It is used to treat who complains of foreign body or cerumen (ear wax) impaction. 8. cloudy fluid. Problems with the nerve pathways from your inner ear to your brain can also cause SNHL. Fill the reservoir of the irrigator; check that the temperature of the water in the tank is approximately 38 C - 40 C. 0. . either of the two organs, one on each side of the head, by which people or animals hear sounds…. Post a Question. MRS. noun: Refers to person, place, thing, quality, etc. You may have pain in one or both ears. Do not use drops if you have a hole in your eardrum (a perforated eardrum). [1] Major components of earwax include cerumen, produced by a type of modified sweat gland, and sebum, an oily substance. Use otoscope to. Ear spray is a routine process used to remove excess earwax, or cerumen, and. Most ear problems can be dealt with during our normal office hours. 1. Objective: This guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Weitere Aktionen. 2 out of 5 stars 11,348. To access the deeper external ear canal structures during the procedure, you should:, Ear irrigation should not be performed if. You may report 69210 Removal impacted cerumen requiring instrumentation, unilateral if instrumentation is used to remove impacted cerumen. Refresh air in the ear. The irrigation of the ear is a routine procedure that is used to remove excess cerumen, or wax, as well as foreign materials from the ear. In order to help Otolaryngologist – Head and Neck Surgeons correctly code, the Academy helped the American Medical Association (AMA) draft a CPT Assistant article on the removal of impacted cerumen. Using the palms to get some reverse pressure in the ear and vacuum the water out may be possible. Q. It is used to treat who complains of foreign body or cerumen (ear wax) impaction. 1 Count (Pack of 1) 4. Though both surface and subsurface water come from precipitation such as rain or snow, it is far more difficult to determine the origin of subsurface water. Irrigation is the process of applying water to the crops artificially to fulfil their water requirements. OE can be classified as acute (lasts less than 6 weeks) or chronic (lasts more than 3 months). Aural toilet is a procedure used to clean the external auditory meatus (EAM) of the ear of wax, discharge and debris. Your inner ear contains two main parts: the cochlea and the semicircular canals. Other removal methods include irrigation, using wax-softening products, and manual removal. The problem may go unnoticed and untreated for a long time. SARASWATHY. In order to reduce litigation in ear irrigation and provide the patient with effective and safer ear care this document was originally produced by the ‘Action On ENT’ Steering Board (2002) and endorsed by the Royal College of General Practitioners, The Royal College of Nursing, The Primary Ear Care Centre and the Medical Devices Agency. Irrigation when the wax is hard increases the risks of perforating the ear drum. Sterile cotton balls and cotton-tipped To clean the external auditory canal. VITCOCO Ear Wax Removal Kit Ear Camera 1296P High-Definition Earwax Cleaner Portable USB Charging Visible 6 LED Otoscope. It may take 4-5 days for the ear canal to recover from infection, in which case more wax will be required to protect it. Anyone can get swimmer’s ear, but it is most often seen in children. Ear irrigation is a procedure in which nurses flush their patient’s ear canal with sterile water or saline solution. cotton balls in a container to. Sweep both the inferior and superior fornices. e. While it can be dangerous to try to use tools to remove this plug in your ear, ear irrigation is a much easier, gentler, and safer option. instil water into the ear canal 15 minutes before repeating ear irrigation. . Ear Irrigation Protocol for SCC Care Coordinators Patient: The patient presents with suspected cerumen impaction, either due to history of the same, loss of hearing, or. The purpose of ear irrigation is to remove earwax that is obstructing the ear canal or to remove a foreign object. the practice of supplying land with water so that crops and plants will grow: 2. About Henry Schein. Ever. 003429. In the literature, there are only few cases reported about aural myiasis. Ear Infections. From personal experience sometimes the drops can thin out your earwax which would explain why it’s honey-like now. Dear irrigation is a procedural in which nurses wash my patient’s ear canal with sterile water or saline download. The doctor uses a tool called an otoscope to get a clear image of the middle ear to see if irrigation is necessary. In medicine, the caloric reflex test (sometimes termed 'vestibular caloric stimulation ') is a test of the vestibulo-ocular reflex that involves irrigating cold or warm water or air into the external auditory canal. Earwax Blockage. 