Category: Audiology in nutshell

As you know Wax Removal is now one of the courses we run at TJ Audiology Training. This blog is about what Otitis Externa is; how to spot the signs and what to do, if you are removing wax, about to take an impression or to do a hearing test.

What is otitis externa? Firstly, it’s in the name Otitis is Latin for ear and Externa is external ear and it is an inflammation/infection of that area (generally it just the ear canal).  Some people call it swimmers’ ear. But be aware this can mean something different depending on the region you live in the UK or what country you are in.

What causes Otitis Externa?

We aren’t exactly sure but some of the possible causes are:

• Damage to the skin in the ear canal (caused by cotton buds, scratching or poking) can cause inflammation and infection.
• Water can get into the ear canal during swimming. The stagnant water triggers an infection (Remember all water contains pseudomonas bacteria) . This often happens if there is a lot of wax and the water gets stuck behind the wax.
• Hot, humid weather makes inflammation of the ear canal more likely to develop.
• Skin conditions such as eczema, or psoriasis, can make someone more likely to get problems with the ear canal.
• Diabetes, radiotherapy (near the ear) and immune and conditions that effect the immune system can also make the client more prone to infection

How to spot the signs?

• In general the first sign your client will complain of is persistent itchiness and dry flaky skin around he canal and their may be some redness too.
• Smell – this like off cheese or smelly socks (it stays with you when you smell it!)
• A watery discharge from the ear canal (this can change later when its whiter)
• Discomfort moving the jaw when chewing or speaking.
• The ear canal starting to close up due to swelling and inflammation.
• Reduced hearing due to the canal being full of discharge or the canal is completely swollen
• Fungal spores are also a form of otitis externa. These will be either white and furry or black (see picture below)

What should you do as an ear care professional?

Firstly, if they are seeing you for ear impressions or a hearing test, then you need to send them away. The swollen canal will prevent an accurate impression and you can’t do a hearing test as the risk of cross infection is too high.

What if they are seeing you for wax removal?

It may be that you can’t see it or smell it till you have removed some wax. If this is the case then remove as much as you can comfortably for the client. This will give any intervention a better chance of working, as you have made the canal clear of as much debris and discharge for antibiotics to work on the skin. Remember the ear may be sore so you may have to work slowly and gently and you not be able to remove all of it. (Please note irrigation is not an option here only microsuction; as water from irrigation will make things worse).

Remind them of good aural hygiene. No water near the ears and no touching of the ears whatsoever.

Once you have removed the wax and discharge, refer the client to the GP. They may prescribe eardrops or spray. Often, it’s a combination of an antibiotic to treat any infection, and a steroid to reduce the inflammation and itching. The treatment usually lasts for 7 to 10 days. They need to follow the prescribed course. If they return to you because the treatment hasn’t worked, then you need to recommend that the nurse or GP take a swab sample, as the antibiotics may be the wrong type for the bacteria present.

Lastly

If the canal is swollen shut and the pinna and the concha are also swollen then the otitis externa has developed into cellulitis, this is a rare occurrence/side effect . (This may have occurred due to the client scratching the already infected ear and adding another bacteria). They will require intravenous antibiotics for this, so in this case suggest they attend A+E as this cannot be given at a GP surgery.

 

Personally my mind boggles when it comes to this subject. Cochlear anatomy is amazing and the cochlear itself is so tiny only 36mm in length and yet it does so much. Whilst there are many good explanations out there, anatomist Dr Sam Webster description from Swansea University is one of my favourites. Watch his video below for more information on cochlear anatomy. Be prepared to get a cup of coffee or tea and set 30 minutes aside to watch his explanation!

Its been a long while since we have posted a blog!!!!!!!!

TJ Audiology Training as you may have noticed has changed its name ever so slightly and we now have a new a fantastic new logo.  Watch this space for new developments  in the next 6-12 months. Like our new wax course Ear Wax Removal/ Aural Care Course

We will be running the wax removal course again on 22nd -23rd January 2025; with volunteer human ears to practice on too! Our students loved the September course which we ran using equipment from  Puretone   so please get in touch if you would like to know more.

Otis the virtual patient (from Innoforce.com) can be use to practice basic audiometry and tympanometry and masking.

We use it in our classes as it is a great way of developing your skills in audiometry without having the pressure of the time or the client’s ability to focus, while getting used to the controls and techniques required. If you’re learning how to carry out masking, it is an invaluable learning and evaluation tool and your don’t need to rely on your supervisor to explain results.

Otis is a little bit like a real person, for example, your client can fall asleep if you take too long or shout if you present sounds that are too loud. You can view your otoscopy, history and tymp data as part of the assessment. There is reference data for masking and symbols.

You have real time evaluation and assessment of your procedure as you do the audiometry – it tracks your accuracy, time and errors. You can also progress from easier audiograms, to more difficult cases.

Although the ear is small in size, it is essential for hearing and balance, and problems of the ear can be linked to other conditions. Understanding the structure and function of the ear will help us to pick up problems early and improve the care of patients with ear problems.

Here’s a very helpful article published in the Nursing Times which explains about the ear and its role in hearing.

