UNIT 5: Ch 20 (Porth's 5th Ed) - Disorders of Hearing and Vestibular Function Flashcards
- During a procedure to remove impacted cerumen, the nurse should be assessing the
patient for which of the following most critical complications?
A) Excessive bleeding from the ear
B) Pain related to instillation of warm fluids to soften the cerumen
C) Symptomatic bradycardia from vagal nerve innervation
D) Respiratory distress related to fluid entering bronchiole tubes
Ans: C
Feedback:
Because the external auditory canal is innervated by the auricular branch of the vagus
nerve, coughing or even cardiac deceleration can result from stimulation of the canal by
cerumen impactions or removal attempts. Since this just involves irrigation using a bulb
syringe and warm tap water, bleeding should not occur. Pain may occur but is not a
critical complication. Since the fluid is going into the ear canal, there should be no fluid
entering the respiratory system.
- A 60-year-old man has presented to his family physician following an earache that has
become progressively more painful in recent days. Following a history and examination
with an otoscope, the man has been diagnosed with otitis externa. Which of the
physician’s following statements to the man is most accurate?
A) “You’ll need to avoid getting any water in your ear until you finish your course of
antibiotic pills.”
B) “I’m going to instill some warm water into your ear to flush out debris and
bacteria.”
C) “I’ll prescribe some ear drops for you, and in the mean time, it’s important not to
use ear swabs.”
D) “This likely happened because your ears aren’t draining like they should, but
antibiotics that you’ll put in your ears will resolve this.”
Ans: C
Feedback:
Antimicrobial ear drops are the standard treatment for otitis externa, and the ears must
be protected from trauma during infection. Oral antibiotics are not commonly used, and
flushing the ears is not indicated for the condition. A lack of normal ear drainage is not
part of the etiology of otitis externa.
- During descent, an airplane passenger is complaining that his “ears are plugged.” What
aspect of the structure and function of the ear best accounts for the passenger’s
complaint?
A) The inner ear adjusts its volume in response to atmospheric pressure, increasing
during low pressure and decreasing in high pressure.
B) The eustachian tubes must remain patent to equalize pressure between the middle
ear and inner ear.
C) The tympanic membrane is selectively permeable in order to accommodate
pressure changes, and this capacity is often impaired during upper respiratory
infections.
D) Air must be able to flow between the middle ear and nasopharynx in order to
accommodate pressure changes.
Ans: D
Feedback:
The eustachian tubes between the middle ear and nasopharynx must be patent to allow
for changes in atmospheric pressure. Pressure is not accommodated by changing the
volume of the middle ear, and the tympanic membrane is not selectively permeable to
air.
- A 4-year-old boy has had otitis media with effusion (OME) for several weeks, and his
condition has recently progressed to acute otitis media (AOM). Which of the following
factors could have contributed to his AOM? Select all that apply.
A) Reflux of fluid from the boys nose into his middle ear
B) A deficiency in immunoglobulin M
C) Accumulation of cerumen in the external acoustic meatus
D) Sensorineural deficits in the auditory control apparatus
E) Exposure to respiratory virus
Ans: A, E
Feedback:
Reflux via the eustachian tubes, IgG deficiency, and exposure to RSV have all been
implicated in the development of AOM. Cerumen accumulation in the outer ear,
deficient IgM, and sensorineural deficits are unlikely to contribute to AOM
- Which of the following would be considered an abnormal finding when the nurse
practitioner uses an otoscope to look at a toddler’s ear? The tympanic membrane is
described as
A) “transparent.”
B) “a shallow, oval cone pointing inward toward apex.”
C) “small, whitish cord seen traversing the middle ear from back to front.”
D) “yellow, amber discoloration noted.”
Ans: D
Feedback:
Otoscopic signs of middle ear effusion will be seen in the tympanic membrane as a
yellow, amber discoloration. All of the other distracters are normal findings.
- When educating the parents of a child who has just had tympanostomy tube insertion,
the nurse should provide further teaching if the parents say which of the following
statements?
