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NSG230Ear
| Answer | |
|---|---|
| outer projection of ear, composed of cartilage. collects sound waves | auricle (pinna) |
| Extends from the pinna to the tympanic membrane. Skind covering the cartilage is thick, contains sebaceous and ceruminious glands and hair follicles. Transmits sound waves to eardrum | External auditory canal |
| golden to black substance secreted by sebaceous and ceruminous glands | cerumen (wax) |
| Located at the end of the auditory canal, thick transparent sheet of tissue that provides a barrier btwn external/outer ear. | Tympanic membrane (eardrum) |
| Vibrates in response to sound/transmits vibrations in middle ear | tympanic membrane |
| Portion of ear? *auricle *external auditory canal *tympanic membrane | external |
| Portion of ear? *ossicles *eustachian tube | middle |
| *Malleus *incus *stapes | ossicles; three bones that make up middle ear |
| Vibrations of the tympanic membrane causes ossicles to move and transmit sounds to the _______ _______. | oval window |
| Vibration of the oval window causes _________ to move and stimulates receptors of hearing. | fluid |
| connects the nasopharynx and middle ear. Brings air into the middle ear, equalizing pressure on both sides of the eardrum. | Eustachian tube |
| Middle ear cavity is filled with _____. | air |
| known as the labyrinth | inner ear |
| Location in ear? *cochlea *vestibular apparatus | Inner |
| receptor end organ for hearing | organ of corti, located in the cochlea |
| Area that transmits sound waves from the oval window and initiates nerve impulses carried by the cranial nerve VIII to the brain | cochlea;organ of corti. |
| Nerve impulses carried by the organ of Corti are transmitted to this area of the brain | temporal lobe of the cerebrum |
| connects the cochlea to the three semicircular canals | vestibular apparatus |
| Organ of balance | vestibular apparatus |
| Vestibular apparatus has semicircular canals that contain fluid and hair cells connected to the sensory nerve fibers of the vestibular portion of this cranial nerve | 8th |
| describe how the tympanic membrane should appear | pearl gray, white or pink. Shiny or translucent |
| How is the whisper test performed? | Standing 12-24 inches away from patient. Ear not being tested is occluded. |
| Tuning fork held against mastoid bone, then in front of ear. | Rinne test |
| While performing Rinne test the sound is heard longest by bone conduction. Positive or negative? Implications? | Negative, indicates conductive hearing loss is present. |
| Normal findings with a Rinne Test? | sound heard twice as long/as loud by air conduction than bone. Positive test. |
| Tuning fork placed on midline of skull, forehead or teeth. | Weber test |
| Performing weber test, sound is heard louder in one ear. Indicates? | conductive Hearing loss in that ear. |
| Performing Weber test, sound is heard louder in unaffected ear,indications? | sensorineural loss is present. |
| test which produces pure tones at varying intensities to which patient can respond | audiometry |
| Treatment for hematoma between skin and cartilage of the ear | aspiration, antibiotics prophylactically |
| involves inflammation/infection of the epithelium of the auricle and ear canal | external otitis; swimmers ear. can also be seen in people with hearing aids, or ear plugs |
| External otitis is often caused by which organisms? | bacteria, fungi, pseudomonas, proteus, E coli, staph |
| S/S of external otitis | *Pain one of first signs, especially on movement of auricle or on app of pressure to the tragus *drainage *possible hearing loss or dizziness |
| Med management of external otitis | *C&S of drainage *asa or codeine for pain *antibiotic ear drops *corticosteroid drops if infection bacterial. *systemic antibio of needed |
| Tx external otitis *after drops placed in ear, how long to stay in position? *cotton ball in ear for... *stay out of water for.... | *2-5 minutes *15-20 minutes *7-10 days |
| implication for removing beans or vegetables from ear | don't irrigate |
| If a live insect gets into the ear, how do you kill it? | Place few drops of mineral oil or lidocaine in ear. |
| Most common problem with middle ear/mastoid | acute otitis media |
| Any surgeries done to the ear, assessments would be made to...? | facial nerve |
| mastoiditis occurs -- to -- weeks after episode of acute OM | 2-3 |
