SENSORY FUNCTION: Assessment & Management of Patients with Hearing and Balance Disorders

Question 1

The organ of hearing is known as the ____.

Answer 1

Cochlea

Question 2

Mechanical vibrations are transformed into neutral activity so that sounds can be differentiated by the ____.

Answer 2

Organs of Corti

The Organ of Corti is an organ of the inner ear located within the cochlea which contributes to audition.

Question 3

A sensorineural (perceptive) hearing loss results from impairment of the ____ cranial nerve.

Answer 3

Eight (8th)

(The vestibulocochlear nerve consists of the vestibular (balance) and cochlear nerves (hearing), also known as cranial nerve eight (CN VIII).)

Question 4

The critical level of loudness that most people (w/out a hearing loss) are comfortable with is a decibel (dB) reading of ____ dB.

Answer 4

30 dB

(Hearing becomes uncomfortable if the sound pressure level is above 110 decibels (threshold of discomfort), and it becomes painful above 130 decibels (threshold of pain).)
(*Sounds at or below 70 dBA are generally considered safe. Any sound at or above 85 dBA is more likely to damage your hearing over time. *)

Question 5

Severe hearing loss is associated with a decibel loss in the range of ____ to ____ dB.

Answer 5

70 to 90 dB

Question 6

A hearing loss that is a manifestation of an emotional disturbance is known as ____ hearing loss.

Answer 6

Functional hearing loss

Question 7

The minimum noise level known to cause noise-induced hearing loss, regardless of duration, is ____ to ____ dB.

Answer 7

85 to 90 dB

Question 8

It is projected that by 2050, ____ of people over age 55 will have some form of hearing loss.

Answer 8

50 %

Question 9

A facial nerve neuroma is a tumor on the ____ nerve.

Answer 9

Seventh (7th)

(*Facial Schwannoma/neuroma is a very rare tumour which grows on the 7th Cranial Nerve, the Facial Nerve. *)

Question 10

An acoustic neuroma is a benign tumor of the ____ nerve.

Answer 10

Eight (8th)

(*Acoustic neuroma, also called vestibular schwannoma, is a slow-growing, benign tumor that develops on the eighth cranial nerve—the nerve that carries signals from the inner ear to the brain. *)

Question 11

What three tests are used to evaluate gross auditory acquity?

Answer 11

• Rinne Test (used to evaluate hearing loss in one ear)
• Weber Test (a screening test for hearing performed with a tuning fork.)
• Whisper Test (whispered voice test (WVT) is an efficient screening test for detecting hearing loss.)

Question 12

Name the three characteristics that are essential when evaluating hearing.

Answer 12

• Frequency
• Pitch
• Intensity

Question 13

When assessing hearing and balance, what will be included?

Answer 13

Inspection of the external, middle, and inner ear

Question 14

What is the significance of the tympanogram test?

Answer 14

Tympanogram, or impedance audimetry, measures middle ear muscle reflex to sound stimulation and compliance of the tympanic membrane by changing the air presure in a sealed ear canal.

Tympanometry tests how well your middle ear works by measuring eardrum movement.

Question 15

Altered sensation of orientation in space

Answer 15

Dizziness

Question 16

Illusion of movement in w/c the person or surroundings are sensed as moving

Answer 16

Vertigo

Question 17

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

Answer 17

Exostoses

An exostosis is an extra growth of bone that extends outward from an existing bone.

Question 18

Involuntary rythmic eye movement

Answer 18

Nystagmus

Question 19

Sensation of fullness or pain in the ear

Answer 19

Otalgia

Question 20

Drainage from the ear

Answer 20

Otorrhea

Question 21

A condition characterized by abnormal spongy bone formation around the stapes

Answer 21

Otosclerosis

Question 22

Progressive hearing loss associated with aging

Answer 22

Presbycusis

Question 23

Drainage from the nose

Answer 23

Rhinorrhea

Question 24

Subjective perception of sound with internal origin; unwanted noises in the head or ear.

Answer 24

Tinnitus

Question 25

SITUATIONAL QUESTION:

The nurse is performing an assessment of a patient’s ears. Which appearance of the tympanic membrane does the nurse document as normal?

a. Pearly gray and translucent
b. White and cloudy
c. Pink with white exudate
d. Dark yellow with cerumen

Answer 25

**a. **Pearly gray and translucent

(A healthy TM should appear pearly grey and translucent.)

