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Pediatrics Ch 23
Ear Anatomy, Otitis Media, Otitis Externa, Barotrauma
| Question | Answer |
|---|---|
| Which cranial nerve receptors are contained in the ear | 8th – Acoustic |
| What does the ear function to perform | Hearing and Balance |
| What are the divisions of the ear | External, Middle, Inner |
| How is the tympanic membrane of a newborn positioned | Horizontal |
| What is the appearance of the tympanic membrane of a newborn | Dull, Opaque, Inconsistent light reflex |
| What are the characteristics of the newborn Eustachian tube | Short, Wide, Straight |
| What are the Eustachian tube’s functions | Ventilation of the middle ear, Protection from nasopharyngeal secretions and sound pressure, Drainage |
| What is a nurse looking for when examining the ear | Alignment, Cleanliness, Drainage |
| What can low set ears indicate | Kidney disorders, Mental retardation |
| How should the ears be aligned | Should cross an imaginary line from the inner canthus to the lower occiput |
| What is used to examine the inner ear | Otoscope |
| What positions are used to examine the ears | Laying with arms held above the turned head, In the lap of an adult with head pressed to adult’s chest |
| How are ears positioned for drops to be instilled | Infant’s pinna is pulled down and back, Children’s pinna is pulled up and back |
| What is an acute external ear infection called | Otitis externa AKA Swimmer’s ear |
| What are signs of an otitis externa infection | Pain and tenderness on manipulating the pinna or tragus |
| Why are the ear canals of newborns pliable | Underdeveloped cartilage and bony structure |
| Define erythematous | With otitis externa, the ear canal may be erythematous, but the tympanic membrane is ___ |
| What should be ruled out before diagnosing otitis externa | Foreign body, Cellulitus, Diabetes Mellitus, Herpes Zoster |
| What are the treatments for otitis externa | Irrigation, Topical antibiotics, Antivirals |
| What is otitis media | Inflammation of the middle ear |
| Where is the middle ear located | Tiny cavity in temporal bone |
| What guards the middle ear | Tympanic membrane |
| Which part of the ear contains the organs of hearing and balance | Inner |
| What does sound pass through from the tympanic membrane to get to the inner ear | Oval window |
| What is the middle ear connected to | Mastoid sinuses, Throat |
| What part of the ear opens into the throat | Eustachian tube in the middle ear |
| What allows infection to easily spread to the middle ear and mastoid | Mucous membrane lining |
| Where do middle ear secretions drain to | Nasopharynx through the eustachian tube |
| Where is air pressure between the middle ear and outside air equalized | Eustachian tubes |
| What happens if there is unequalized pressure in the ear | Negative pressure allows organisms to be swept into the eustachian tubes |
| What usually occurs after an upper respiratory infection | Otitis media |
| What age group is typically affected by otitis media | 6 – 24 month, Early childhood |
| What are the most common causes of otitis media | Streptococcus pneumonia, Haemophilus influenza |
| What has reduced the incidence of pneumococcal otitis media | Polyvalent pneumococcal polysaccharide vaccine |
| Why are polyvalent pneumococcal polysaccharide vaccines ineffective in children under 2 | They are unable to produce antibodies |
| Why are infants more probe to middle ear infections | Short, Wide, Straight eustachian tubes |
| What are the signs and symptoms of an ear infection | Articulation problems, Diarrhea, Fever, Headache, Hearing loss, Inattentive behavior, Irritability, Loud speech, Pain in the ear, Rubbing or pulling the ear, Rolling the head, Speech development problems, Vomiting |
| What does the tympanic membrane of a patient with otitis media look like | Red and Bulging |
| What may happen if an abscess forms in the ear | It may rupture the eardrum, drain, and relieve pressure |
| What can result from eardrum rupture | Hearing loss |
| When is otitis media considered a chronic condition | Lasts longer than 3 months |
| What can chronic otitis media lead to | Cholesteatoma |
| What is cholesteatoma | A cystlike sac filled with keratin debris |
| What kind of physician should treat cholesteatoma | Otolaryngologist |
| What are the complications of repeated acute attack of otitis media | Development of chronic otitis media with effusion |
| What is effusion | Fluid accumulation |
| How is an ear infection treated | Causative organism found, Relieve symptoms, Throat culture, Broad spectrum antibiotics, Analgesics |
| What are broad spectrum antibiotics | Those that cover gram positive and gram negative bacteria |
| What is myringotomy | Incision in the tympanic membrane to relieve pressure and prevent tears by spontaneous rupture |