| mastoiditis is diagnosed by symptoms and loss of what? | loss of septra between mastoid cells on x-ray |
| Tx for mastoiditis | Aggresssive antibio; IV timentin and gentamicin at first, continued for 14 days |
| As much tissue as possible is preserved; to avoid disruption of hearing | modified mastoidectomy |
| Removal of middle ear structures including incusm malleous and the diseased portion of mastoid process. Mid ear and mastoid become a large cavity. No reconstruction is made. | Radical mastoidectomy |
| Surgical reconstruction of the middle ear. Can restore/preserve hearing. | Tympanoplasty |
| A tympanoplasty would be done using which method for mastoidectomy? | Modified |
| May be done with the use of partial or total ossicular prosthese in combo with a fascia graft to repair perforation of tympanic membrane | Tympanoplasty |
| Where would you expect to see incision sites for tympanoplasty? | *endaural (within ear canal) or *postauricular (behind auricle or ear) |
| Teaching for patient who will undergo any form of mastoidectomy/tympanoplasty | Teach length of surgery, hospital stay, postop instructions, may be given only local anesthesia |
| Postop teaching for mastoidectomy/tympanoplasty | *mild pain earache/discomfort in cheek/jaw *keep off affected ear *dizziness may occur first time ambulating. *avoid unnecessary movements *keep ear dry *blow nose gently, one side at a time *sneeze/cough with mouth open *No straw drinking 2-3 wks |
| NSG implications for postop mastoidectomy/tympanoplasty | *Pain should be mild, mild analgesia *ambulate with assist *assess NV-prevent vomiting *HOB at 30degrees *assess drainage on dsg, should be small amt of serosanguineous, change PRN *teach popping sound may be evident 2-3 wks |
| Patient who had an mastoidectomy/tympanoplasty reports bleeding, what do you advise them to do? | Unless drainage is slight, call MD |
| sense alterations after mastoidectomy/tympanoplasty? | hearing may be temporarily or permanently affected. position with unaffected ear toward door. Explain that surgical packing may be reason for loss. Popping sounds may be heard 2-3 weeks following. |
| Teaching following mastoidectomy/tympanoplasty? | *blow nose gently one side at a time, sneeze, cough with mouth open for 1 wk *no phys activity for 1 wk, no sports/exercise for 3 wks. *No air travel 1wk-1mo *Resume work 1wk *change cotton ball daily *ear dry 4-6wks, no shampoo for one week. |
| common cause of conductive hearing loss. Autosomal dominant disease. abnorm bone formation, causes footplate of stapes to be fixed in oval window. | otosclerosis |
| Groups most common for otosclerosis to occur? | female caucasian, especially in pregnancy, children who have osteogenesis imperfecta |
| S/S of otosclerosis | Progressive hearing loss occurs in adolescence/early adult. Accels during pregnancy. Bilateral most of time, rate of loss asymmetric. Bone conduction retained, phone conversation may be ok. tinnitus, if inner ear, sensorial loss. |
| Diagnostic for which disorder? when examining inner ear, tympanic membrane appears as reddish/pinkish orange r/t increased vasculatiry *Rinne test shows bone conduction equal to or greater than air conduction | Otosclerosis |
| 3 classifications of inner ear problems? | *sensorineural loss *tinnitus *vertigo |
| medical management of otosclerosis? | *hearing aid may improve ability to hear by amplification *Sodium flouride or calcium carbonate may be prescribed to slow bone resorption and overgrowth. |
| Teaching for patient who will undergo a stapedectomy? | Will hear much better on table in OR, after in recovery when swelling and edema occurs, hearing will worsen. teach that the hearing will improve again. |
| Possible complication of stapedectomy that results in fluctuating hearing levels, tinnitus, and nystagmus | Perilymph fistula; incomplete closure of oval window |
| location of Incision in a stapedectomy? | Endaural |
| Which surgery? TM is rolled back, gelform placed over the flap. cotton ball placed in ear, bandaid covers ear. | Stapedectomy |
| Patient positioning following stapedectomy? | HOB at 30 degrees or flat |
| Endolympatic hydrops | menieres disease |
| Highest risk group for menieres? | aged 30-60, men and women affected equally |
| Disorder caused by excess endolymph in the vestibular and semicircular canals. Increased endolymph ruptures the membraneous labyrinth; mixing high potassium endolymph and low potassium. Causes degen of vestibular and cochlear hair cells | Menieres |
