Ear
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4-9-08
Jennifer Jenkins
Sensory Ear Disorders Anatomy of the Ear o Consists of three parts: o External Ear o Middle Ear o Inner Ear External Ear o Housed in the temporal bone & includes: o Auricle or pinna o External auditory canal Middle Ear o Air filled cavity that is connected by the eustachian tube to the nasopharynx. It includes: o Tympanic membrane o Ossicles Inner Ear o Hearing: o Balance: o Cranial nerve: VII & VIII Functions o Hearing o Balance & equilibrium Assessment: INSPECTION o Deformities (one ear larger than the other, one ear may be missing, are they the same on each side) o Lesions or cuts o Discharge o Size o Symmetry o Angle of attachment to the head o Pain when you touch them, is there any tenderness o Dermatitis or inflammation Otoscopic Examination o Otoscope o Positioning o Discharge o Inflammation o Foreign bodies o Tympanic membrane o Fluid-DO NOT FLUSH EAR WITH COLD WATER, FLUSH WITH WARM WATER to remove ear wax o Air bubbles o Blood o Masses
Evaluation of Gross Auditory Acuity o Whisper Test o Weber Test-tuning fork to test bone conduction (should be same on both sides) o Rinne Test-tuning fork held away from the ear to conduct air Diagnostic Evaluation o Audiometry o Clinical Hearing Tests
Hearing Loss
o More than 26 million people affected o Appropriately 10 million have irreversible hearing loss o Occupational exposure o Types of Hearing Loss o Conductive o Sensorineural o Mixed o Functional Clinical manifestations: o Tinnitus-ringing in the ears (aspirin causes this if you take it chronically) o Increase inability to hear in groups o Need to turn up the volume on the television set o Change in attitude o Disinterests and inattentive, failing grades Gerontologic considerations: o Age o Cerumen o Atrophy of the tympanic membrane o Cochlear degeneration o Familial o Lifelong exposure to loud noises o Medication o Psychogenic factors and other disease processes Management: o Prevention o Surgical o Aural rehabilitation o Nursing care
Cerumen Impaction
• Cerumen normally accumulates in the external ear canal. • It does not usually need to be removed. (it normally removes itself) • More common in the elderly Management: o Irrigation o Suction o Instrumentation-curex o Referral
4-9-08
Jennifer Jenkins
Foreign Bodies
o Beads o Pebbles o Peas o Earrings o Insects Management: o Three standard methods o Irrigation o Suction o Instrumentation o Referral
External Otitis (Otitis Externa) pg. 1802
Know difference between otitis media and otitis externa Causes:
o Inflammation of the external auditory canal
o Water in the ear canal (use ear plugs, cotton balls with Vaseline on them) when swimming o Trauma o Bacterial & fungal o Dermatitis o Allergic reactions to hair products Clinical manifestations: o Pain o Discharge o Aural tenderness o Fever o Pruritus o Hearing loss o Feeling of fullness o Erythematous & edematous ear canal o Cellulitis & lymphadenopathy Medical Management o Analgesic o Antibiotics o Corticosteroids o Antifungals Nursing Management o Keep the external ear canal clear of drainage. o Avoid allowing water to enter the ear canal. o Barrier (ear plugs, etc.) o Antiseptic otic preparations should be kept at room temperature Gapping Earring Puncture o Wearing heavy pierced earrings
o After an infection o Allergic reaction o Wearing more than one earring Management: Surgery Causes
Tympanic Membrane Perforation
o Infection o Trauma o Foreign objects Medical Management: o Spontaneous healing o Protect from water Surgical management: o Tympanoplasty
Acute Otitis Media
Causes:
o Infection of the middle ear lasting less than 6 weeks
o Streptococcus pneumonias, Haemophilus influenzae, Moraxella catarrhalis o Obstruction of the eustachian tube o Bacteria can enter the eustachian tube from contaminated secretions in the nasopharynx & middle ear, from a perforated tympanic membrane. Clinical manifestations: o Symptoms varies with severity o Otorrhea o No aural tenderness o Fever o Tympanic membrane erythematous & bulging o Hearing loss o Otalgia • Poor feeding in children Medical Management o Antibiotics o Antipyretics-for fever o Analgesics Surgical Management: o Myringotomy or Tympanotomy-incision into the membrane o Pressure Equalizing (PE) Tubes usually in children-keeps open