Question 26

The nurse cautions Mr. Wray about taking certain medications that will increase dizziness or tinnitus. Which medications will the nurse inform the patient should be avoided?

Answer 26

Aspirin / Aspirin products

(At high doses, aspirin toxicity can produce bilateral tinnitus.)

Question 27

SITUATIONAL QUESTION:

The nurse is examining the area behind the patient’s auricle and sees a flaky scaliness. Which disorder does the nurse suspect the patient has?

a. Sebaceous cysts
b. Seborrheic dermatitis
c. Tophi
d. Acute external otitis

Answer 27

**b. **Seborrheic dermatitis

(A flaky scaliness on or behind the auricle usually indicates seborrheic dermatitis and can be present on the scalp and facial structures as well)

Question 28

SITUATIONAL QUESTION:

The nurse is assessing the auricles of a patient. When the left auricle is manipulated, the patient reports pain. Which is the significance of this finding?

a. The patient may have seborrheic dermatitis.
b. The patient may have an inner ear infection.
c. The patient may have acute external otitis.
d. The patient may have acute otitis medtia.

Answer 28

c. The patient may have acute external otitis.

Question 29

SITUATIONAL QUESTION:

The student is learning how to adequately use an otoscope to examine the ear. Which method should the instructor educate the student to use when examining with an otoscope?

a. Otoscope should be held in the examiner’s left hand, in a pencil-hold position, with the examiner’s hand braced against the patient’s face.
b. Otoscope should be held in the examiner’s left hand, with a full hand grasp to be able to guide the scope into the internal ear.
c. Otoscope should be held in the examiner’s right hand, with a full hand grasp to be able to guide the scope into the internal ear.
d. Otoscope should be held in the examiner’s right or left hand, with a full hand grasp to be able to guide the scope into the internal ear.

Answer 29

a. Otoscope should be held in the examiner’s left hand, in a pencil-hold position, with the examiner’s hand braced against the patient’s face.

(This position prevents the examiner from inserting the otoscope too far into the external canal.)

Question 30

SITUATIONAL QUESTION:

A patient comes to the clinic with some hearing loss. The physician is unable to observe the tympanic membrane due to the accumulation of cerumen. Which intervention will the nurse provide so that observation can be made?

a. The nurse can remove the wax with a cerumen curette
b. The ear can be irrigated with cool water until all of the wax is removed.
c. The nurse can instill a small amount of mineral oil into the canal and have the patient return for removal of the wax.
d. The nurse can instill mineral oil into the canal and immediately irrigate to remove the adherent wax.

Answer 30

**c. **The nurse can instill a small amount of mineral oil into the canal and have the patient return for removal of the wax.

(Instill 3-5 drops into the affected ear at bedtime. Over night the oil will turn the hard/dry wax into a liquid substance. In the morning, simply clean the outer part of the ear with a washcloth to remove the residual oil and ear wax.)

Question 31

SITUATIONAL QUESTION:

A patient is scheduled to have an auditory brain stem response in 2 days. What does the nurse instruct the patient to do in preparation for the test?

a. Shave several areas on the scalp where the electrodes will be placed.
b. Do not eat or drink 8 hrs prior to testing.
c. Wash and rinse hair before test but do not apply any other hair products.
d. Omit daily medications prior to testing.

Answer 31

**c. **Wash and rinse hair before test but do not apply any other hair products.

Question 32

SITUATIONAL QUESTION:

A patient with vertigo is scheduled to have an electronystagmography in 2 weeks. Which instructions will the nurse provide to the patient prior to the test?

a. Withhold caffeine and alcohol 48 hours before the test.
b. Withhold blood pressure medication 24 hours before the test.
c. Withhold vestibular suppressants 48 hours before the test.
d. Do not eat or drink anything 12 hours before testing.

Answer 32

a. Withhold caffeine and alcohol 48 hours before the test.

(No drinking or coffee for 48 hours before an ENG.)

Electronystagmography (ENG) is a test used to evaluate vertigo and certain other hearing and vision disorders. Vertigo is a false sense of spinning or motion that can cause dizziness.

