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Ear 1329
| Question | Answer |
|---|---|
| 3 areas of the ear | outer ear, middle ear, inner ear |
| also called the auricle; consists of pinna, external acoustic meatus, tympanic membrane | outer ear |
| air filled cavity in the temporal bone; consists of eustachian tube, 3 small bones, oval window | middle ear |
| extends from the middle ear to the pharynx; equalizes pressure in the middle ear | eustachian tube |
| 3 small bones in the middle ear | malleus, incus, stapes |
| also called the labyrinth; consists of cochlea, semicircular canals, vestibulocochlear nerve | inner ear |
| provides hearing | cochlea |
| provides balance | semicircular canals |
| Cranial Nerve VIII | vestibulocochlear nerve |
| vibrates the fluid and stimulates the nerve receptors in the Organ or Corti (located in the cochlea); waves converted to nerve impulses and transmitted along the cochlear nerve to the brain | mechanics of hearing |
| perception and interpretation of sound depend on a complex series of steps; malfunction at any step can result in some type of hearing impairment | physiology of hearing |
| age related changes with hearing | skin of auricle may become dry and wrinkled; cerumen production declines; protective wax is drier; hairs in canal coarser/longer; eardrum thickens; bony joints in midde ear degenerate; atrophy of cochlea, cochlear nerve cells, and organ or Corti |
| type of hearing loss associated with age | presbycusis |
| specialize in diagnosis and treatment of ENT disorders | otolaryngologists (ENT doctors) |
| person trained in performing hearing tests, measuring hearing loss, and recommending treatment to improve hearing | audiologist |
| instrument used to examine the external auditory canal; uses a light, lens, and speculum | otoscope |
| normal intact eardrum: | pearly gray and transmits light |
| basic hearing tests: | whisper test; audiometry; caloric test; electronystagmography; Rinne's test; Weber's Test; Rombert Test |
| stand 1-2 feet away from client and whisper; ask client to epeat words that are whispered | whisper test |
| assessment of the ability to hear simple sound waves; measured in decibels; measured by the intensity at which sound is first heard | audiometry |
| used to diagnose disorders in the vestibular system; inner ear; ear is irrigated with cold or warm water and the pt is observed for reactions that suggest vestibular problem; nystagmus is the expected response; slight dizziness may occur | Caloric Test |
| evaluates the mechanism that facilitates maintaining balance (vestibular function); done with caloric stimulation; measures duration and velocity of eye moveent recorded | Electronystagmography |
| use a tuning fork to assess the condution of sond by air and by bone | Rinne's and Weber's test |
| tuning fork tests conductive and sensorineural hearing loss; AC>BC | Rinne's |
| tuning fork to top of head, sound should be heard equally | Weber's |
| evaluates balance; feet together and eyes closed; arms out at side; if swaying, loss of balance or arm drifting occurs, test is abnormal | Romberg test |
| can occur from repeated exposure to loud noises; impairs the ability to communicate with others | hearing loss |
| 3 types of hearing loss | conductive, sensorineural, mixed |
| results from interference with the transmission of sound waves from the external or middle ear to the inner ear; can be reversible; can result from increased cerumen, failure of bones in ear to vibrate, trauma, tumors | conductive hearing loss |
| sometimes called nerve deafness; irreversible; patients with this type can hear sounds but have difficulty understanding speech | sensorineural hearing loss |
| age related deafness (sensorineural hearing loss) | presbycusis |
| combination of conductive and sensorineural hearing loss; can be from middle ear conditions, otitis media, otosclerosis, etc; temporal bone fractures | mixed hearing loss |
| due to some problem in the CNS | central hearing loss |
| medical treatments of hearing loss: | hearing aids, sign language, speech reading, close captioning, TDD (telecommunication device), lights attached to doorbell, phones, hearing dogs |
| most beneficial in conducting hearing loss, need to be prescribed for cleint's current hearing loss | hearing aids |
| electrodes placed into inner ear and attached to receiver located in bone behind the ear, stimulate nerve fibers in the cochlea to produce sound; several months of training are needed to learn to tell the sounds apart; variable results for profoundy deaf | cochlear implant |
| nursing management for cochlear implant | assess for degree of hearing loss; s/s of hearing loss |
| s/s of hearing loss | hight television volume, asking others to repeat words, frequent nodding, will try to read lips |
| see box 43-2 pg. 627 | |
| To help clients with hearing loss | talk slower and louder, write things down, use pictures and pamphlets during instructional conversations, return demonstrations |
| device that amplifies sound; cost can range from several hundred to several thousand dollars | hearing aids |
| interferes with sound transission carried on air waves; pts report feeling of fullness, pain (otalgia) in ear and dimished hearing; removed with 1-2 drops of 1/2 strength hydrogen peroxide, warm glycerin or mineral oil, or softened w/commercial agents | impacted cerumen |
| With foreign objects in the ear, client will: | complain of pain, have decrease in hearing; have feeling of movement of hear buzzing |
| assessment for foreign objects shows: | foreign object, swelling and redness in auditory canal |
| treatment for foreign objects: | mineral oil; forceps |
