within 4 days of proper treatment
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42 Cerumen Natural defense mechanism Migrates to the outer EAC Protects the inner ear Risk factors for impaction Misshapen EAC or excessive hair growth Excessive production Atrophy of ceruminous glands Devices: ear plugs, hearing aids, ear pieces
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43 Excessive / Impacted Cerumen Clinical presentation Increased internal ear pressure Dull pain Gradual hearing loss Vertigo Tinnitus Chronic cough Cerumen impaction affects up to 10% of children and more than 50% of the elderly nursing home population Photo adopted from: http://www.empowher.com/media/reference/cerumen-impaction
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44 Treatment for Impacted Cerumen Carbamide peroxide 6.5% in anhydrous glycerin Only FDA approved OTC product Loosens, softens, removes excessive earwax Age ≥ 12 years Adverse effects: mild pain, rash, irritation, discharge, dizziness Never insert objects into the ear to attempt to remove earwax Photo adopted from: http://audiology.tistory.com/entry/impactedcerumen/
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45 Carbamide Peroxide 6.5% Products Auro Ear Drops ® Debrox ® Murine Earwax Removal ® OTIX drops ® Physician Choice ® Photo adopted from: http://www.drugstore.com/
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46 Directions for Carbamide Use Apply 5 – 10 drops in the affected ear and allow it to remain for 10 – 15 minutes Carefully rinse with an otic syringe filled with warm water Apply twice daily for ≤ 4 days If visible cerumen still remains or
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