Question 33

SITUATIONAL QUESTION:

A patient has been diagnosed with a fungal infection causing external otitis. What is the most common fungal infection in the ear?

a. Staphylococcus aureus
b. Aspergillus
c. Pseudomonas
d. Streptococcus

Answer 33

**b. **Aspergillus

Question 34

SITUATIONAL QUESTION:

A patient has been treated for external otitis for the second time during the summer months. Which education will be provided for the patient to reduce the risk of developing this problem? (Select all that apply)

a. Do not clean the external canal with cotton-tipped applicators.
b. Irrigate the ears daily with a warm saline solution.
c. Avoid getting the ear wet when swimming or showering.
d. Use an antiseptic otic preparation after swimming, unless there is history of tympanic membrane perforation.
e. Ensure that cerumen is absent from the external canal by irrigating once a week after instilling mineral oil.

Answer 34

**a. **Do not clean the external canal with cotton-tipped applicators.
**c. **Avoid getting the ear wet when swimming or showering.
**d. **Use an antiseptic otic preparation after swimming, unless there is history of tympanic membrane perforation.

Question 35

SITUATIONAL QUESTION:

A patient has serious otitis media with significant hearing loss in the right ear. The patient states, “I have not been able to hear for 2 months.” Which procedure does the nurse prepare the patient for?

a. Irrigation of the ear
b. Myringotomy
c. Removal of cerumen with a cerumen curette
d. Instillation of otic solution

Answer 35

**b. **Myringotomy

(*A myringotomy may be done: To restore hearing loss caused by chronic fluid build-up and to prevent delayed speech development caused by hearing loss in children. *)

A myringotomy is a procedure to create a hole in the ear drum to allow fluid that is trapped in the middle ear to drain out.

Question 36

SITUATIONAL QUESTION:

The nurse is talking with a patient diagnosed with Ménière’s disease about the patient’s symptoms. What symptom does the patient inform the nurse is the most troublesome/problematic?

a. Nausea
b. Diarrhea
c. Tinnitus
d. Vertigo

Answer 36

d. Vertigo

(Ménière disease is a balance disorder. It’s caused by an abnormality in part the inner ear called the labyrinth. Fluid build-up here can cause a severe spinning sensation (vertigo) and affect the hearing.)

Question 37

SITUATIONAL QUESTION:

The nurse is caring for a patient with Ménière’s disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack?

a. Meclizine
b. Furosemide
c. Corticosporin otic solution
d. Gentamicin intravenously

Answer 37

a. Meclizine (Antivert)

(Pharmacologic therapy for Ménière’s disease consists of antihistamines, such as meclizine, which shortens the attack (NIDCD, 2010).)

Question 38

SITUATIONAL QUESTION:

A patient is complaining of ringing in the left ear and hearing loss in the same ear, but does not have any associated dizziness or vertigo. What should this patient be assessed for?

a. Otitis media
b. Acoustic neuroma
c. Labyrinthitis
d. Tinnitus

Answer 38

b. Acoustic neuroma

(True vertigo (the sensation of spinning or tilting) is NOT COMMONLY associated with acoustic neuromas, but it can sometimes occur due to tumor growth or bleeding.)

Question 39

SITUATIONAL QUESTION:

The nurse is talking to a family member of a hearing-impaired patient and the patient states,
“I know you are talking about me. You are just whispering so that I will not hear what you are saying.” What does the nurse recognize this statement indicates?

a. False pride
b. Indecision
c. Insecurity
d. Suspiciousness

Answer 39

d. Suspiciousness

(From the patient’s statement, the nurse can draw conclusions/suspicion that the patient has hearing impairment. Because the patient thinks that the nurse is whispering when in actual fact he/she is having a conversation that is well audible to the family member.)

Question 40

SITUATIONAL QUESTION:

The nurse is developing a plan of care for a patient with severe vertigo. Which expected outcome statement would be a priority for this patient?

a. Patient will experience no falls due to balance disorder.
b. Patient will take medications as prescribed.
c. Patient will perform exercises as prescribed.
d. Patient will have decreased fear and anxiety.

Answer 40

**a. **Patient will experience no falls due to balance disorder.

(Nursing care priority for patients with severe vertigo should always to prevent them from harm / injury.)