Exam 15: Ear Disorders
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| A focused assessment of the ear should include | Occurrence of ear drainage, tinnitus, vertigo, wax buildup, pressures, pain and pruritus.
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| Otoscopy: | (1) Direct visualization of the external auditory canal and the eardrum.
(2) Nursing implication: Explain to patient the purpose and procedure. Reassure patient that test is painless, requiring only 2 minutes.
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| Tuning Fork Tests: | Weber's Test.
Rinne Test.
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| Weber's test | placing the stem of a vibrating tuning fork in the center of the patient's forehead or on the maxillary incisors. The loudness of the sound is equal in both ears if hearing is normal.
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| Rinne Test | test is performed with tuning forks placed 0.5 inch from the external auditory meatus and the vibrating stem placed over the mastoid bone.
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| Audiometric testing | (1) Measures hearing acuity and determines type and degree of hearing loss.
(2) Nursing implication: provide purpose and explain procedure.
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| Vestibular testing | measures balance and equilibrium. Problems with the vestibular system may manifest as nystagmus or vertigo.
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| Romberg test | measures the patient's ability to perform specific tasks with feet together and eyes open and then with eyes closed.
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| Romberg Test: Normal Response | maintaining balance throughout the entire test.
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| Romberg Test: Abnormal Response | loss of sense of position during the test.
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| Past-point testing | measures the patient's ability or inability to place a finger accurately on a selected point on the body. Inability to correctly perform the test indicates a lack of coordination in voluntary movements.
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| Hearing impairment is | decreased auditory acuity ranging from partial to complete hearing loss.
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| Six types of hearing loss | Conductive hearing loss.
Sensorineural hearing loss (nerve deafness).
Mixed hearing loss.
Congenital hearing loss.
Functional hearing loss.
Central hearing loss.
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| Conductive hearing loss | Caused by any disease or injury that interferes with conduction of sound waves to the inner ear.
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| Sensorineural hearing loss (nerve deafness) | Sound is conducted normally, but a defect in the inner ear results in its distortion. Results from malfunction of the inner ear, vestibulocochlear nerve, or auditory center of the brain. Sensorineural hearing loss is usually irreversible.
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| Mixed hearing loss | A combination of conductive and sensorineural pathology.
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| Congenital hearing loss | Is present from birth or early infancy, and may be the result of anoxia or trauma during the delivery. May be caused by Rh incompatability or mother’s exposure to syphilis or rubella during pregnancy. Possible use of ototoxic drugs.
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| Otitis externa: clinical manifestations | Pain with movement of the pinna or with chewing.
Redness, scaling and pruritis
Swelling of affected area.
Watery discharge and crusting of the external ear.
Dizziness or diminished hearing. (swelling may occlude ear canal).
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| Otitis externa: Dx tests | a culture of the exudates is obtained
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| Otitis externa: Medical management | Oral analgesics.
Corticosteroids used to reduce edema.
Antimicrobial agents such as antibiotic or antifungal ear drops.
Insertion of a wick to prevent loss of medication from canal and to maintain continuous absorption of the medication.
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| Otitis externa: | infection of the external ear and adjacent skin (caused by allergy, virus, fungi or bacteria or trauma). The most common cause is contact with contaminated water (swimmer's ear).
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| Otitis Media: | May be caused by bacterial or viral infection, allergy, exposure to cigarette smoke, and mycoplasma.
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| Otitis Media: Clinical Manifestations | (a) A feeling of fullness in the ear.
(b) Some hearing loss.
(c) May have severe, deep throbbing pain behind the tympanic membrane.
(d) Tinnitus.
(e) Fever may also be present.
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| Otitis Media: Dx Tests | a culture of the purulent drainage to identify the causative organisms.
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| Otitis Media: Medical Management | ABx Therapy.
Needle aspiration.
Analgesics.
Sedatives.
Local heat & nasal decongestants.
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| Why assess for cholesteastoma | squamous epithelium of the external auditory canal grows into the middle ear following a perforation of the ear drum.
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| Labyrinthitis: | an inflammation of the labyrinthine canals of the inner ear. A common cause is a viral upper respiratory infection that spreads into the inner ear. Other causes include certain drugs and food. Tobacco and alcohol may also be causative factors.
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| Labyrinthitis: Clinical manifestations | (a) Severe and sudden vertigo (most common symptom).
(b) Nausea and vomiting.
(c) Nystagmus.
(d) Photophobia.
(e) Headache.
(f) Ataxic gait.
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| Labyrinthitis: Assessment Subjective | Noting the frequency and duration of the vertigo.
Safety measures taken during an attack.
Assessment of other symptoms such as tinnitus, nausea, hearing ability.
Assess patient's feeling such as fear, anxiety.
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| Labyrinthitis: Objective data | Noting vomiting as well as any jerking movement of the eyeballs.
Color and moisture of skin.
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| Labyrinthitis: Diagnostic Tests | (a) Electronystagmography may show diminished or absent nystagmus.
