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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
Created by: purpleapple87