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Cerumen impaction

Ear examination with an otoscope

Otoscope fof ear examination

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Perform ear syringing.mwemasite.com

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The aim is to remove wax debris and foreign bodies from the external meatus 

Materials Needed

• Ear syringe and nozzles
• Warm, clean water or normal saline at body temperature
• Baking-soda if available
• Large kidney dish or similar to catch post-syringing water
• Nylon cape and hand-towels to protect clothing

Steps

• Hold the syringe by three rings, the index and the middle fingers are inserted into the 2 rings on the syringe
• The thumb is inserted into the central ring on the piston
• The nozzle should be firmly fixed to the body of the syringe
• Use water or normal saline
• The fluid should be at body temperature

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• Pull the pinna upwards and backwards
• Direct the nozzle towards anterior or posterior wall
• Should not direct to the ear drum
• Use moderate force to remove wax, greater force may damage the ear; little force will not bring the wax out

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Foreign body in the ear

Foreign body remioval

Foreign Body in the Ear

• Common foreign bodies are:
• Broken pencils, Beads, Grain seeds, Broken sticks, Small stones, Insects

Symptoms

• Sensation of foreign body in the ear
• Pain

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Requirements for Removing Foreign Body in the Ear

• Good source of sharp light
• Head mirror
• Cerumen hook

steps

• Explain the procedure to the patient
• You must have good source of light to visualize the meatus clearly,
• If is an insect, pour cooking or any non irritating oil into the ear to suffocate it.
• Pull the pinna outward and backwards to stretch the meatus
• Use the cerumen hook to remove the foreign body
• Or perform ear syringing .
• Other deep seated foreign bodies refer to higher centre

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Possible complications

• Injury to external meatus
• Perforation of ear drum

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pericondritis

otorrhea

Foreign body in the nose

Foreign Bodies in the Nose

• Common foreign bodies in the nose:
• Organic
• Wood, paper, cotton seeds, foam rubber, balloon
• These foreign bodies causes marked local irritation
• Inorganic
• Metal objects, metal buttons, beads, plastics objects,

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Clinical features

• Sneezing
• Nasal discharge (unilateral)
• Foul smelling nasal discharge if is long standing foreign body
• There may be blood stained discharge

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Treatment

• Removal of foreign body usually done awake
• Rarely short course of anesthesia is required when the foreign body is deeply seated, and when the child is uncooperative during removal of foreign body.
• Use the proper instruments, care should be taken so that the foreign body does not slip back resulting to aspiration in the airway

Procedure of removing foreign body from the nose

• Explain the procedure to the patient
• Use blunt angled probe, insert above the foreign body and pass behind it
• Hook the foreign body and pull out gently, to avoid traumatizing the nasal mucosa
• Vegetables tend to swell, must attended without delay
• Control and stop nasal bleeding if happens

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epistaxis

Nose pinching

Causes of Epistaxis

• Causes of Epistaxis can be Grouped as Follows

Congenital e.g. haemangioma in the nose

Traumatic: Traumatic to the nose and paranasal sinuses or head injury

• Post operative procedure in the nasal and paranasal sinus
• Nasal picking

Inflammatory: Acute vestibulitis, Acute rhinitis and sinusitis

• Adenoid may cause inflammation and congestion in the nose with resistant epistaxis

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Common Causes of Epistaxis in Children

• Foreign body in the nose
• Picking the nose
• Vestibulitis
• Nasal diphtheria
• Hypertrophic adenoids with secondary congestion in the nose
• Idiopathic

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Common causes of epistaxis in adult

• Hypertension

• Malignancy

• Idiopathic

Common site of epistaxis

• Nasal septum- little’s area- about 90%
• Above middle turbinate- due to hypertension
• Woodruff’s plexus posterior end of inferior turbinate

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Nasal packing(anterior)

Anterior Nasal Packing Procedure

Material required

• Nasal speculum
• Dissecting forceps or nasal packing forceps
• Two kidney dishes(one with sterile gauzes and another to receive soaked gauzes)
• Topical lignocaine 4% or more,
• Must have good light to visualize nostrils Anterior nasal packing with ribbon gauze

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Procedure

• Explain the procedure to the patient
• Spray topical lignocaine 4% to reduce pain
• Have a nasal speculum in one hand open to widen the nostrils
• With the other hand take tip of ribbon gauze with dissecting forceps
• Insert the ribbon gauze into the nasal cavity; start with a tip of a ribbon
• Pack the whole ribbon into the cavity. Cover the nose with piece of gauze and adhesive plaster
• Cover the patient with oral antibiotics and analgesics
• Put the patient in upright position

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rhinorrhea