1. They're rare but, if left untreated, they can damage the delicate structures inside your ear that are essential for hearing and balance. 1 4. Protecting the delicate skin of the ear canal from getting irritated when water is in the canal. An ear exam may be done if you have an earache, ear infection, hearing loss, or other ear symptoms. Ear irrigation is an ear cleansing method that people use to remove a buildup of earwax. If the water temperature is too cold or too hot, complications, such as dizziness or damage to the ear canal, can result. The. Ear irrigation is the process of flushing the external ear canal with sterile water or sterile saline. This article outlines the key skills required to undertake safe and effective ear irrigation in the management of ear wax, a common problem experienced by patients in primary care. cleaning, prodding, scratching, or scraping the ear canal with a cotton swab. Earwax is vital for protecting your ability to hear. 3, 4 Cerumen becomes drier at an older age due to atrophy of the cerumen glands. it is used to treat patients who complain of foreign body or cerumen (ear wax) impaction Ear irrigation entails rinsing the external. Physicians should diagnose impaction only when an accumulation of cerumen is associated with symptoms (e. Irrigating the ear with water will usually clear plugs of earwax. Located on either side of the head, the ears are found directly over the temporal lobe of the brain. 7,10,11 Proper temperature and amount of irrigation fluid are important factors for patient safety. Ringing or noises in the ear (tinnitus) Hearing loss. Objectives: Identify the the indications for ear irrigation. Using the saturated cotton ball, drip the saline solution into your ear. To remove the foreign bodies. 9% nasal drops (off-label use as ear drops). Symptoms of otitis externa include: 2. To hold your cat in your lap to place ear medications, drape your left forearm across the cat’s body to keep it in your lap. To protect bedding and garments. Expose healthy tissue. Perforated Eardrum. The result of the simple calculation method will therefore be more accurate than the result of the estimation method. How should you position the adult's ear? pull the auricle upward and outward. The AMA CPT Assistant article “Removal of Impacted Cerumen. Assist the client to a sitting position or lying position with the head tilted towards affected ear. Otitis externa is often referred to as “swimmer’s ear” because repeated exposure to water can make the ear canal more vulnerable to inflammation. It cleans, lubricates, and protects the lining of the ear canal, trapping dirt, dust, and hair, and repelling water. See examples of IRRIGATION used in a sentence. Pain that mimics an ear infection. However, despite being considered effective and safe, ear syringing causes major complications in 1 out of 1,000 patients and is associated with a variety of risks. Electric Ear Wax Removal Tool Ear Cleaning Kit Safe and Effective Ear Irrigation Flushing System Reusable Ear Washer for Adults with Ear Cleaner Camera, Blue. g. Definition Ear irrigation is the process of flushing the external ear canal with sterile water or sterile saline. Break 'ear irrigation' down into sounds: say it out loud and exaggerate the sounds until you can consistently produce them. " Simply put, xeriscape landscaping is a type of. In medicine, the caloric reflex test (sometimes termed 'vestibular caloric stimulation ') is a test of the vestibulo-ocular reflex that involves irrigating cold or warm water or air into the external auditory canal. Cerumen, or wax as it is commonly known, is a normal secretion of the ceruminous glands in the outer meatus. Use about 10 cc of irrigating solution each time. DEFINITION • An eye irrigation is the washing of the conjunctival sac by a stream of liquid. It is also used to dry the EAM following ear irrigation PURPOSE Aural toilet is used to clear the EAM (external auditory meatus) of debris, discharge, soft wax or excess fluid following irrigation EVIDENCESodium Chloride Irrigation - Clinical Pharmacology. Place an emesis basin next to the eye to catch drainage d. 30 Disposable Irrigation Tips . Long story if you care to read it. Itching, pain, and temporary conductive hearing loss may result. Ear irrigation is a therapeutic medical procedure that is used to clear away excessive earwax (cerumen). When a patient comes in with ear pain due to impacted cerumen, the health-care provider would normally instruct the nurse to perform ear irrigation. 