| nursing management for foreign objects in the ear: | instruct client to clean ears with face towels; nothing placed in ear canal; protection of ears from flying insects |
| inflammation of tissue in uter ear; can be from entry of pathogen into canal after injury, moisture, infected hair follicle | otitis externa (Swimmer's Ear) |
| Assessment of otitis externa shows: | redness in tissue; swelling; enlarged lymph nodes; fever |
| treatment of otitis externa | warm soaks to ear; analgesics; antibiotic drops |
| nursing management with otitis externa | instruct client to carry out medical treatment; provide teaching to prevent reoccurrence; advise client to avoid the use of non-prescription remedies unless approved by physician |
| infection of the middle ear; usually develops after respiratory infections (purulent), allergic reactions (serous), fluid accumulates in middle ear, causin painful pressure on the tympanic membrane | otitis media |
| characterized by hearing loss and continuous or intermittent drainage; scarring can be present; leaves client prone to repeated infections | chronic otitis media |
| With chronic otitis media, the eardrum is usually __________ or shows signs of a healed _____________. | perforated; perforation |
| Infection in the middle ear can extend to the mastoid bone because: | the middle ear is directly connected to the air cells in the mastoid bone. |
| Because the brain lies next to the mastoid bone, the infection can spread there as well, causing: | meningitis, brain abcess |
| usually follows an acute respiratory infection, otitis media, pneumonia or influenze | labyrinthitis |
| labyrinthitis - assess for: | Hx allergy or URI |
| s/s of labyrinthitis | fever, tinnitis, dizziness, pain (relieved with perforation), hearing loss, red eardrum, elevated WBC (normal is 5,000 - 10,000) |
| treatment for labyrinthitis | antibiotics, myringotomy, tympanotomy |
| incision mad to ear drum to facilitate drainage | myringotomy/tympanotomy |
| repair of perforated eardrum | myringoplasty |
| nursing assessment | drinage, pain and hearing loss (24-48 hours of drainage is normal) |
| bony overgrowth of the stapes; interferes with vibration and transmission of sound; has no cure; unknown cause but does have family link; s/s occurs 20-30 years; conductive hearing loss that can progress to mixed | otosclerosis |
| s/s of otosclerosis | progressive bilateral hearing loss; tinnitus; pinkish orange ear drum (should be pearly gray) |
| assessment of otosclerosis | Rinne test; BC>AC (bone conduction > air conduction) normally AC>BC; Webber test; sound goes to affected ear |
| treatment of otosclerosis | hearing aid; stapedectomy; prosthetic stapes inserted |
| complications of treatment of otosclerosis | dislocation of prosthesis, infection, dizziness, facial nerve damage |
| nursing managment after otosclerosis prosthetic | drainage from ear; fever; bedrest for 24 hours; positioned on nonoperative side; methods to prevent dislodgement (no sneezing, coughing or vomiting) |
| disorder of the labyrinth; cause is unknown, but symptoms are r/t accumulation of fluid in the inner ear; attributed to viral infections or head injuries; usually in middle-aged adults; classic symptoms are hearing loss, tinnitus, vertigo; unilateral | Meniere's Disease |
| s/s of Meniere's Disease | vertigo, tinnitus, hearingloss, nystagmus, "ora" (can tell when attack is coming on), HA, fullness in affected ear; attacks may last from minutes to weeks |
| Diagnosing Meniere's Disease | Medical history and physical exam, Caloric test, CT scan/MRI, audiometry |
| treatment of Meniere's Disease | decreasing fluid production in inner ear; facilitating drainage from inner ear; treating symptoms; low Na diet; cessation of smoking; antihistamines; bedrest during attacks (because of vertigo) |
| drug therapy for Meniere's Disease | meclizine (Antivert - treats vertigo), diazepam (Valium - for nerves), promethazine (Phenergan - for nausea), diuretics (for fluid) |
| With Meniere's Disease, assess for: | medical history, s/s, hearing deficit (worse during attack) |
| With Meniere's Disease, provide patient with: | medications and teaching as ordered, bed rest (usually strict bedrest), assist with ADLs, educate on medical regimen, low Na diet, hearing aids |
| damage to ear or eighth cranial nerve caused by specific chemicals, including some drugs | ototoxicity |
| s/s of ototoxicity | tinnitus and hearing loss |
| common ototoxic drugs (pg. 633 - ototoxic substances) | salicylates (aspirin), aminoglycoside antibiotics, loop diuretics (Lasix), Quinidine (antidysrhythmic), Quinine (antimalarial) |
| If tinnitus occurs while taking an ototoxic drug: | stop medication and call physician |
| benign Schwann cell tumor that progressively enlarges and adversely affects cranial nerve VIII (the vestibular and cochlear nerve); unknown cause; odds are 1:100,000 in getting disease; unilateral | acoustic neuroma |
| most arise in auditory canal and extend into the cerebellar region, pressing on the brain stem; hearing loss is secondary to compression of the nerve or interference with the blood supply to the nerve and cochlea | acoustic neuroma |
| s/s of acoustic neuroma | hearing loss (usally gradual); impaired facial movement or sensation; tinnitus in affected ear; vertigo with or without balance disturbances |
| treatment of acoustic neuroma | removal of tumor without damaging facial nerve |
| complications of removal of acoustic neuroma | facial nerve paralysis; CSF leak; meningitis; cerebral edema (IICP - Increased Intracranial Pressure) |
| After removal of acoustic neuroma, assess for: | pupillary changes, bradycardia, HTN and respiratory distress |
Created by:
akgalyean
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