The Ear

Peter Glen L. Reyes, PTRP, RN,MAN

Medical Surgical nursing

Copyright JMDairo08

Hearing Hearing- is a special sensory function that

incorporates the sound transmitting of the external canal.

Copyright JMDairo08

Physiology of hearing Sound waves enter the ear canal and strike the

tympanic membrane, causing it to vibrate; these vibrations sequentially move the malleus, incus and stapes Movement of the stapes against the oval window into which it fits starts a ripple in the perilymph, which is transmitted to the endolymph inside the cochlear duct and stimulates the organ of Corti

Cochlear

nerve conducts impulses from the organ of Corti to the brain;  Hearing occurs when impulses reach the auditory area in temporal

Interpretation of sounds  Loudness: neurologic or psychologic

interpretation of intensity, the greater the intensity, the greater the size of nerve impulse Pitch: corresponds to frequency; the higher the frequency, the higher the pitch of the sound Quality: sound rarely represents a pure tone but many frequencies occurring simultaneously

Auditory assessment

External ear

examination - inspect and palpate the auricle, auditory canal and eardrum - visualization is easier by straightening the auditory canal Normal eardrum is slightly conical (externally concave), shiny, and pearly gray in

CHANGE IN COLOR MAY INDICATE DISEASE BLUE- blood in the middle ear (chemotympanum) YELLOW OR AMBER- serum in the middle ear RED OR PINK- indicates middle ear infection

Sound is measured in terms of

frequency and intensity Frequency- is expressed by cycles / seconds or Hertz. normal individual can perceive only from 20- 20,000 cycles, within this only 500-2,000 are important in understanding daily speech Intensity or pitch- force movement of vibrations measured by decibels

comfortable decibel is from 40 – 65 decibels ordinary conversation is from 40-50 decibels jet plane- 140 decibels

Anatomy of the ear  External ear

 Pinna  Eardrum  Middle Ear  3 bones

Malleus  Incus  Stapes 

Copyright JMDairo08

Middle ear Tympanic

membrane- is thick transparent sheet tissue that provides barrier between the external ear and the middle ear. Eustachian tubeopens into the middle ear and allows for equalization of pressure on both sides of the tympanic membrane.Copyright JMDairo08

Anatomy of the ear Inner ear Cochlea- is the spiral shape organ of hearing.

Semicircular canal- contains the membranous semicircular canals in which located the crista ampullaris, the sense organ for sensations of equilibrium and head movements; vestibular nerve supplies the crista Copyright JMDairo08

Semicircular canals contain fluids and hairs cells connected to the sensory nerve fibers on the vestibular portion of the eight cranial nerve. -The inner ear maintains sense of balance or equilibrium. -The cochlea is the spiral shape organ of hearing. -Eight cranial nerve •The cochlear branch of the nerve transmits neuroimpulses from the cochlea to the brain where they are interpreted as sounds. •Vestibular branch maintains Copyright JMDairo08 balance and equilibrium.

Assessment of Ear Inspection of the ear Adults: Pull pinna BACKWARD and UPWARD Pedia: Pull pinna BACKWARD and DOWNWARD

Copyright JMDairo08

Copyright JMDairo08

Assessment of Ear Otoscopy Eardrum is conical.

Pearly gray and shiny

Copyright JMDairo08

Assessment of Ear Audiometer Test of hearing

Measured in decibels

Copyright JMDairo08

Nursing Modalities for the ear Ear irrigation** Use of peroxide or normal saline Solution should be warmed With a steady stream, direct the stream of solution against the roof of the canal Position on the irrigated side to promote drainage Copyright JMDairo08

Nursing Modalities for the ear Eardrops instillation Use warm solution Position patient on the side with the affected ear uppermost Straighten the ear by pulling pinna up and back Hold position for 5 minutes

Copyright JMDairo08

Hearing loss Hearing loss- represents impairment of the

ability to detect and perceive sound. Conductive hearing loss- is caused by

disorders in which the auditory stimuli are not transmitted through the structures of the outer and middle ears to the sensory receptors in the inner ear.

Copyright JMDairo08

Conductive hearing loss A. Conductive hearing loss -occurs when the

sound waves are blocked to the inner ears fibers because of external ear or middle ear disorders. Disorders can be often be corrected with no damage to hearing or minimal permanent hearing loss.

Copyright JMDairo08

Conductive hearing loss Causes: A. Any inflammatory process or obstruction of

the external or middle ear.(Impacted earwax or foreign body) B. Tumors C. Otosclerosis D. A build up of scar tissue on the ossicles from the previous middle ear surgery.

Copyright JMDairo08

OTOSCLEROSIS Formation of new spongy bone in the

labyrinth of the ear causing fixation of the stapes in the oval window; this prevents transmission of auditory vibration to the inner ear Common among women Cause in unknown nut with familial tendency

Sensorineural hearing loss Sensorineural hearing loss: Description: Is a pathologic process of the

inner ear of the sensory fibers that lead to the cerebral cortex. Is often permanent and measures must be taken to reduce further damage or attempt to amplify sound as a means of improving hearing some degree.