4. A cerumen impaction is an accumulation of cerumen that causes symptoms, such as hearing loss, fullness, otorrhea, tinnitus, dizziness, or other symptoms, and/or prevents a required assessment of the ear canal, tympanic membrane, or audiovestibular system. High Definition Ear Wax Removal 【Safe & Effective Ear Wax Removal】Electric Ear Cleaner is a safe, effective, and gentle way to clean your ears. This part of the ear is located behind the eardrum. Advise the person to use the drops 3–4 times daily for 3–5 days initially. The eardrum. Remove wax with forceps, irrigation and/or ear drops N/A N/A: Viral or bacterial infection Oral steroids, decongestants and antibiotics for bacterial infections N/AMicro-suction earwax removal is a safe, effective, and painless procedure for removing excess earwax. If it is, a syringe-like tool is used to insert water or a saline. There are a few contraindications to performing irrigation of the ear including lack of patient consent. 1. Introduction. To evaluate vestibular functions eg: by thermal caloric test. 3K+ bought in past month. Healthcare professionals often perform bladder irrigation following a surgery involving the urethra, the tube that carries urine. 2 Do not offer adults manual syringing to remove earwax. It is more common to occur in tropical regions, where humidity and warm weather provide a good environment for this infestation. Elephant Heed Washer Bottle System due Doc Easy. Fans say that as the candle burns, it creates a. The fluid can become thick and. Purpose Nasal irrigation is used to clear infected sinuses or may be performed after surgery to the nose region. This method is less invasive than 69210: A continuous, low-pressure flow of liquid (e. Irrigation is one of the techniques used to remove earwax from the ear canal. Signs and symptoms of glue ear can include: problems hearing – children may want to have things repeated, talk loudly or have the television up loud. IRRIGATION meaning: 1. When repaired appropriately, lacerations to the ear generally heal well because of this generous dual blood supply. Place the ear wick in the canal with a forceps or tweezer, then place 5 or so drops of antibiotic solution in the ear to expand. Pretreat the ear with 2 to 4 drops of warm water orpaganismos said: ↑. Nasal irrigation clears mucus and flushes out pathogens, allergens or other debris. Anyway, when my ears get compacted and won’t even. [ 5] Many options are available to attempt to clear ear wax. The doctor will apply a high-pressure flow of water to the ear canal to dislodge and remove the plug. Provide details on what you need help with along with a budget and time limit. The procedure ends when the cerumen impaction is removed or the physician and patient or caregiver agree that another approach is required. Summary. Ear discharge, also known as otorrhea, is any fluid that comes from the ear. Cerumen (i. Ear irrigation: If done gently should feel just like water in the ear when showering or bathing. Learn how we can help. irrigation: [noun] the therapeutic flushing of a body part with a stream of liquid. Definition Ear irrigation is the process of flushing the external ear canal with sterile water or sterile saline. a. Kevin Daus answered. A ruptured eardrum (tympanic membrane perforation) is a hole or tear in the thin tissue that separates the ear canal from the middle ear (eardrum). Then we are more likely to use irrigation. Reporting 69209. 4. Summary. Cleanse external ear of any drainage with cotton ball or washcloth moistened with normal saline or water. deafness. Nevertheless, there are limitations, contraindications, and potential side effects of the. Ear wax, or cerumen, is a. 2. To apply heat. EAR IRRIGATION. We recognize that the term "impaction" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen. It may be serous, serosanguineous, or purulent. To remove the earwax. Cerumen is a mixture of secretions and sloughed epithelial cells. The job of. Set the pressure at minimum. Have the patient support the basin under the ear to receive the irrigating solution. Normally, the canal is skin-colored and has small hairs. It is slightly acidic, giving bactericidal qualities in both its. Learn about PE tube insertion and aftercare for your child. This method has previously been shown to reverse hearing loss in 9% of cases and improve hearing by about 5 dB. Ear instillation Definition. Have the patient sit up or lie with head tilted toward the side of the affected ear. Associated symptoms may include ear pain, fever, pruritus, vertigo Dizziness and Vertigo Dizziness is an imprecise term patients often use to describe various related sensations, including Faintness (a feeling of impending syncope) Light-headedness Feeling of imbalance or unsteadiness. 