A) “I will call the physician if I see that the tube has come out.”
B) “I will be looking for any drainage coming from the ears.”
C) “I’m so glad that we can take the child swimming next week when we go on
vacation.”
D) “I’m so glad we had the child tested for allergies prior to having these tubes
placed.”
Ans: C
Feedback:
After tube insertion, the ears of children with tubes must be kept out of water. All of the
other distracters are normal post-op teaching for this procedure. Anytime a device
comes out after surgery, the physician should be notified. Routine post-op education
includes looking for infection, which in this case could be fever, increase in drainage
from the ear, or restlessness. Prior to surgery, most children with recurrent otitis media
have allergy testing performed.
- A 29-year-old woman has been diagnosed with otosclerosis after several years of
progressive hearing loss. What pathophysiological process has characterized her
diagnosis?
A) New spongy bone has been formed around her stapes and oval window.
B) Her incus, malleus, and stapes have become disconnected from her normal neural
pathways.
C) Her temporal bone is experiencing unusually rapid resorption.
D) Her tympanic cavity is becoming filled with bone due to inappropriate
osteogenesis.
Ans: A
Feedback:
Otosclerosis begins with resorption of bone in one or more foci. During active bone
resorption, the bone structure appears spongy and softer than normal (i.e.,
osteospongiosis). The resorbed bone is replaced by an overgrowth of new, hard,
sclerotic bone. Distortion of neural pathways, resorption of the temporal bone, and
filling of the tympanic cavity do not occur with otosclerosis.
- Distraught at the persistent ringing in his ears and his inability to alleviate it, a
50-year-old man has visited his health care provider. After diagnostic testing, no
objective cause (like impacted cerumen or vascular abnormality) was found. Given
these testing results, which of the following teaching points by the care provider is most
appropriate?
A) “This is most often the result of a psychological disturbance, and therapy is often
useful in relieving tinnitus.”
B) “There are many drugs such as blood pressure pills, relaxants, heart medications,
and antihistamines that can cause tinnitus.”
C) “A specialist can listen with a sensitive microphone to determine whether you are
actually hearing these sounds.”
D) “There are some treatments like tinnitus retraining therapy, which includes the
extended use of low-noise generators, which has shown good success.”
Ans: D
Feedback:
Current treatment modalities for tinnitus address the symptoms of the problem rather
than curing the underlying etiology. While therapy can be of some use, it is inaccurate
to characterize tinnitus as a psychological disturbance. Medications, including
antihistamines, anticonvulsant drugs, calcium channel blockers, benzodiazepines, and
antidepressants, have been used for tinnitus alleviation; they are not implicated as a
cause. While listening to differentiate between objective and subjective tinnitus is
possible, the absence of objective sounds does not mean that tinnitus does not exist,
rather that it is subjective. The use of tinnitus retraining therapy, which includes
directive counseling and extended use of low-noise generators to facilitate auditory
adaptation to the tinnitus, has met with considerable success.
- Following focal seizures that have damaged the dominant hemisphere of a patient’s
auditory association cortex, the nurse may observe the patient displaying
A) receptive aphasia.
B) facial drooping.
C) auditory hallucinations.
D) delusions of grandeur
Ans: A
Feedback:
Damage to the auditory association cortex, especially if bilateral, results in deficiencies
of sound recognition and memory (auditory agnosia). If the damage is in the dominant
hemisphere, speech recognition can be affected (sensory or receptive aphasia). The
others are not caused by focal seizures.
- Following a serious bout of bacterial meningitis, the parents of a 14-month-old has
noted the child is not responding to verbal commands. The nurse will explain the
pathophysiologic principle behind this by educating the patients by which of the
following statements?
A) “This could be caused by the same organism that caused the meningitis, infecting
the child’s tympanic membrane.”
B) “This may be due to a loss of hair cells and damage to the auditory nerve.”
C) “The ear and the lining of the brain that was infected are all connected together.”
D) “It is common for meningitis to use up all the natural killer cells and therefore
increase the risk of having brain tumors develop.”
