Chapter 50: Assessment of Ear and Hearing Flashcards
hyperacusis
intolerance for sound levels that do not bother others
Changes with aging and the ear
The pinna becomes elongated because of loss of elasticity. This is normal. Hair in the canal becomes coarser and longer which is normal. They may require more frequent irrigation to keep wax from clumping. Cerumen is dryer and impacts more easily reducing hearing function. Irrigate canal weekly or when a change in hearing is noticed. TM loose elasticity, dull and retratcted (know this before dx otitis media). Hearing acuity decreases in some people. High frequency sounds are lost first. F, S, SH, and PA sounds. Close door and face patient when speaking. Make sure they have their glasses on. Speek slower and in a deeper voice. It may help them to wear a stethoscope.
Hearing tests
Tuning Fork: Weber places the fork on the middle of the prs head and asks to indicate which ear the sound is louder. Should be the same.
Rinne:fork stem on the mastoid process an ask when the sound is no longer heard. When no longer heard, bring fork to front of pinna and then ask when sound is no longer heard. 2-3X longer in front of pinna. (air conduction)
ABR: auditory brainstem evoked response. pts who can’t indicate sound recognition
ENG electonystagmography for balance. Detects nystagmus. Eyes and ears depend on each other for balance. Fast, avoid caffeine, can’t do if have pacemaker, fluids after
Caloric:evaluate auditory nerve. warmer or colder water: normal is vertigo or nystagmus within 20 to 30 seconds. Fast, affected side tested first, bedrest after with careful intro to fluids
Dix-Hallpike for vertigo: reposition quickly from sit to lying supine towards each side. Nystagmus will occur after 5-10 seconds. Keep eyes open. double vision
Tympanometry: mobility of eardrum and structures by changing air pressuer.
Cerumen impaction older adult
Assess hearing using voice tests Otoscope eval Ear irrigation at 98 degrees no more than 5-10 ml at at time Stop if N&V or dizzy teach how to do it themselves watch return wash ears daily with soapy wet washcloth.
Vertigo
Nausea and vomiting, falling, nystagmus, hearing loss, tinnitus. Restricted motions and move slowly, maintain hydration, take medications that reduced vertigo such as diazepam.
presbyusis
sensorineural hearing loss that occurs cuz of aging B12 defieciency and folic acid
Tympanoplasty
reconstructs the middle ear to improve conductive hearing loss.
Preop: systemic antibiotics, irrigate ear with vinegar and water to restore pH. avoid sick people. Hearing loss is normal after surgery cuz of packing the canal. Deep breathe and light cough.
Post op: antiseptic soaked guaze. If incision dressing is plaed. Keep pt flat, head turned to side with operative ear facing up for at least 12 hours. Antibiotics. Direct conversation in good ear
Stapedectomy
for hearing loss related to otosclerosis.
Preop: free from infection, hearing is initially worse but success is high. risk of failure>deafness. Complications include vertigo, infection, facial nerve damage
Post op: Improvement in hearing may take 6 weeks. Pain meds and antibiotics. CN VII, VIII, X can be damaged, assess them. Vertigo, N&V common. Antivertiginous drugs and antiemetics given. Assist with ambulation, side rails up, change position slow