2 out of 5 stars 2,473the ear canal. This is a straightforward procedure where a controlled flow of water, at body temperature, is squirted into the ear through a purpose-made machine (an electronic ear irrigator. How To Use Irrigation In A Sentence. An ear instillation is a solution of topical medicine prepared for administration into the ear canal. Ear irrigation may also be used for caloric stimulation. dizziness or vertigo. This method is discussed as a separate topic. syringe: [noun] a device used to inject fluids into or withdraw them from something (such as the body or its cavities): such as. If your child is showing signs of ear-related pain or discomfort, it's best to reach out to their pediatrician. Irrigation should NOT be carried out if: the patient has previously experienced complications following this procedure in the past there is a history of a middle ear infection in the last six weeks Ear irrigation. To manage the symptoms of sinus conditions and ear congestion, a person can: Breathe in steam from a bowl of hot water or shower. Ear irrigation, also known as ear lavage, is a procedure to remove ear wax that can build up in the ear canal and block part or all of it. Healthy earwax color and texture can greatly vary. An ear lavage, also known as ear irrigation or ear flush, is a safe method of earwax removal when performed by a healthcare professional. The ear canal may be obstructed by cerumen (earwax), a foreign object, or an insect. It is used to treat patients who complain of foreign body or cerumen (ear wax) impaction. Ear irrigation is the process of flushing the external ear canal with sterile water or sterile saline. It can be done at home or by a healthcare provider using body-temperature water. While it’s generally a safe process, it’s not uncommon go experience einige dizziness and select symptoms afterward. It is used alone or in association with other therapies in several conditions—including chronic rhinosinusitis and allergic rhinitis—and to treat and prevent upper respiratory tract infections, especially in children. During a shower, a small amount of warm water enters the ear canal and loosens any wax accumulated there. EAR IRRIGATION . As a nurse or medical assistant in a doctor's office, you may be asked to assist with ear irrigation to remove excess cerumen or foreign materials from the ear, and to instill ear medication. Cerumen typically is asymptomatic and does not impair physical examination. [1] [. Ear irrigation, using a targeted water stream, is a safe, effective way to flush out excess wax. Accumulation of cerumen is usually asymptomatic but can occasionally cause bothersome symptoms, such as hearing loss and/or ear discomfort. Hearing loss (temporary or permanent) and tinnitus (ringing type noise inside the ear) or worsening of it if already. 44. cotton balls in a container to. When cold water or air enters your ear and the inner ear changes temperature, it should cause fast, side-to-side eye movements called nystagmus. Ask the patient to hold the receiver under the same ear. The yellowish waxy substance is a combination of lubricants and dry. Ear irrigation. Contraindications. An individual assessment should be made of every patient to ensure that it is appropriate for ear irrigation to be carried out. Definition von Ear Irrigation Dear irrigation is a procedural in which nurses wash my patient’s ear canal with sterile water or saline download. Irrigation. By using caloric irrigation, you are stimulating each end. Squirt that shit in your ear canal. Inner ear, consisting of: Cochlea. Nasal irrigation is used to clear infected sinuses. Earwax can be many colors, including brown, orange, red, yellowish, and gray. DEFINITION : An eye irrigation is the washing of theInexpertly performed irrigation of the ear canal for wax can lead to perforation. One of the most common characteristics of chronic rhinitis is post-nasal drip. 003429. Ear Irrigation. Diagnosis is based on inspection. EAR (OTIC) INISTILLATION Definition: Instill liquid medication into external auditory canal for such therapeutic effects. These include: irrigation (syringing with unregulated manual syringes should no longer be used); the use of wax softeners/solvents alone; the use of wax softeners prior to irrigation; and the manual removal of wax by use of an oto-endoscope and small instruments or a binocular microscope with suction and. A pneumatic attachment is available to apply pressure to assess the mobility (i. Ear irrigation is the process of flushing the external ear canal with sterile water or sterile saline. Ear drops, oils, peroxide, or irrigation may also be helpful. Fever, usually low-grade. Place the towel on the patient's shoulder on the affected side. (ear-cleaning process) limpieza de oído nf + loc adj. Otitis externa is often referred to as “swimmer’s ear” because repeated exposure to water can make the ear canal more vulnerable to inflammation. Pathogens include germs, like bacteria and viruses. What are the instructions? Plan to irrigate your nose with hypertonic solution saline 2-3 times per day. Learn more. Perform a patient care handwash and gather the equipment and