| autonomic symptoms associated with menieres? | Pallor, sweating, N&V |
| Med tx of menieres? | *diuretics; maintain lower labyrinth pressure *atropine, decreases PNS response (decreased BP/HR) *Inapsine (sedative/antiemetic *antivert, compazine, vistaril; decrease whirling sensation, nauses *Valium/ativan reduce dizziness *antihistamines |
| If medications cannot control the sympotoms of menieres, what else can be done? | *Drill hole to shunt fluid to subarachnoid space. *Gentamycine inside mid/inner ear (ototoxic) deadens. |
| Diet that would be useful in menieres disease? | Low sodium |
| Relieves the excess pressure in the labyrinth. Shunt is inserted btwn membranous labyrinth and subarachnoid space to drain excess fluid away from labyrinths, maintains lower pressure | Endolymphatic decompression |
| What are the benefits of endolymphatic decompression? Detractions? | *For most, it preserves hearing. *vertigo relieved in 70% *sensation of fullness and tinnitus remains in 50% or more |
| Destruction of a portion of the acoustic nerve is an alternative to shunting. In this procedure, the portion of cranial nerve VIII controlling balance and sensation of vertigo is severed. | vestibular neurectomy |
| What are the risks/benefit of a vestibular neurectomy? | *relieves vertigo in 90% of people *risk of damage to the cochlear portion of the nerve and resultant hearing loss. for most hearing loss stabilizes after neurectomy, and improves for some. |
| Surgery of last resort in tx of menieres. | labyrinthectomy |
| Labyrinth is completely removed, destroying cochlear funciton | labyrinthectomy |
| Implications/benefit with a labyrinthectomy | *done only when hearing loss is nearly complete and vertigo is present. *relieves vertigo in nearly all cases, client may remain unsteady and have continued problems with balance. |
| Nsg dx for R/F trauma r/t vertigo Interventions? | *bedrest/siderails up/call light *quiet, dark room *ambulate with assist only *avoid head movement/position changes *flourescent/flickering lights including TV makes condition worse *medications for nausea/vertigo |
| with aging the hair cells of the cochlear degenerate. | Presbycusis |
| Hearing degeneration with presbycusis? | Gradual loss begins in early adult. continues thru life. If noise inducted, high tones are lost first. |
| AKA otitis interna | labyrinthitis |
| Uncommon disorder, bacteria, virus enters and affects the inner ear through mid ear, meninges, or blood. | Labyrinthitis |
| Viral cause of labyrinthitis is suspected when onset follows...... or after no evidence of bacterial infection | URI |
| Inflammation of inner ear affecting the cochlear or vestibular portion of the labyrinth or both. Tends to occur spring to early summer | labyrinthitis |
| S/S of labyrinthitis? | *severe vertigo (hallmark) *N&V *any movement aggravates vertigo, causes r/f falls when attempt to stand *vertigo lasts days-weeks, subside gradually over 1-2 weeks, peaks 48 hrs *Temp/perm hearing loss possible *may/may not see nystagmus |
| Med management of labyrinthitis? If bacterial cause | Large dose antibio (IV) No specific tx if viral |
| most common complication of labyrinthitis? | Meningitis |
| Benign tumor of cranial nerve VIII | acoustic neuroma |
| Age most likely for acoustic neuroma to occur? | 40-50 |
| Area in which acoustic neuroma is likely to occur? | Internal auditory meatus, compresses the auditory nerve where it exits skull to inner ear. |
| Vestibular and cochlear branches are affected by an acoustic neuroma, however which area is likely to be the location 2x most often? | vestibular division |
| Would you expect to see chemo or radiation as a tx of acoustic neuroma? | No- doesn't respond to either. |
| Which cranial nerves are often affected by acoustic neuroma? | cranial nerves VII (facial) and V (trigeminal) |
| What would occur if an acoustic neuroma were allowed to grow? | Destruction of labyrinth, including cochlear and vestibular apparatus |
| Early s/s of acoustic neuroma? Earliest symptom? | disorders of the inner ear, tinnitus, unilateral hearing loss, nystagmus, and mild intermittent vertigo. Most likely early symptom is reduced touch sensation to posterior ear canal |
| What diagnostics would be useful in indicating the presence of an acoustic neuroma? | Ct/mri, and x-ray of temporal can show erosion. |