Copyright JMDairo08

Sensorineural hearing loss Cause: Damage of the inner ear structures - Damage of the eight cranial nerve - Prolong exposure to loud noise - Medications - Trauma - Inherited disorders - Metabolic and circulatory disorders - Infection - Surgery Copyright JMDairo08

Sensorineural hearing loss Trauma: - head injury - Noise Central nervous system infection (meningitis)

Vascular: Atherosclerosis Ototoxic drugs: Aminoglycosides, salicylates, loop diuretics

Copyright JMDairo08

Sensorineural hearing loss Tumors: -Vestibular Schawannoma ( acoustic

neuroma) -Meningioma -Metastatic tumor Idiopathic: -Meniere disease

Copyright JMDairo08

Sensorineural hearing loss Meniere’s Syndrome Diabetis mellitus Myxedema

Copyright JMDairo08

Mixed hearing loss Is also known as conductive and

sensorineural hearing loss. Signs and symptoms: Frequent asking others to repeat statement Straining to hear Turning head or leaning forward to favor one ear. Shouting in conversation Ringing in ears Copyright JMDairo08

Mixed hearing loss Failing to respond when not looking in a

direction of the sound Answer question incorrectly Raising the volume of the radio or TV Avoiding large groups  Withdrawing from social interaction

Copyright JMDairo08

Copyright JMDairo08

Copyright JMDairo08

Hearing aids 

Indicated for conductive hearing loss Client education regarding hearing aids - Encourage the client to use hearing aid slowly - Adjust the volume to the minimal hearing level to prevent feedback squeaking. -Teach the client to concentrate on the sounds heard - Instruct the client to clean the ear mold with mild soap and water.

Copyright JMDairo08

Hearing aids Avoid excessive wetting of the hearing aid

and try to dry after cleaning. Clean the ear cannula with the aid toothpick or pipe cleaner Turn off the hearing aid when not use. Keep extra batteries on hand Keep hearing aid in safe place Prevent hair sprays, oils or other hair and face products from coming in contact with the receiver of the hearing aid. Copyright JMDairo08

Presbycusis - Is associated with aging - Leads to degeneration or atrophy of the

ganglion cells in the cochlea and loss of elasticity of the basilar membranes - Leads to compromise the vascular supply to the inner ear with changes in several areas of the ear structure. Assessment: Hearing loss gradual and bilateral Copyright JMDairo08

Presbycusis Client states that he or she has no hearing

problem with hearing but cannot understand what the words are. Client thinks that the speaker is numbling.

Copyright JMDairo08

Otitis media

Copyright JMDairo08

Otitis Media Inflammation of the MIDDLE ear

Copyright JMDairo08

Otitis Media Etiologic

Factors:

Strep pneumonia Haemophilus influenzae Moraxela catarrhalis

Copyright JMDairo08

Otitis Media Pathophysiology Inflammation Exudative formation

Copyright JMDairo08

Otitis Media Assessment findings  Ear pain  Ear itchiness Sense of fullness Tinnitus/Vertigo Copyright JMDairo08

Otitis Media Assessment findings Decreased hearing Redness Drainage of exudates Copyright JMDairo08

Otitis Media Complications  Abscess  Meningitis  Mastoiditis Conductive Hearing loss Copyright JMDairo08

Otitis Media Medical Management 2.Antibiotics- systemic and ear drops

Copyright JMDairo08

Otitis Media Medical Management IF CHRONIC CASE: Tympanoplasty And Mastoidectomy

Copyright JMDairo08

Otitis Media Nursing Interventions 2.Manage the infection – – –

Giving antibiotics cleansing of the ear Instillation of ear drops Copyright JMDairo08

Otitis Media Nursing Interventions 2. Perform ear irrigation  Never

done if tympanic membrane is PERFORATED!!!

3. Promote safety Copyright JMDairo08

Meniere’s Disease The primary lesion appears to be in the endolymphatic sac, which is thought to be responsible endolymphatic filtration and excretion. - Increase production of endolymph, and decrease production of perilymph

Copyright JMDairo08

Meniere’s Disease Cause is UNKNOWN - Proposed possible condition: - Trauma - Infection ( syphilis) - Immunologic - Endocrine ( Adrenal pituitary insufficiency

and hypothyroidism) - Vascular disorders - Viral or fluid transport system to the inner ear. Copyright JMDairo08

Meniere’s Disease 

Pathophysiology

There is INCREASED pressure of the fluid in the

cochlea There is INCREASED fluid pressure in the semicircular ducts

Copyright JMDairo08

Meniere’s Disease  Pathophysiology  INCREASED pressure attacks of

VERTIGO, TINNITUS and HEARING LOSS

Copyright JMDairo08

Meniere’s Disease ASSESSMENT findings

Vertigo- whirling sensation Unilateral or bilateral

hearing loss Vomiting Diaphoresis Nystagmus Copyright JMDairo08

Meniere’s Disease Medical management

1.Diuretics (acetazolamide, furosemide) are given to REDUCE the fluid pressure and decrease sodium 2. LOW salt diet 3. Antihistamine and antivertigo Copyright JMDairo08

- Suppressant drugs ( prochlorazine,

promethazine, diazepam) Corticosteroids ( prednisone ) - may be used in satisfactory hearing and resolved dizziness Gentamicin therapy -ablation of the vestibular system- effective in controlling vertigo. Surgical method- endolymphatic shunt

Copyright JMDairo08

Meniere’s Disease  Nursing Management 2. Assist patient DURING attack  Stand in front  Encourage to change position

slowly  Advise to lie down  Avoid bright lights  Support patient when ambulating Copyright JMDairo08

Meniere’s Disease  Nursing Management

2. Administer medications as prescribed diuretics anti-emetics

Copyright JMDairo08

Meniere’s Disease  Nursing Management

3. Prevent the attacks of Meniere’s  Provide low salt diet  Encourage to stop smoking  Take medications as

prescribed Copyright JMDairo08

Thank you