solutions required for the ear irrigation. A person can relieve minor to moderate symptoms by using a saline nasal spray or irrigation system. It is often used by individuals with sinus problems, allergies, or upper respiratory infections. A steady, gentle stream is used; pressure should be sufficient to reach the desired area, but not enough to force the fluid beyond the area to be irrigated. Sc(N) ASSOCIATE PROFESSOR IN NURSING MEDICAL SURGICAL NURSING ; 2. Here we describe the anatomy of the ear in simple terms. Often the use of cerumenolytics is combined with either irrigation or manual removal. PURPOSES. Before and after attempting to remove. Creating a vacuum. Treatment is careful manual removal with proper lighting and instruments. Anatomy Of EarNAME: TAN, LI LUREN RAPHAELLE S. Symptoms of otitis externa include:2. Ear irrigation is performed to remove material that blocks the external ear canal, to clean the ear canal of drainage, and to reduce local discomfort. The ear is composed of many mechanical parts and nerves that not only interpret sound, but also correct imbalance in the body. Dizziness. . Ear irrigation is a common medical procedure performed by healthcare providers to remove excess ear wax buildup. In some cases, inflammation can extend to the outer ear, such as the pinna or tragus. auditory canal with a stream of liquid. Accumulation of cerumen is usually asymptomatic but can occasionally cause bothersome symptoms, such as hearing loss and/or ear discomfort. Ear irrigation is used to soften and remove earwax ( cerumen) buildup. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. ear up as irrigation proceeds. Clinical Example (69210) A 69-year-old male presents with a recent worsening of hearing in the left ear over a several-day period. 1K views•12 slides. In most cases, earwax impaction isn’t dangerous and symptoms go away with treatment. 17. The acute form is caused primarily by bacterial infection, with Pseudomonas aeruginosa and Staphylococcus aureus. Definition. Place the protective cape and paper towel on the patient’s shoulder and under the ear to be irrigated. Irrigation activation systems can increase the effectiveness of the irrigations . The pointed end is placed in your ear while the other end is lit. 1 out of 5 stars 139 ratings | 3 answered questions . remove foreign objects from the external auditory canal 2. Nasal irrigation, or a sinus flush, is the practice of rinsing out your nasal passageways. Definition. External otitis is an acute infection of the ear canal skin typically caused by bacteria ( Pseudomonas is most common). tinnitus – hearing sounds coming from inside the body. Post-nasal drip. Describe and demonstrate how to instill medication safely into a patient's ear. Lernen Sie die Übersetzung für 'irrigation' in LEOs Englisch ⇔ Deutsch Wörterbuch. Before having ear irrigation or microsuction to remove earwax, it is advisable to apply olive oil eardrops 3 times a day to each ear, for 7 to 10 days before having the wax removed. Normal saline solution is the most widely used irrigant because of availability, sterility. Usually, the procedure takes between 15 to 30 minutes. In some people, the glands produce more wax than can be easily removed from the ear. An ear irrigation is the washing of the external auditory canal with a stream of liquid. Cough. Abstract. Ear irrigation is the removal of wax from the ear using water via an electronic irrigator. It can remove germs or debris that can cause allergies, such as dust or pollen, as well as loosen thick mucus, enhance mucocilliary clearance (how the nose. Dizziness, vertigo or balance problems. canal de riego loc nom mPeople with ETD may experience a number of warning signs. Though mostly made of cartilage and skin, the outer ear arises from the temporal bone. b. Ear instillations are used primarily to treat wax build-up and inflammations or infections of the ear. This is to make sure it is normal. Nowadays, there is a whole variety of irrigating. Parents or teachers may notice this, especially in noisy places such as classrooms. Myiasis of the ear is an infestation of the ear by maggots (the larval stage of flies). Eye instillation and ointment Archana Syiem. Learn more. Irrigation, on the other hand, refers to the process of flushing out a body cavity or wound with a stream of liquid. having a skin. Cerumen is a mixture of secretions and sloughed epithelial cells. Thank. Ear irrigation, also known as ear lavage, is a procedure to remove ear wax that can build up in the ear canal and block part or all of it. This condition affects your hearing by damaging your stape, a tiny U-shaped bone in your middle ear. The superficial temporal artery and posterior auricular artery provide the blood supply to the ear. Penetrating injuries of the tympanic membrane may result in dislocations of the ossicular chain, fracture of the stapedial footplate, displacement of fragments of the ossicles, bleeding, a perilymph fistula from the oval or round window resulting. irrigation翻譯：灌溉。