Serous Otitis Media
o Fluid without evidence of infection in the middle ear o Primarily in children
4-9-08
Jennifer Jenkins
o Frequently seen in patients after radiation therapy o Eustachian tube dysfunction o Barotrauma o Carcinoma Clinical manifestations: o Hearing loss o Feeling of fullness o Popping & crackling noises o Dull tympanic membrane o Air bubbles Management: o No treatment needed if infection not present o Myringotomy o PE Tubes o Corticosteroids o Valsalve maneuver-pinch the nose and blow
Chronic Otitis Media
o Repeated episodes of acute otitis media. causing o Irreversible tissue pathology and o Persistent perforation of the tympanic membrane Clinical manifestations: o Hearing loss o Foul-smelling otorrhea or drainage o Absence of pain o Perforated tympanic membrane o Cholesteatoma-white mass behind the tympanic membrane Medical management: o Suctioning o Antibiotic otic drops o Systemic antibiotics Surgical Management: o Tympanoplasty-re-establish function o Ossiculoplasty-reconstruction of middle ear bones o Mastoidectomy-remove cholesteatoma
Otosclerosis o Involves the stapes o Results from the formation of new abnormal spongy bone, with resulting fixation of the stapes o Transmission of sound is prevented. o Common in women
o Hereditary o Pregnancy worsens the condition Clinical Manifestations: o May involve one or both ears o Progressive conductive hearing loss o or o Mixed hearing loss o Tympanic membrane is normal o Bone conduction is better than air conduction Medical management: o No known non-surgical treatment. o Florical-supplement to help mature bone growth o Amplification Surgical management: o Stapedectomy-removal of stapes and insert graft Motion Sickness
o o o o o o
Conditions of the Inner Ear
Disturbance of equilibrium caused by constant motion o Clinical Manifestations Sweating Pallor Nausea Vomiting o Management: Antihistamines-benadryl Anticholinergics-dramamine, procalamine patches
Meniere’s Disease
o Abnormal inner ear fluid balance o Common in adults o Average age of onset 40s o Both ears affected equally o Bilaterally in 20% of patients o Twenty percent have a positive family history Clinical Manifestations o Fluctuating, progressive sensorineural hearing loss o Tinnitus o Feeling of pressure or fullness in the ear o Episodic, incapacitating vertigo o Nausea & vomiting Assessment & Diagnostic Findings: o Vertigo o Diaphoresis o Imbalance or disequilibrium o Attacks may awaken at night o Hearing loss fluctuates with tinnitus & aural pressure Physical Exam: o Normal PE
4-9-08
Jennifer Jenkins
o Weber test lateralizes to ear opposite the hearing loss o Audiogram reveals sensorineural hearing loss in the affected ear o No absolute diagnostic test Management: o Diet o 2000mg/day Sodium Diet o Medication o Antihistamines-meclazine o Tranquilizers-valium o Antiemetics-pheregan o Diuretics-HCTZ o Psychological o Surgical o To eliminate attacks of vertigo Medications:
Prevention
Ototoxicity
o Aspirin o Quinine o Aminoglycosides
o Patients should be counseled about side effects of ototoxic medications. o Blood levels should be monitored o Audiogram twice weekly during therapy Common Nursing Diagnoses o Risk for injury o Pain o Sensory perceptual alteration o Alteration in comfort o Ineffective coping o Fear o Anxiety
Acoustic Neuroma
Benign Tumor of Cranial Nerve VIII Usually arise from the Schwann cell Account for 5-10% of all intracranial tumors Occur equally in men and women at any age Most are unilateral Management o Surgery to remove-can develop paralysis on one side, meningitis o Gamma Knife if surgery is refused Assessment/Diagnostic o Unilateral tinnitus and hearing loss with or without vertigo and balance disturbances o Conventional Audiometry most useful o MRI with a paramagnetic agent o CT with contrast
