Ch. 40 Flashcards
function of ear
- promote auditory sensory perception which occurs when sound is delivered through air to external canal
- sound waves strike eardrum
- receptors at cochlea change vibrations into action and are conducted to brain as nerve impulses
how often should older adults be screened for hearing acuity?
on a regular basis
age-related changes in the ear
- drier, impacted cerumen
- loss of tympanic membrane elasticity
- degenerative changes of pinna and cochlea
- diminished hearing acuity
- disturbed vestibular function
- decreased ability to hear high-frequency sounds
conductive hearing loss: causes
- cerumen
- foreign body
- edema
- infection
- tumor
- perf tympanic membrane
conductive hearing loss: assessment findings
- evidence of obstruction with otoscope
- abnormal tymp membrane
- speaking softly
- hearing better in noisy places
*No permanent damage/hear loss
sensorineural hearing loss: causes
- prolonged exposure to noise
- presbycusis
- ototoxic drugs
- Menieres disease
- Acoustic neuroma
- DM
sensorineural hearing loss: assessment findings
- normal appearance of external canal and tymp membrane
- occasional dizziness
- speaking loudly
- hearing poorly in loud places
*Hearing loss often permanent
which type of hearing loss is often permanent?
sensorineural
assessment clues of hearing loss
- during interview, face patient and assess their posture and responses: tilting head to one side or leaning forward
- ask questions about any history of hearing issues, exposure to loud noise
- ask questions about meds- anything ototoxic like NSAIDS, diuretics, or certain antibiotics
tests to assess hearing
- voice test
- watch test
- tuning fork tests: weber, rinne
- audiometry
weber test
- tuning fork hearing test used to screen for conductive or sensorineural hearing loss
- heard midline
rinne test
- tuning fork hearing test used to screen for conductive or sensorineural hearing loss
- positive in healthy individuals: indicates air conduction is more beneficial than bone conduction
gross hearing acuity tests
- assess clients response to normal voice tones
- watch tick test
- tuning fork tests: weber’s test, Rinne test
non-surgical/medical interventions for hearing loss
- early detection
- safety measures (d/t hearing loss)
- medications
- assistive devices: hearing aids
surgical interventions for hearing loss
- tympanoplasty
- implants (ie cochlear devices)
tympanoplasty
microsurgery ― surgery using a microscope or endoscope― to fix holes in the eardrum that do not heal on their own
cochlear implant
A cochlear implant is an implanted electronic hearing device, designed to produce useful hearing sensations to a person with severe to profound nerve deafness by electrically stimulating nerves inside the inner ear
interventions for hearing loss
- surgical
- nonsurgical
- maximize communication
- community resources (support groups)
how can you maximize communication in a patient with hearing loss?
- lip-reading
- sign language
- collaborate with speech therapist/audiologist
- manage anxiety
3 types of otitis media
- acute
- chronic
- serous
acute otitis media
- sudden onset of ear pain
- lasts a few days - few weeks (depending on if receive treatment)
- treatment: oral antibiotics (amoxicillin)
chronic otitis media
- continually getting acute otitis media several times a year
- treatment: tubes put into ears
serous otitis media
- typical inflammation of otitis media but with fluid build up in middle ear
otitis media: assessment
- ear pain: most common sx
- patient may report tinnitus, HA, malaise, fever, N/V, dizziness
- otoscopic findings will vary depending on the condition’s stage
- eardrum may be spontaneously perforated
otitis media: nonsurgical management
- quiet environment
- bedrest with limited head movement
- heat and cold applications
- systemic and topical antibiotic therapy
- analgesics
- antihistamines
- decongestants
earwick
If the ear canal is very swollen, it can make using ear drops difficult. Your doctor may insert a tiny sponge called an ear wick into the canal to help carry the medicine into the ear.
irrigation of the external ear
a procedure in which nurses flush their patient’s ear canal with sterile water or saline solution
surgical management of otitis media
myringotomy
- surgical opening of the pars tensa of the eardrum
- operative procedure includes grommet (polyethylene tube) placed through the tympanic membrane to drain fluid from ears
post-operative care (post-myringotomy)
- keep external ear and canal free of other substances while the incision is healing
- keep head dry for several days
- no showering!
mastoiditis
infection of mastoid air cells caused by progressive otitis media
clinical manifestations of mastoiditis
- swelling behind ear
- pain when moving ear or head
- red, dull, thick, immobile eardrum
treatment of mastoiditis
- antibiotics
- surgical removal of infected tissue if no response to antibiotics
tinnitius
continuous ringing or noise perception
- cannot be observed or confirmed with dx tests
- one of the most common problems with ear or hearing disorders
one of the most common problems with ear or hearing disorders
tinnitus
diagnostic tests for tinnitus
there are none
- cannot be observed or confirmed with dx tests
*continuous ringing is the typical dx sx
if no cause of tinnitus is found, therapy focuses on ___
- masking the tinnitus with background sound, noisemakers, and music during sleeping hours
common manifestations of many ear disorders
- vertigo
- dizziness
if a patient feels vertigo or dizziness, advise them to
- restrict (fast) head motions and move more slowly
- maintain adequate hydration
- take anti-vertiginous drugs (on an as needed basis)
- prevent loss-of-balance accidents
Ménière’s Disease
condition with classic trio of symptoms:
1. tinnitus
2. one-sided sensorineural hearing loss
3. vertigo
- occur in attacks that can last for several days
- common in adults 20-40 years old
Ménière’s Disease: nonsurgical management
- slow head movements
- diet (low sodium/salt) and lifestyle changes
- smoking cessation
Ménière’s Disease: drug therapy
- *diuretics (Furosemide)
- nicotinic acid
- antihistamines (Meclizine)
- *antiemetics (Meclizine, Promethazine, Ondansetron)
- intratympanic therapy with gentamycin and steroids.
*most common
Ménière’s Disease: surgical management
- labyrinthectomy
- last resort because hearing in the affected ear is often lost from the procedure
Ménière’s Disease: Meniett device
The Meniett device is a minimally invasive, nondestructive treatment that may be used to provide longer-term reduction of vestibular symptoms in patients with Ménière’s disease
most common cause of impacted ear canal
cerumen
symptoms of impacted ear canal
- fullness of ear with or without hearing loss
- may have pain
- itching
- dizziness
- bleeding from the ear
management of impacted ear
- referral to ENT
- liquid agents that can dissolve the wax in the ear: cerumenolytic agent
- watchful waiting
- manual removal
if mastoiditis is not treated, complications:
- brain abscess
causes of tinnitus
- age
- ototoxic drugs: NSAIDS (ASA, Ibup), diuretics (lasix), certain antibiotics (ie. genomyacin)
- loud noise
common in adults 20-40 years old
Ménière’s Disease
