Laguna State Polytechnic University Sta. Cruz, Main Campus Sta. Cruz, Laguna College of Nursing S.

Y 2010-2011

CERUMEN IMPACTION MASSES OF THE EXTERNAL EAR

Submitted by: Del Mundo, Rose Ann Gauna, Nergelyn Sawadjaan, Glaiza

Submitted to: Prof. Janice Bernardo

Bibliography Cerumen Impaction Introduction http://www.drugs.com/cg/cerumen-impaction.html Antomy and physiology Essential of human anatomy and physiology(eight edition) Author: Elaine N. Marieb Pathophysiology http://bestpractice.bmj.com/bestpractice/monograph/1032/basics/pathophysiology.html Medical management http://www.drugs.com/cg/cerumen-impaction.html Nursing diagnosis medical-surgical nursing(volume 1) Brunner and Suddarths

Massess of external ear Introduction http://www.earsite.com/tumors/cholesteatoma.html Antomy and physiology Essential of human anatomy and physiology(eight edition) Author: Elaine N. Marieb Diagnostic test http://www.earsite.com/tumors/cholesteatoma.html Medical management http://www.earsite.com/tumors/cholesteatoma.html Surgical mangement-http://www.earsite.com/tumors/cholesteatoma.html Nursing diagnosis

CERUMEN IMPACTION

I.

INTRODUCTION A. Definition Cerumen impaction is the blockage of the outer ear canal by tightly packed cerumen. The outer ear canal is the tube from the opening of your ear to the eardrum. Cerumen, also called ear wax, is the yellowish oily substance produced in the outer ear canal. A wet cerumen is sticky and brownish in color, while a dry cerumen is crusty and greyish. Cerumen helps clean out dead skin cells and prevents dirt and water from entering the inner ear. Cerumen may also protect the ear from germs, such as bacteria and fungi. Normally, cerumen flows outward to the opening of the ear where it falls out or gets washed away. Cerumen impaction happens when the wax dries, builds up, and gets stuck along the ear canal. Causes: Anything that affects the normal outward flow of cerumen may cause impaction. Cerumen impaction may be more common in men, elderly, and in people with mental health problems. It is not a sign that a person is not clean. The following factors may cause ear wax more likely to become impacted: Advanced age wherein the ears tend to make drier cerumen. Conditions that produce too much cerumen, such as keratosis and other skin diseases. Narrow or abnormally shaped ear canals. Wearing a hearing aid. Incorrect use of cotton buds (swabs), or using needles, hair pins, or other objects to clean the ears. B. Statistical Data Cerumen impaction affects between 2 percent to 6 percent of the general population in the United States. It apparently affects males and females equally.

II.

ANATOMY & PHYSIOLOGY

The external ear (pinna) serves to protect the tympanic membrane (eardrum), as well to collect and direct sound waves through the ear canal to the eardrum. About 1 inches long, the canal contains modified sweat glands that secrete cerumen, or earwax. Too much cerumen can block sound transmission. Cerumen is the soft yellow wax secreted by glands in your ear canal, more commonly known as earwax. Cerumen impaction occurs when earwax becomes wedged in (impacted) and blocks the ear canal. Cerumen or earwax has many useful purposes. One of the main uses is that it protects against infection. It helps fight bacterial ear infections and protects the inside of your ear. Earwax moves out of your ear naturally.

III.

PATHOPHYSIOLOGY

Risk Factors: Age narrowed ear canal Ears that overproduce cerumen

Presence of water in the canal

Swelling of the cerumen

Trap bacteria in the medial ear canal

Infection of the canal

Symptoms:

Trouble hearing. Dizziness. Otalgia or Ear fullness Itchiness or pain in the ears. Ringing in the ears.

IV.

RISK FACTORS:

The following factors increase your chance of developing cerumen impaction: Individuals who obsessively try to clean their ears and try to remove the wax A twisted, narrow, or complicated ear canal Ears that overproduce cerumen Age: affects the elderly and causes hearing loss V. ASSESSMENT: Justification > interferes with conduction of sound waves into the ear.

Symptoms Trouble hearing.

Dizziness. Otalgia or Ear fullness or a feeling that something is plugging up your ear. Itchiness or pain in the ears. Ringing in the ears. > swelling of the cerumen.

> If blocked, air cannot get to the middle ear to equalise the pressure on the eardrum. This can impair hearing or, if the pressure difference is enough to stretch the eardrum, cause pain > perceived when no sound is present

VI.

DIAGNOSTIC / LABORATORY TEST Otoscopy Otoscopy is an examination that involves looking into the ear with an instrument called an otoscope (or auriscope). This is performed in order to examine the 'external auditory canal' the tunnel that leads from the outer ear (pinna) to the eardrum. Inspection of the eardrum can also provide a lot of information about what's happening within the middle ear the space within the skull where the hearing and balance mechanisms are situated.

VII.MEDICAL-SURGICAL MANAGEMENT Pharmacological GENERIC NAME: CARBAMIDE PEROXIDE OTIC BRAND NAME(S): Auro, Debrox USES: This medication is used to treat earwax buildup. It helps to soften, loosen, and remove the earwax. Too much earwax can block the ear canal and reduce hearing. This medication releases oxygen and starts to foam when it comes in contact with the skin. The foaming helps break up and remove the earwax. HOW TO USE: Apply this medication into the ear, usually twice daily or as directed by your doctor. Do not use this medication for more than 4 days at a time unless your doctor instructs you to. Follow all directions on the product package. To make sure that the right amount of medication is given, and to avoid touching the ear with the dropper, have another person give the drops if possible. To lower the risk of dizziness, hold the container in your hand for a few minutes to warm it. To apply ear drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your ear or any other surface. Lie on your side or tilt the affected ear upward. Hold the dropper directly over the ear and place 5 to 10 drops into the ear canal. To help the drops roll into the ear of an adult, hold the earlobe up and back. In children, hold the earlobe down and back. Keep the head tilted for several minutes or insert a soft cotton plug in the ear. If there is any wax remaining after treatment, it may be removed by gently rinsing the ear with warm water or using an ear syringe with a soft rubber bulb. SIDE EFFECTS: symptoms of a serious allergic reaction, including: rash, itching swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Surgical Management Treatment for a cerumen impaction is mainly to remove the hardened wax. The type of treatment to be used may depend on the patient's age, symptoms, or risk factors Wax softeners: Ear drops that are water-based or oil-based may be used to clear or soften the impacted earwax. This may be used alone or in combination with a procedure to take out the ear wax. Procedures: When the impaction can be clearly seen, removal may be done using any of the following:

Irrigation: This procedure may also be called ear syringing. Water that is close to body temperature is used to wash the wax out of the ear canal. Irrigation may not be used on people with an eardrum tear or infection, or who have had ear surgery. Suction: A machine that sucks the object out of the ear canal may be used to remove small formed cerumen plugs. This procedure uses a small plastic tube that goes in the ear and is connected to the machine. Instruments: A curette (scoop-like instrument) or forceps (grasping instrument) may be used to remove the impacted cerumen.

Nursing Responsibilities VII. Nursing Diagnosis Acute pain related to surgery Disturbed auditory sensory perception related to ear disorder Risk for trauma related to impaired balance