You gotta see the ear drum in a kid with fever and ear pain. It’s that simple. And if you thought the screaming, kicking and thrashing was offering enough of a challenge, you also encounter a Shrek-esque accumulation of cerumen. How should you proceed? Check out the handy table below.
|
|
|
|
Potential Contraindications
|
|
|
- Easy to do
- Specialized manual skill NOT required
|
- Blind procedure
- TM or EAC injury
- May cause otitis externa, pain, vertigo, cough, hearing loss, or cardiac depression
- Specialized equipment may be required
- If otitis externa present, may cause pain
|
- Presence of tympanostomy tubes
- Nonintact TM
- Recurrent otitis externa
- Vertigo
|
|
|
- Direct visibility for removal is required
|
- TM or EAC injury
- May cause pain, vertigo, cough, or cardiac depression
- May push cerumen further into EAC
- Requires mono/binocular otoscope
- Requires manual skill
- Requires greater patient cooperation
|
- Inability to view auditory canal
- Uncooperative patient
|
|
|
- Easy to do
- No specialized equipment or otoscopy required
- Specialized manual skill NOT required
|
- May cause pain, vertigo, or temporary hearing loss
- Localized reactions and skin irritation
- May cause otitis externa
- If otitis externa present, may cause pain
|
- Allergies to the drop ingredients
- Presence of tympanostomy tubes
- Nonintact TM
|
EAC=external auditory canal, TM=tympanic membrane
Oh, and lest I forget, here are some common cerumenolytics
1. Tap/distilled water and sterile saline solutions
2. Water-based preparations: acetic acid, triethanolamine polypeptide oleate condensate, docusate sodium, hydrogen peroxide, sodium bicarbonate
3. Oil-based preparations: mineral, olive, almond, and arachis oil
4. Nonwater-/nonoil-based combination preparations