Ans: B
Feedback:
Deafness or some degree of hearing impairment is the most common serious
complication of bacterial meningitis in infants and children. The mechanism causing
hearing impairment seems to be suppurative labyrinthitis or neuritis resulting in the loss
of hair cells and damage to the auditory nerve. There is no direct connection between
the meninges of the brain and the tympanic membrane. Bacterial meningitis is not
associated with an increased risk of developing a brain tumor.
- Which of the following questions is most likely to be clinically useful in the differential
diagnosis of sensorineural versus conductive hearing loss?
A) “What medications do you currently take?”
B) “What effect is this hearing loss having on your quality of life?”
C) “Has your hearing loss developed quickly or more slowly?”
D) “Do you ever hear a persistent ringing in your ears?”
Ans: A
Feedback:
Conductive hearing loss occurs when auditory stimuli are not adequately transmitted
through the auditory canal, tympanic membrane, middle ear, or ossicle chain to the inner
ear. It can be a temporary loss from impacted cerumen. Sensorineural hearing loss
occurs with disorders that affect the inner ear, auditory nerve, or auditory pathways to
the brain. Numerous drugs have ototoxic potential, a consequence of which is
sensorineural hearing loss. The onset and course of hearing loss and the presence or
absence of tinnitus do not necessarily help to differentiate between conductive and
sensorineural hearing loss. The subjective effect of the client’s hearing loss, while a
valid concern, does not help with the differential diagnosis.
- Otitis media (OM), which can occur in any age group, is the most common diagnosis
made by health care providers who care for children. Which bacterial pathogen causes
the largest proportion of cases that result in sensorineural hearing loss?
A) Streptococcus pneumoniae
B) Acoustic neuromas
C) Haemophilus influenzae
D) Parainfluenza
Ans: A
Feedback:
S. pneumoniae is the most common cause of bacterial meningitis that results in
sensorineural hearing loss after the neonatal period. Acoustic neuromas are cancers that
cause impaired hearing. Parainfluenza and influenza viruses are common viral
pathogens in OM.
- As part of a health promotion initiative, a public health nurse is meeting with a group of
older adult residents of an assisted living facility. Which of the following teaching
points about hearing loss in the elderly should the nurse include in the teaching session?
A) “It is actually a myth that seniors have worse and worse hearing as they age.”
B) “Most hearing loss in older adults is the result of easily fixed problems, such as
impacted ear wax.”
C) “Experts don’t quite know what causes seniors to lose their hearing with age, but
drugs like aspirin can contribute to the problem.”
D) “With older adults, the goal is to adjust lifestyle to accommodate diminished
hearing rather than trying to treat the hearing loss itself.”
Ans: C
Feedback:
Presbycusis is an identified phenomenon that is thought to be multifactorial, and
ototoxic drugs are known to contribute significantly to hearing loss in the elderly.
Sensorimotor etiologies are most common, and while lifestyle modifications are often
necessary, this does not rule out treatment of the hearing loss.
- A stroke affecting which of the following areas of the brain would be most likely to
leave an individual’s vestibular system intact and posture and balance maintained?
A) The brain stem
B) The thalamus
C) The temporal and parietal cortex
D) The limbic system of cerebrum
Ans: D
Feedback:
While the brain stem, thalamus, and temporal and parietal cortex are components of the
vestibular apparatus, the limbic system is not a central component of the maintenance of
posture and balance
- Which of the following individuals is most likely to be diagnosed with a central
vestibular disorder?
A) A man who got up quickly from his bed and sustained an injury after he “blacked
out”
B) A woman who has ongoing difficulty in balancing herself when walking
C) A woman who suffered a loss of consciousness after being struck on the head
during a soccer game
D) A man who states that he feels car sick whenever he rides in the back seat of a
vehicle
Ans: B
Feedback:
Central vestibular disorders are marked by a sensation of motion that interferes with
balance but that is mild and constant and chronic in duration. It should be differentiated
from postural hypotension, loss of balance from a head injury, or motion sickness