(b) Audiometric testing shows low tone sensorineural hearing loss..
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| Labyrinthitis: Medical Management | (a) No specific treatment.
(b) Usually antibiotics and dimenhydrinate or meclizine HCL for vertigo are prescribed.
(c) Parenteral fluids are ordered if nausea and vomiting persist.
(d) Usually resolves with little or no hearing impairment.
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| Obstruction of the ear: | caused by impaction or excessive secretion of cerumen or by foreign bodies such as peas, insects or small toys.
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| Obstruction of the ear: Clinical Manifestations | (a) Ear to feel occluded.
(b) May be presence of tinnitus or buzzing, pain in the ear and slight hearing loss.
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| Obstruction of the ear: Subjective data | questioning about home remedies used to remove the object and any possible foreign bodies being introduced into the ear.
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| Obstruction of the ear: Objective data | includes noting any presence of a foreign body in the external ear canal. Observation of tugging of the pinna by children.
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| Obstruction of the ear: Dx testing | otoscopic examination provides visualization of the cause of the obstruction.
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| Obstruction of the ear: Medical management | Removal of cerumen by irrigation or cerumen spoon.
Removal of foreign objects with forceps, if possible.
Medications, such as carbamide peroxide 6.5%, may be used to soften cerumen.
Surgical removal of foreign object.
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| Otosclerosis: | Chronic progressive conductive hearing loss occurs due to gradual replacement of normal bone in the otic capsula by highly vascular otosclerotic bone occurs. The replacement bone is described as spongy.
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| Otosclerosis: Clinical Manifestation | (a) Slow progressive conductive hearing loss.
(b) Patient describes a low- to medium- pitched tinnitus.
(c) Deafness is usually first noted between 11 and 20 years of age.
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| Otosclerosis: Subjective data | includes noting the degree and progression of hearing loss or tinnitus and progression of mild dizziness to vertigo. Assess family history for the disease.
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| Otosclerosis: Objective data | includes assessment of behavioral clues related to hearing loss.
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| Otosclerosis: Dx Tests | Otoscopy.
Rinne test.
Weber's test.
Audiometric testing.
Tympanometry.
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| Otosclerosis: Medical Management | Sodium fluoride with vitamin D and calcium carbonate.
Amplification of sound with a hearing aid may be effective.
Stapedectomy (removal of the staples of the middle ear and insertion of a graft and prosthesis) restores hearing.
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| Meniere's Disease | chronic disease of the inner ear characterized by recurrent episodes of vertigo, progressive unilateral nerve deafness, and tinnitus.
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| Meniere's Disease: clinical Manifestations | Recurrent episodes of vertigo.
Hearing loss may be present.
Sudden movements often aggravate the symptoms.
During an attack, nausea, vomiting, diaphoresis, tinnitus, and nystagmus may occur.
Attacks last from a few minutes to several hours.
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| Meniere's Disease: Subjective data | noting frequency and severity of vertigo attacks; Assessment of actions taken by the patient during an attack and degree of relief those actions provided.
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| Meniere's Disease: Objective data | determining the extent of hearing loss. Observe the patient for associated signs during an attack.
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| Meniere's Disease: Diagnostic Tests: done to rule out central nervous system disease. | Audiogram.
Tuning fork test shows sensorineural deficit.
Vestibular test shows lack of balance.
Oral Glycerol test.
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| Stapedectomy: | removal of the stapes of the middle ear and insertion of a graft and prosthesis to restore hearing loss from otosclerosis..
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| Tympanoplasty: | any of several operative procedures on the eardrum or ossicles of the middle ear designed to restore or improve hearing in patients with conductive hearing loss. For eg. Repair of perforated ear drum, dislocation or damage to ossicle.
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| Myringotomy: | a surgical incision of the eardrum performed to relieve pressure and release purulent exudates from the middle ear.
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| Cochlear implants: | An induction coil is surgically implanted beneath the skin behind the ear and an electrode wire is placed in the cochlea.
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| Amoxicillin: | Systemic penicillin antibiotic used in acute otitis media.
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| Carbamide peroxide: | Cerumen removal.
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| Colistin/myomycin/hydrocortisone/thonzonium: | Antibiotic/steroid/detergent used for susceptible disease of external auditory canal, mastoidectomy and otitis media fenestration.
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| Meclizine hydrochloride: | Anticholinergic antihistamine that acts as antiemetic, antivertigo agent. Possible effectiveness for diseases affecting vestibular system.
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| Antipyrine/benzocaine: | Analgesic, local anesthetic, used for otitis media adjunct to cerumen removal.
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| Acetic Acid: | Antibacterial, antifungal, astringent, used for superficial infections of external auditory canal.
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| Dimenhydrinate: | anticholinergic antihistamine used to treat vertigo.
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| Trimethoprim/sulfamethoxazole | sulfa antibiotic used for acute otitis media
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