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Care
Published in Henry J. Woodford, Essential Geriatrics, 2022
Older people tend to present with complex problems. Cognitive assessment is sometimes overlooked. If not performed, then issues will be missed that impact safety in hospital and hinder safe discharge. Examination should also include looking in concealed areas such as under bandages and at the common sites of pressure ulcers (preferably at the time of arrival at your department). Also, if there is hearing impairment, look for ear wax and, when relevant, check hearing aid batteries. Test for visual impairment and ensure the correct (and clean) glasses are available. Always review drug lists and consider medication adverse effects as part of the differential diagnosis (see page 54).
Ear
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
This is often seen in swimmers and returned tropical travellers. It is frequently a sequel to water trapped behind earwax in the ear canal, which swells and encourages stasis and subsequent infection. The vast majority of cases seen settle with simple treatment, but be wary of rarer serious causes.
Acute otitis externa
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Look for any surrounding cellulitis and/or lymphadenitis. It may be important to demarcate the edge of the cellulitis to monitor treatment. With regards to the external canal, look for tenderness, erythema, oedema or narrowing (Figure 12.1). Obstruction of ear canal may necessitate aural toilette, wick placement or even the use of systemic antimicrobial agents. Examine to ensure there is not currently any foreign body in the ear canal. Cotton buds, hearing aids, middle ear ventilation tubes and even excess ear wax can traumatise the external canal skin, increasing susceptibility to infection.
Prevalence, risk factors and causes of hearing loss among adults 50 years and older in Santiago, Chile: results from a rapid assessment of hearing loss survey
Published in International Journal of Audiology, 2023
Natalia Tamblay, Mariela C. Torrente, Barbara Huidobro, Daniel Tapia-Mora, Katherine Anabalon, Sarah Polack, Tess Bright
The most common otoscopic finding overall was impacted wax, present in 4.4% of total ears increasing to 5.9% of ears among those over 70 years of age. This was similar to findings from the RAHL in China (3.4% of ears) (Bright et al. 2020b). However it was considerably lower compared to the RAHL in Malawi (19.5% of ears) (Bright et al. 2020a) and a population-based study in Canada in which 21% of 70–79-year-olds had impacted earwax (Feder et al. 2015). The difference in the prevalence of earwax may be explained by the different age groups included variable access to ear and hearing services (likely lower in Malawi), or variability in the assessment and classification of the level of earwax occlusion in different studies (e.g. presence or absence of wax versus full obstruction by wax). A possible explanation for the increased prevalence of impacted earwax among older adults (over age 70) may be poorer awareness or educational outreach targeting this population.
Temporary threshold shift following ear canal microsuction
Published in International Journal of Audiology, 2020
Cerumen (earwax, or wax) is a natural physiological substance of the ear secreted from the external auditory meatus (EAM, or ear canal), which cleans, protects and lubricates the EAM. Unless the levels become excessive, it forms a coating on the EAM and then migrates using a self-cleaning process that moves the cerumen to the entrance of the meatus, where it is naturally expelled. However, cerumen or other debris in the ear (e.g. shed hairs, dirt, sand, skin and foreign objects) can become excessive and sometimes impacted. Impacted cerumen or debris can cause problems, such as conductive hearing loss, aural fullness, tinnitus and vertigo (Schwartz et al. 2017; Sharp et al. 1990; Subha and Raman 2006). In these circumstances, removal of cerumen/debris is recommended (for the purposes of the current study, cerumen/debris will be referred to as cerumen). Approximately 2.3 million people per year in the UK seek medical treatment for impacted cerumen to alleviate the symptoms (Guest et al. 2004).
Distortion product otoacoustic emission together with tympanometry for assessing otitis media with effusion in children
Published in Acta Oto-Laryngologica, 2018
Lei Jin, Keyong Li, Xiaoyan Li
All subjects underwent a routine medical history and physical examination by an otolaryngologist. The tonsillar size was graded by specialists as follows: (i) Grade 1 = small tonsils confined to the tonsillar pillars; (ii) Grade 2 = tonsils that extended outside the pillars; (iii) Grade 3= tonsils that extended the pillars, but did not meet at the midline; and (iv) Grade 4 = large tonsils that met at the midline [7]. Pediatric flexible nasal endoscope was performed in every patient 1 day before the surgery, and the adenoid size was classified during nasal inspiration according to the percentage of nasopharyngeal space obstruction as follows: small <50%; medium 50–75%; and large >75% [8]. Rhinosinusitis was also diagnosed by endoscopy findings, such as pus in the meatus nasi medius and nasal pharynx. Chronic tonsillitis was defined as five or more episodes of true tonsillitis per year with symptoms for at least 1 year [9]. Allergic rhinitis (AR) was confirmed by a specific IgE blood test or prick test and the duration and persistence of symptoms and comorbidities according to the AR and its Impact on Asthma classification. Physical examination of the ear using an otoscope was performed, and earwax was removed before the auditory examinations. The presence of liquid, opacity, retraction, perforation or erythema was noted. Concurrent AR, sinusitis and chronic tonsillitis were recorded. Patients with maxillofacial malformations, such as cleft palate and mandibular retraction, were excluded. None of the 339 patients had undergone previous myringotomy (with or without tube placement) or any other form of otologic surgery.