Ear Injury and Ototoxicity

Question 1

Strategies to prevent ear injury and disease

Answer 1

1. Environmental noise control
2. Immunizations: childhood and adult
3. Ototoxic medications

Question 2

Ototoxicity Causing Medications

Answer 2

1. Salicylates, esp. aspirin
2. Diuretics
3. Antineoplastic medicaitons
4. Antibiotics - esp aminoglycosides

Question 3

Signs and Symptoms of Ototoxicity

Answer 3

1. Tinnitus
2. Diminished Hearing
3. Changes in Equilibrium

Question 4

If symptoms develop what should be done for ototoxicity?

Answer 4

Immediate withdrawal of medications may prevent further damage and may cause the symptoms to disappear

Question 5

What advice should the RN give a paitent who is concerned about hearing loss due to environmental noise?

Answer 5

1. Ear protection
2. Periodic audiometric screening

Question 6

Definition of meniere’s disease/vertigo

Answer 6

Disorder of the inner ear in which there is excessive accumulation of endo-lymphatic fluid in the membranous labyrinth

Question 7

Assessment of Meniere’s Disease/Vertigo

Answer 7

1. Recurrent severe attacks of vertigo
2. Attacks last several hours to days
3. Hearing loss may become permanent with frequent attacks

Question 8

Nursing Diagnoses Meniere’s Disease/Vertigo

Answer 8

• Risk of Injury
• Disturbed Sensory Perception: Auditory

Question 9

Outcomes Meniere’s Disease/Vertigo

Answer 9

1. Identifies ways to prevent injury during attack
2. Remains free of injury
3. Demonstrates clear instructions about care

Question 10

Treatment of Meniere’s Disease/Vertigo

Answer 10

1. Quiet, darkened room in a comfortable position
2. Avoid sudden head movements of position changes
3. Avoid fluorescent or flicking lights or watching television
4. Emesis basin available because vomiting is common
5. Siderails up and bed in low position: call for assistance to get OOB
6. Hydrops Diet
   
   1. Low sodium diet, no ETOH, caffeine, nicotine, and food with MSG
7. No alcohol, caffeine, nictotine

Question 11

Medication Treatment for Meniere’s Disease/Vertigo

Answer 11

1. Diuretics: help prevent attacks by decreasing fluid pressure that triggered the attack
2. Benzodiazepines: CNS depressant that slows down nervous system components of inner ear
3. Antihistamines
4. Anticholinergics
5. Ca Channel Blockers

Question 12

Meclizine Hydrochloride (Antivert)

Answer 12

**Side/Adverse Effects: **

drowsiness, fatigue, blurred vision, dry mouth

Nursing Implications:

• Caution clients to avoid driving or other activities requiring alertness until response to the medication is known
• Advise patient that frequent mouth rinses and good oral hygiene may decrease dryness of mouth
• Caution patient to avoid concurrent use of alcohol and other CNS depressants with this medication

Question 13

Surgical Treatment for Meniere’s Disease/Vertigo

Answer 13

1. Endolymphatic Decompression
2. Vestibular neurectomy
3. Labyrinthectomy

Question 14

Endolymphatic Decompression

Answer 14

• Relieves pressure in labyrinth and creates shunt between membranous labyrinth and subarachnoid space for fluid drainage
• Preserves hearing in most cases
• Relieves vertigo in ~70% of cases
• Relieves tinnitus and sensations of ear fullness in 50% of cases

Question 15

Vestibular neurectomy

Answer 15

• Severing of portion of eighth cranial nerve that controls balance and sensation of vertigo
• Relieves vertigo in 90% of cases

Question 16

Labyrinthectomy

Answer 16

• Complete removal of labyrinth, destroyng cochlear function
• Relieves vertigo but causing loss of any minimal remaining hearing as well
• Last resort