了解更多。 This paper builds upon the theoretical framework from the precision irrigation literature to study the roles of information, institutions, and price incentives in irrigated agriculture. Fill the reservoir of the irrigator; check that the temperature of the water in the tank is approximately 38 C - 40 C. any of various organs (as of a fish) capable of detecting. This comprehensive article aims to provide a thorough. Treatment is careful manual removal with proper lighting and instruments. redness, swelling, drainage, abrasions, and pr. 3. If your child has recurrent ear infections, they may need to receive pressure equalizer (PE) tubes. Clinical Example (69210) A 69-year-old male presents with a recent worsening of hearing in the left ear over a several-day period. cleanse the canal from. Irrigation canal on the left. Questions are posted anonymously and can be made 100% private. The solution may contain antibiotics or steroid medications. Irrigation has been a key aspect of agriculture for over 5,000 years and has been developed by many cultures around the world. When I need someone to talk to, Patricia is always willing to lend an ear. Protect the patient and bed with a waterproof pad. ence of cerumen or for eign objects; attempted. The provider flushes or washes (irrigation/lavage) out the entrapped wax (cerumen) from a patient’s external ear canal with a stream of water to correct hearing loss or discomfort. dummy. 2. Wash hands and collect the articles and take it to the bedside. A cerumenolytic is an ear wax ( cerumen) softening agent. Earwax: Summary. 1, 2 About 5% of adults, 10% of children and one-third of geriatric and cognitively impaired individuals are affected. toward side of the affected ear. figurative, dated (listen to [sb]) prestar atención, escuchar con atención, escuchar atentamente loc verb. Inspected pinna and external auditory meatus for. You are about to preform an ear irrigation on an adult. 6-7. PURPOSE To remove foreign bodies buildup, which can cause the following symptoms vision loss photophobia itching. Earwax Blockage. Regulate air pressure in the middle ear. Irrigation is a cleansing method that involves inserting warm water into your ear canal to clear excess wax away, and removing loosened wax particles with a forceps delivery or other medical. Clinicians perform an otoscope exam to assess the condition of the external auditory canal (EAC), tympanic membrane (TM), and the middle ear. Irrigation may involve using a syringe to insert liquid into the ears to flush the earwax out. Thumb forceps in a sterile solution. This depends on how deep the ear wax is inside the ear, the amount, and the type of ear wax. PURPOSE • Treat inflammatory process of conjunctiva • Apply medication for an antiseptic effect • Remove foreign objects or irrigating chemicals • Apply heat or cold to the eyes • Prepare for eye surgery. It involves washing out the ear canal with water from a commercial irrigator or a syringe with a catheter. Pharyngeal or tracheal foreign bodies are medical emergencies requiring surgical consultation. Ear irrigation involves using a pressurised flow of water to. Irrigation of the ear is one method providers can use to treat cerumen impaction when appropriate. 21. Ear irrigation is usually done to clear the ear canal, clean any discharge, soften and remove ear wax, or remove a foreign body from the patient's ear. DATE: NOVEMBER 4, 2021 EAR IRRIGATION DEFINITION Ear irrigation is a routine procedure used to remove excess earwax, or cerumen, and foreign materials from the ear. The AMA CPT. You can also use a commercial ear irrigation kit. Nutrients may also be provided to the crops through irrigation. Excessive ear wax (cerumen) is frequently the cause of muffled hearing. NICE advises healthcare professionals to use either the ear irrigation method or. To produce local anesthesia. Fussiness in infants. Use of salt water in ear can help the ear wax to get softened and for the removal of it. The purpose of this statement is to describe the use of aural irrigations for removal of. Sweep both the inferior and superior fornices. Hold the medication in your right hand. It is essential that irrigation of the eye is understood and performed correctly. All you need is a little warm water and a syringe or bulb syringe. 6K views•14 slides. Steps 6-11 of Ear irrigation. Necrotizing (malignant) external otitis, an infection involving the temporal and adjacent bones, is a relatively rare complication of external otitis. PURPOSE To cleanse the canal of discharge, to soften and remove impacted cerumen, or to dislodge a foreign object. 3.