A nurse would question an order to irrigate the ear canal in which of the following circumstances?
A. Ear pain
B. Hearing loss
C. Otitis externa
D. Perforated tympanic membrane
Correct Answer: D. Perforated tympanic membrane.
Irrigation of the ear canal is contraindicated with perforation of the tympanic membrane because the solution entering the inner ear may cause dizziness, nausea, vomiting, and infection. Tympanic membrane perforation is when there is a tear in the tympanic membrane leading to a connection between the external auditory canal and the middle ear. This can be caused by infection, trauma, or rapid changes in pressure leading to sudden otalgia, otorrhea, tinnitus, and vertigo.
Option A: Otalgia is ear pain and breaks down into two categories of primary otalgia and secondary otalgia. Primary otalgia is pain coming directly from the ear where secondary otalgia is referred to pain from somewhere outside the ear. Infections cause most primary otalgia and are treated with antibiotics, while mechanical ones receive treatment with decongestants, nasal steroids, or myringotomy.
Option B: Management of conductive hearing loss focuses on the treatment of the underlying disease. Conservative methods such as removal of the foreign body, micro-suction of the cerumen, or discharge in the ear canal are necessary if the ear canal is blocked. Conservative treatment of sensorineural hearing involves the use of assistive listening devices and amplification. Hearing aids are devices designed to improve audition up to 40 to 60 dB with good results.
Option C: The mainstay of uncomplicated otitis externa treatment usually involves topical antibiotic drops and pain control. Pain can be intense and severe; therefore, it should be managed appropriately. Acetaminophen or nonsteroidal anti-inflammatory drugs have been proven to be adequate for mild to moderate pain.
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