My Title for this Blog is based on a study I have recently read entitled: “Incidence, Correlates, And Interventions Used For Pressure Ulcers of the Ear” published in “Medsurg Nursing, Sept-Oct 2011, Vol 20, No 5, pages 241-246.
This is an interesting study done in a 550 bed US hospital. This is an issue I have long known exists. As a Respiratory Therapist I have run across it many times. The surprise is the prevalence this article suggests. The other surprise has been the lack of interest this subject is given when pointed out. Oxygen cannula is generally a ‘very’ low interest item in the healthcare system often delegated to purchasing of the lowest cost item on the market despite the negative sequela that can occur for patients. Previous studies I have read have suggested the percentage of pressure ulcers occurring at the ears as around the 4 to 5 % range. This study began as this facility had noted an increasing incidence that had begun around the 2% and been rising to around 12% in their facility. They referenced other studies that had shown similar trends and noted that virtually all pressure ulcer research was for the lower 1/2 of the body with little study of pressure ulcers to the top half.
With this in mind these researchers decided a study of pressure ulcers around the ears might be warranted. Then the unthinkable happened. The numbers jumped from 12% to 37%.
“Results demonstrated an incidence of pressure ulcers of the ear three times higher than noted on the facility’s quarterly skin assessment audits (37%). The research team questioned this result and investigated further by questioning several nurses and the graduate student who participated in data collection. All involved were able to describe accurately the various stages of pressure ulcer development. Upon subsequent quarterly skin assessment audits, this result was validated by an incidence of 36%.”
My Take-Away: This is an issue that needs to be given more serious consideration. There are solutions, prevention is far cheaper (and more compassionate) than treatment.
Declaration: I have been promoting a cannula that could potentially eliminate this issue for two years now with little interest from healthcare workers (mostly due to contractually obligations and the bureaucracy involved in changing). My solutions are not the only ones available (as the article demonstrates) but either way this issue should be studied and addressed. I was happy to find this group who did. I would post the article in its entirety if it were freely available but it is not. Sorry.
A few quotes I liked:
“The one finding of statistical significance indicated patients who are new to oxygen delivery via nasal cannula are the most susceptible to skin breakdown of the ears.”
“Among the assessed patients (n=100, using a confidence interval of 95%), the incidence of skin break-down was 37%, with a range of 28%-47%. Only one patient exhibited pressure ulceration proximal to the ear on admission. Remaining cases were iatrogenic.”
“Once they develop, these chronic wounds are very resistant to any known medical therapy. Estimates of complete healing for pressure ulcers are as low as 10%.”
“A well-educated staff who actively utilize preventive techniques is central to the identification of pressure ulcer risk and prevention of pressure ulcer development.”
“The purpose of this study was to describe the incidence, severity, and demographic and clinical factors associated with the development of pressure ulcers of the ear for patients using oxygen delivered by nasal cannula during hospitalization on an acute medical-surgical unit.”
“With pressure ulcers of the ear in particular, the discomfort associated with the pressure of nasal cannula tubing can lead patients to remove the tubing, thereby compromising their oxygen therapy.”
Lungs For Life 
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