Jennifer Jenkins
Sensory Ear Disorders Anatomy of the Ear o Consists of three parts: o External Ear o Middle Ear o Inner Ear External Ear o Housed in the temporal bone & includes: o Auricle or pinna o External auditory canal Middle Ear o Air filled cavity that is connected by the eustachian tube to the nasopharynx. It includes: o Tympanic membrane o Ossicles Inner Ear o Hearing: o Balance: o Cranial nerve: VII & VIII Functions o Hearing o Balance & equilibrium Assessment: INSPECTION o Deformities (one ear larger than the other, one ear may be missing, are they the same on each side) o Lesions or cuts o Discharge o Size o Symmetry o Angle of attachment to the head o Pain when you touch them, is there any tenderness o Dermatitis or inflammation Otoscopic Examination o Otoscope o Positioning o Discharge o Inflammation o Foreign bodies o Tympanic membrane o Fluid-DO NOT FLUSH EAR WITH COLD WATER, FLUSH WITH WARM WATER to remove ear wax o Air bubbles o Blood o Masses
Evaluation of Gross Auditory Acuity o Whisper Test o Weber Test-tuning fork to test bone conduction (should be same on both sides) o Rinne Test-tuning fork held away from the ear to conduct air Diagnostic Evaluation o Audiometry o Clinical Hearing Tests
Hearing Loss
o More than 26 million people affected o Appropriately 10 million have irreversible hearing loss o Occupational exposure o Types of Hearing Loss o Conductive o Sensorineural o Mixed o Functional Clinical manifestations: o Tinnitus-ringing in the ears (aspirin causes this if you take it chronically) o Increase inability to hear in groups o Need to turn up the volume on the television set o Change in attitude o Disinterests and inattentive, failing grades Gerontologic considerations: o Age o Cerumen o Atrophy of the tympanic membrane o Cochlear degeneration o Familial o Lifelong exposure to loud noises o Medication o Psychogenic factors and other disease processes Management: o Prevention o Surgical o Aural rehabilitation o Nursing care
Cerumen Impaction
• Cerumen normally accumulates in the external ear canal. • It does not usually need to be removed. (it normally removes itself) • More common in the elderly Management: o Irrigation o Suction o Instrumentation-curex o Referral
4-9-08
Jennifer Jenkins
Foreign Bodies
o Beads o Pebbles o Peas o Earrings o Insects Management: o Three standard methods o Irrigation o Suction o Instrumentation o Referral
External Otitis (Otitis Externa) pg. 1802
Know difference between otitis media and otitis externa Causes:
o Inflammation of the external auditory canal
o Water in the ear canal (use ear plugs, cotton balls with Vaseline on them) when swimming o Trauma o Bacterial & fungal o Dermatitis o Allergic reactions to hair products Clinical manifestations: o Pain o Discharge o Aural tenderness o Fever o Pruritus o Hearing loss o Feeling of fullness o Erythematous & edematous ear canal o Cellulitis & lymphadenopathy Medical Management o Analgesic o Antibiotics o Corticosteroids o Antifungals Nursing Management o Keep the external ear canal clear of drainage. o Avoid allowing water to enter the ear canal. o Barrier (ear plugs, etc.) o Antiseptic otic preparations should be kept at room temperature Gapping Earring Puncture o Wearing heavy pierced earrings
o After an infection o Allergic reaction o Wearing more than one earring Management: Surgery Causes
Tympanic Membrane Perforation
o Infection o Trauma o Foreign objects Medical Management: o Spontaneous healing o Protect from water Surgical management: o Tympanoplasty
Acute Otitis Media
Causes:
o Infection of the middle ear lasting less than 6 weeks
o Streptococcus pneumonias, Haemophilus influenzae, Moraxella catarrhalis o Obstruction of the eustachian tube o Bacteria can enter the eustachian tube from contaminated secretions in the nasopharynx & middle ear, from a perforated tympanic membrane. Clinical manifestations: o Symptoms varies with severity o Otorrhea o No aural tenderness o Fever o Tympanic membrane erythematous & bulging o Hearing loss o Otalgia • Poor feeding in children Medical Management o Antibiotics o Antipyretics-for fever o Analgesics Surgical Management: o Myringotomy or Tympanotomy-incision into the membrane o Pressure Equalizing (PE) Tubes usually in children-keeps open
