HEARING Flashcards by Arlene Sotelo

Assessment

Inspection of the external ear
Otoscopic examination
Gross auditory acuity
Whisper test
Weber test
Rinne test

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Otalgia

a sensation of fullness or pain in the ear

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Weber test

assesses bone conduction of sound. Rinne test assesses both air and bone conduction of sound.

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Diagnostic Evaluation

Audiometry
Tympanogram
Auditory brainstem response
Electronystagmography
Platform posturography
Sinudoidal harmonic acceleration
Middle ear endoscopy

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Hearing loss

Prevalence increases w/ age
Increased incidence w/ age = presbycusis
Risk factors incl exposure to excessive noise levels

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Conductive - hearing loss

caused by external of middle ear problem

loss of hearing in which efficient sound transmission to the inner ear is interrupted by some obstruction or disease process

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Sensorineural - hearing loss

caused by damage to the cochlea or vestibulocochlear nerve

loss of hearing related to damage to the end organ for hearing or CN VIII or both

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Mixed - hearing loss

both conductive and sensorineural

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Functional (psychogenic) - hearing loss

caused by emotional problem

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Symptoms

tinnitus: perception of sound, often ringing in the ears

increased inability to hear in a group

turning up the volume on the TV

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As hearing loss increases symptoms also include:

deterioration of speech, fatigue, indifference, social isolation or withdrawal

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Communicating w/ Hearing Impaired Persons

-use a low tone, normal voice
-speak slowly & distinctly
-reduce background noise & distractions
-face the person & get their attention
-speak into the less impaired ear
-used gestures & facial expressions
-write out info or obtain a sign language translator

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CERUMEN IMPACTION (condition of the external ear)

-removal by irrigation, suction, or instrumentation
-gentle irrigation should be used w/ lowest pressure, directing stream behind the obstruction.
-Glycerin, mineral oil, half strength H2O2 or peroxide in glyceryl can soften cerumen

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FOREIGN BODIES
(condition of the external ear)

-removal may be by irrigation, suction, or instrumentation
-objects that may swell (veggies/insects) should not be irrigated
-can be dangerous and may be required to do so in the OR

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EXTERNAL OTITIS (condition of the external ear)

-caused by bacteria Staphylococcus or Pseudomonas or fungal infection from Aspergillus
-therapy is aimed at reducing discomfort, edema, and treating infection

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EXTERNAL OTITIS S/S

pain, tenderness, discharge, edema, erythema, pruritus, hearing loss, feelings of fullness in the ear

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MALIGNANT EXTERNAL OTITIS

rare, progressive infection that affects the external auditory canal, surrounding tissues, and skull

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TYMPANIC MEMBRANE PERFORATION

condition of the middle ear caused by infection or trauma.
Can be trauma like skull fracture, explosion injury, severe blow to ear. Or q-tip pushed to far into ear.

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ACUTE OTITIS MEDIA (condition of the middle ear)

-most frequently seen in children
-pathogens are bacterial or viral

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ACUTE OTITIS MEDIA S/S

otalgia (ear pain), fever, and hearing loss

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ACUTE OTITIS MEDIA TREATMENT

-antibiotic therapy
-myringotomy or tympanotomy

SEROUS OTITIS MEDIA (condition of the middle ear)

fluid in the middle ear w/out evidence of infection

CHRONIC OTITIS MEDIA (condition of the middle ear)

-result of recurrent acute otitis media
-chronic infection damages the tympanic membrane, ossicle, and involves the mastoid

CHRONIC OTITIS MEDIA TREATMENT

-prevent by tx of acute otitis
-tympanoplasty, ossiculoplasty, or mastoidectomy

TYMPANOPLASTY (middle ear surgical procedures)

reconstruction of the tympanic membrane

OSSICULOPLASTY (middle ear surgical procedures)

reconstruction of the bones of the middle ear prostheses are used to reconnect the ossicles to reestablish sound conduction

MASTOIDECTOMY (middle ear surgical procedures)

removal of diseased bone, mastoid air cells, and cholesteatoma cholesteatoma: benign tumor, causes high pressure in the middle ear, which causes hearing loss and neurologic disorders and destroys structures

MASTOIDECTOMY ASSESSMENT

-health hx -incl data related to the ear disroder - hearing loss, otalgia, otorrhea, vertigo -duration, intensity, causes, previous tx -medications Physical assessment: -erythema, edema, lesions -discharge, color, odor -review audiogram results

MASTOIDECTOMY DIAGNOSES

anxiety acute pain risk for infection impaired verbal communication risk for injury related to imbalance or vertigo deficient knowledge

Reducing anxiety

reinforce info & pt education provide support & allow to discuss anxieties

Relieving pain

medicate w/ analgesics constant throbbing pain & fever may indicate infection

Preventing injury

safety measures such as assisting w/ ambulation provide antiemetics or antivertigo meds

Preventing infection

monitor for s/s of infection admin antibiotics prevent contamination of ear w/ water from showers, washing hair, etc

Patient Education

-medication education: analgesics, antivertigo meds -activity restrictions -safety issues related to potential vertigo -f/u care

Conditions of the Inner Ear

dizziness, vertigo, nystagmus, tinnitus, labyrinthitis, nenign positional vertigo, ototoxicity, acoustic neuroma (tumor of the VIII CN)

Meniere Disease

-abnormal inner ear fluid balance caused by malabsorption of the endolymphatic sac or blockage of the endolymphatic duct episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss

Meniere Disease S/S

episodic vertigo tinnitus fluctuating sensorineural hearing loss Feeling of: pressure, nausea, vomit

Meniere Disease Treatment

-low sodium diet (1k-1.5k mg/day) -Meclizine (Antivert), tranquilizers-valium, antiemetics-promethazine, and diuretics -surgical management to eliminate attacks of vertigo, endolymphatic sac decompression, middle and inner ear perfusion, and vestibular nerve sectioning

cochlear implant

an auditory prosthesis used for ppl w/ profound sensorineural hearing loss bilaterally who don't benefit from conventional hearing aids

acute otitis media

inflammation in the middle ear lasting less than 6 wks

cholesteatoma

tumor of the middle ear or mastoid or both, that can destroy structures of the temporal bone

chronic otitis media

repeated episodes of acute otitis media causing irreversible tissue damage

endolymphatic hydrops

dilation of the endolymphatic space of the inner ear; the pathologic correlate of Meniere's disease

exostoses

small, hard, protrusions in the lower posterior bony portion of the ear canal

external otitis

inflammation of the external auditory canal (otitis externa)

labyrinthitis

inflammation of the labyrinth of the inner ear

middle ear effusion

fluid in the middle ear w/out evidence of infection

otalgia

sensation of fullness or pain in the ear

otorrhea

drainage from the ear

otosclerosis

condition characterized by abnormal spongy bone formation around the stapes

presbycusis

progressive hearing loss associated w/ aging

rhinorrhea

drainage from the nose