Personally my mind boggles when it comes to this subject. Cochlear anatomy is amazing and the cochlear itself is so tiny only 36mm in length and yet it does so much. Whilst there are many good explanations out there, anatomist Dr Sam Webster description from Swansea University is one of my favourites. Watch his video below for more information on cochlear anatomy. Be prepared to get a cup of coffee or tea and set 30 minutes aside to watch his explanation!

Dr. Hawke is a Professor Emeritus, Department of Otolaryngology-Head and Neck Surgery at the University of Toronto. He is known both for his basic and clinical research in diseases of the ear and sinuses. He has travelled the world extensively as an Invited Professor delivering countless lectures and seminars.

He is one of the pioneers in medical photography. His images are captured using telescopic techniques that he also helped pioneer.

We recommend that you look at his documents on the diseases of the ear as they are incredibly useful.

Michael Saunders is a UK based ENT. His images of the ear canal and drum can be found on the ENT Bristol website along with very helpful descriptions.

Dr. Terry W. Owens was a board certified ENT specialist. He describes how to examine the ear, many common ear problems, what to look for, laboratory tests, common treatments and possible prevention. The text is clear, simple and with minimal technical medical terminology. Here is a link to his photobook which will help you to understand ear diseases.

Otoscopy & Impression Taking

Our otoscopy & impression taking courses will teach you how to take impressions safely and according to the BSA recommended procedure. You will be provided with practical time and knowledge to make sure that your impression reaches the second bend of the ear canal.

We recommend that you watch our Facebook videos on Otoscopy & Impression Taking before the course.

Communication Tactics

Communicating with someone who is deaf doesn’t have to be difficult. But you do need to be patient and take the time to make sure you are communicating properly. These are some of the simple things you can do to make communication straightforward for both of you. You can download this information here.

– Even if someone is wearing hearing aids it doesn’t mean they can hear you perfectly. Ask if they need to lipread.

– If you are using communication support, always remember to talk directly to the person you are communicating with, not the interpreter.

– Make sure you have face-to-face contact with the person you are talking to.

– Get the listener’s attention before you start speaking, maybe by waving or tapping them on the arm.

– Speak clearly but not too slowly, and don’t exaggerate your lip movements – this can make it harder to lipread.

– Use natural facial expressions and gestures.

– If you’re talking to a group that includes deaf and hearing people, don’t just focus on the hearing people.

– Don’t shout. It can be uncomfortable for hearing aid users and it looks aggressive.

If someone doesn’t understand what you’ve said, don’t keep repeating it. Try saying it in a different way instead.

– Find a suitable place to talk, with good lighting and away from noise and distractions.

– Check that the person you’re talking to is following you during the conversation. Use plain language and don’t waffle. Avoid jargon and unfamiliar abbreviations.

– To make it easy to lipread, don’t cover your mouth with your hands or clothing

See more tips on the RNID website.

Glossary of Audiology Terms:

We have put together a list of some words/terminology that might be used during your course. If at anytime your course trainer uses a word/term that you don’t fully understand please do ask for the meaning – your trainer will be happy to explain. You can download this information here.

Audiologist – health care professional who is trained to evaluate hearing loss and related disorders, including balance (vestibular) disorders and tinnitus, and to rehabilitate individuals with hearing loss and related disorders. An audiologist uses a variety of tests and procedures to assess hearing and balance function and to fit and dispense hearing aids and other assistive devices for hearing.

Ear canal / external auditory meatus / external acoustic meatus (EAM) – the canal extending from the opening in the external ear (pinna) to the tympanic membrane.

Mastoid / Mastoid process – a large, bony prominence on the base of the skull behind the ear, containing air spaces that connect with the middle ear cavity

Mastoid cavity – the removal of mastoid cells (usually following infection) results in a mastoid cavity. Sometimes the mastoid cavity is left open into the ear canal.

Retraction of the eardrum – the tympanic membrane is pulled inwards by the negative pressure within the middle ear. Discrete portions (sometimes weaker areas) of the tympanic membrane that are pulled inwards are known as retraction pockets.

Exostoses of the ear (swimmers ear) – the abnormal formation of a bony growth on the ear canal.

Otitis externa – inflammation or infection of the external ear.

Cholesteatoma – A tumour-like mass of keratinizing squamous epithelium (replacing skin cells) and cholesterol, usually occurring in the middle ear and mastoid region.

Otosclerosis / Ossicular Fixation – formation of new bone about the stapes or cochlea, resulting in conductive hearing loss.

Ossicular Discontinuity / Ossicular Chain Disruption – a loss of normal alignment between the three inner ear ossicles, resulting in conductive hearing loss.

Grommet – a small tube inserted into the eardrum in cases of glue ear in order to allow air to enter the middle ear

Acute Otitis Media – a middle ear infection of abrupt onset that usually presents with ear pain.

Otitis Media with Effusion (Glue Ear, OME) – the presence of non-infectious fluid in the middle ear

Suppurative Otitis Media – middle ear inflammation that results in episodes of discharge from the ear

Tympanosclerosis– the medical term for scarring of the ear drum. Scarring occurs after the ear drum is injured or after surgery

Decibel – The decibel (dB) is a logarithmic unit that expresses the ratio of two values of a physical quantity, often power or intensity : 20 log10 p1/p0