Serous Otitis Media
o Fluid without evidence of infection in the middle ear o Primarily in children
4-9-08
Jennifer Jenkins
o Frequently seen in patients after radiation therapy o Eustachian tube dysfunction o Barotrauma o Carcinoma Clinical manifestations: o Hearing loss o Feeling of fullness o Popping & crackling noises o Dull tympanic membrane o Air bubbles Management: o No treatment needed if infection not present o Myringotomy o PE Tubes o Corticosteroids o Valsalve maneuver-pinch the nose and blow
Chronic Otitis Media
o Repeated episodes of acute otitis media. causing o Irreversible tissue pathology and o Persistent perforation of the tympanic membrane Clinical manifestations: o Hearing loss o Foul-smelling otorrhea or drainage o Absence of pain o Perforated tympanic membrane o Cholesteatoma-white mass behind the tympanic membrane Medical management: o Suctioning o Antibiotic otic drops o Systemic antibiotics Surgical Management: o Tympanoplasty-re-establish function o Ossiculoplasty-reconstruction of middle ear bones o Mastoidectomy-remove cholesteatoma
Otosclerosis o Involves the stapes o Results from the formation of new abnormal spongy bone, with resulting fixation of the stapes o Transmission of sound is prevented. o Common in women
o Hereditary o Pregnancy worsens the condition Clinical Manifestations: o May involve one or both ears o Progressive conductive hearing loss o or o Mixed hearing loss o Tympanic membrane is normal o Bone conduction is better than air conduction Medical management: o No known non-surgical treatment. o Florical-supplement to help mature bone growth o Amplification Surgical management: o Stapedectomy-removal of stapes and insert graft Motion Sickness
o o o o o o
Conditions of the Inner Ear
Disturbance of equilibrium caused by constant motion o Clinical Manifestations Sweating Pallor Nausea Vomiting o Management: Antihistamines-benadryl Anticholinergics-dramamine, procalamine patches
Meniere’s Disease
o Abnormal inner ear fluid balance o Common in adults o Average age of onset 40s o Both ears affected equally o Bilaterally in 20% of patients o Twenty percent have a positive family history Clinical Manifestations o Fluctuating, progressive sensorineural hearing loss o Tinnitus o Feeling of pressure or fullness in the ear o Episodic, incapacitating vertigo o Nausea & vomiting Assessment & Diagnostic Findings: o Vertigo o Diaphoresis o Imbalance or disequilibrium o Attacks may awaken at night o Hearing loss fluctuates with tinnitus & aural pressure Physical Exam: o Normal PE
4-9-08
Jennifer Jenkins
o Weber test lateralizes to ear opposite the hearing loss o Audiogram reveals sensorineural hearing loss in the affected ear o No absolute diagnostic test Management: o Diet o 2000mg/day Sodium Diet o Medication o Antihistamines-meclazine o Tranquilizers-valium o Antiemetics-pheregan o Diuretics-HCTZ o Psychological o Surgical o To eliminate attacks of vertigo Medications:
Prevention
Ototoxicity
o Aspirin o Quinine o Aminoglycosides
o Patients should be counseled about side effects of ototoxic medications. o Blood levels should be monitored o Audiogram twice weekly during therapy Common Nursing Diagnoses o Risk for injury o Pain o Sensory perceptual alteration o Alteration in comfort o Ineffective coping o Fear o Anxiety
Acoustic Neuroma
Benign Tumor of Cranial Nerve VIII Usually arise from the Schwann cell Account for 5-10% of all intracranial tumors Occur equally in men and women at any age Most are unilateral Management o Surgery to remove-can develop paralysis on one side, meningitis o Gamma Knife if surgery is refused Assessment/Diagnostic o Unilateral tinnitus and hearing loss with or without vertigo and balance disturbances o Conventional Audiometry most useful o MRI with a paramagnetic agent o CT with contrast