| What may be inserted in a myringotomy | Tympanic membrane (TM) button, Typanostomy ventilating tube (PE Pressure Equalizer) |
| How are TM buttons and PEs removed | Fall out spontaneously within 6 – 12 months |
| How is a child with a ruptured ear drum positioned | On the affected side |
| Hearing LossWhat can hearing loss affect | Speech, Language, Social and Emotional Development, Behavior, Academic achievement |
| When is the inner ear fully formed | During the first months of prenatal life |
| What can cause a hearing loss called congenital deafness | Mother with German measles or other viral infection during the first months of prenatal life |
| What can cause acquired deafness | Infectious diseases, Measles, Mumps, Chickenpox, Meningitis, Common cold, Some medications, Loud noises, Allergies, Ear infections |
| What can cause temporary deafness | Cerumen accumulation |
| At what decibel can some toys emit sound | 110 |
| At what decibel can ear damage be caused | 80 |
| What is a complete bilateral hearing loss | Loss in both ears |
| What problems cause hearing loss | Defects in sound transmission to the middle ear, Damage to the auditory nerve or ear structures, Mix of defects in nerve pathways and interference |
| How do children learn to talk | Imitating what they hear |
| What may be responsible for behavioral problems in school | Partial bilateral deafness |
| What most commonly causes partial bilateral deafness | Chronic ear infections, Blockage of eustachian tubes |
| How should a nurse communicate with a hearing impaired child | Eye level, Face to face, Eye contact, Short sentences, Avoid exaggeration of movement |
| What is the goal of the American Academy of Pediatrics regarding hearing loss | Detection of impairment by 3 months of age, Interventions started no later than 6 months of age |
| What is the preferred method for testing the hearing of a neonate | Evoked Otoacoustic Emissions test (OAE) |
| What test records brain wave responses generated by the auditory system | Brainstem Auditory Evoked Response (BAER) |
| What are the first signs that can alert a parent or nurse to hearing loss in an infant | lack of response to sounds or music or lack of startle response by 4 months |
| When is complete bilateral deafness usually discovered | During infancy |
| When is partial deafness usually discovered | When the child begins school |
| Who usually discovers hearing problems in children during school | School nurse |
| What is tympanometry | Ear pressure measuring |
| What is a Rinne test | Using a tuning fork to evaluate for air conduction |
| What is a Weber test | Using a tuning fork to evaluate for bone conduction |
| What confirms a diagnosis of hearing loss | Visual Reinforcement Audiometry (VRA) |
| What can be used in some children with hearing loss due to nerve damage | Cochlear implants |
| What does the Brazelton Neonatal Behavioral Assessment Scale evaluate regarding hearing | The infant’s orientation response to the sound of a voice |
| The Moro reflex beyond ___ months may indicate deafness | 4 months |
| If an infant makes no verbal attempts by ___ it should undergo a complete physical exam | 18 months |
| When a child with a hearing aid goes to surgery, what is done with the hearing aid | It is given to the parents or put in a safe place |
| What should the nurse check for with hearing aid fit | That there are no ear hairs caught on the end |
| What can ear hair caught on the end of a hearing aid cause | Fit problems, Noise, and Whistling |
| What should children do during decent of an airplane | |
| Yawn or Chew gum to promote swallowing | |
| What should infants be encouraged to do during airplane decent | The bottlefed juice or water to promote swallowing |
| What can be taken before air travel | Systemic decongestants timed so that their peak effectiveness occurs during airplane descent |
| What can cause barometric pressure changes to the ear in adolescents | Underwater diving |
| What can barometric pressure changes in the ear cause | Severe earaches and other serious problems |
| What phase of underwater diving should be slow to minimize negative pressure | Descent |
| Why should the decent phase of underwater diving be done slowly | To minimize negative pressure |
| What may occur during the ascent phase of underwater diving | Sensory hearing loss and vertigo with nausea and vomiting indicating early signs of decompression sickness |
| What are contraindications to diving | Upper respiratory infections or tympanic membrane perforation |
| Why are upper respiratory infection or tympanic membrane perforation contraindications to diving | Vertigo, Nausea, Vomitting, Disorientation can occur with dangerous results |
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futurenurse
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