| Surgical mgmt of acoustic neuroma? | Craniotomy if possible (if tumor not too big) |
| Surgical approach for a craniotomy to tx acoustic neuroma? | Translabyrinth approach used for medium tumors, and when hearing minimal. Hearing destroyed by this approach. care taken to preserve facial nerve function |
| It is almost impossible to preserve hearing when an acoustic neuroma is larger than __cm. | 2cm |
| Recurrence rate of acoustic neuroma after removal? | Rare to recur |
| OSHA regulations determine that any noise over __ decibels damages hearing | 85 |
| Which form of hearing loss is reversible, sensorineural or conductive? | conductive |
| Type of hearing loss? anything which disrupts the transmission of sound from external auditory meatus to inner ear? | conductive |
| Conductive hearing loss, problem occurs where? | outer or middle ear |
| Type of hearing loss? caused by conditions interfering with air conduction, impacted cerumen, middle ear disease, otosclerosis, atresia, or stenosis of external auditory canal | conductive |
| Which form of hearing loss would respond well to a hearing aid? | conductive |
| Type of hearing loss? caused by disorders that affect the inner ear, auditory nerve, or auditory pathways of the brain | Sensorineural |
| In this type of loss, sound waves are effectively transmitted to the inner ear but lost/damaged receptor cells, changes in cochlear apparatus, or auditory nerve abnorms distort ability to receive/interpret stimuli | sensorineural |
| Two main problems associated with sensorineural loss? | 1. ability to hear sound but not understand speech. 2. lack of understanding of the problem by others. |
| Ability to hear high pitched sounds diminishes with ______ hearing loss | sensorineural |
| Damage to this is a significant cause of sensorineural hearing deficit | Hair cells of the organ of Corti |
| Causes of sensorineural hearing loss besides hair cells/organ of corti? | Ototoxic drugs, viral infection, meningitis, trauma, menieres, aging |
| what are the ototoxic drugs associated with sensorineural loss? | salicylates, furosemide (lasix), aminoglycosides, antibiotics, antimalarial drugs, some chemo drugs (platinol, vancocin) |
| This type of loss is related to problems in the CNS from auditory nerve to cortex. Patient unable to understand/put meaning to the incoming sound. | Central hearing loss |
| Common cause of central hearing loss? | CVA or acoustic neuroma |
| Functional hearing loss causes? | Emotional or psychological. No organic cause can be found. refer to qualified hearing and speech services. |
| vaccinations/pg 430 | vacc |
| S/S of hearing loss? | *frequently asking to repeat statements *strain to hear *turning head/leaning good ear toward speaker *shouting in conversation *ringing in ears *no response when not looking at speaker *answers questions incorrectly *loud tv/radio *avoid large groups |
| What hearing aid would be used in sensorineural loss? | cochlear implant |
| Surgical management for middle ear (stapedectomy or tympanoplasty | reconstructive |
| cochlear implants provides client with normal hearing. T/F? | False, provides perception of sound. able to recognize warning sounds; cars, sirens, phones. May receive stimuli to alert to incoming conversation so they can focus on speaker. Extensive training required. |
| hard nodules in the helix or anihelix consisting of uric acid crystals. Assoc w/gout, metabolic disorder. | tophi |
| Usually within skin, possible presence of black dot. Removal or incision and drainage required if painful | sebaceous cyst behind ear |
| wax that has not normally been excreted from the ear. Cannot visualize eardrum | impacted cerumen |
| bony growth extending into canal causing narrowing. | exostosis |
| Normal whisper test? | *able to hear whisper at 30cm |
| ototoxic substances? | toluene, carbon disulfide, mercury |
| S/S that indicate ototoxicity? | tinnitus, diminished hearing, changes in equilibrium |
| Which vaccinations would be promoted to reduce chance of fetal hearing loss? | measles, mumps, rubella |
| If rubella is contracted within the first 8 weeks of pregnancy, what results may be seen in the child? | 85% congenital rubella syndrome, causing sensorineural deafness. |
| Women should avoid pregnancy for what period of time after immunization for rubella? | 3 months |
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