Week 11: Inner Ear Disorders

What is presbycusis?

Age-related hearing loss

What is tinnitus?

Ringing in the ears

What should be assessed with hearing?

Auditory and equilibrium/balance assessment

What is vertigo?

Spinning feeling stimulated by head movement

What is nystagmus?

irregular eye movements (twitching)

What is Meniere’s disease?

Progressive disease characterized by accumulation of endolymph (fluid) in the inner ear that cause attacks

What does a Meniere’s disease related attack look like?

Sudden severe attacks of vertigo, n/v, sweating, and feeling of being pulled to the ground (drop attacks) that can last hours or days

What may a person experience prior to a Meniere’s disease attack?

Fullness of the ear, tinnitus, and muffled hearing

How can we diagnose Meniere’s disease?

Audiogram (hearing test), abnormal vestibular tests, and glycerol test (if glycerol improves hearing during the test, it means the patient is positive for Meniere’s)

What does treatment look like for Meniere’s disease?

Symptomatic treatment for vertigo, nausea, vomiting, etc.

What does treatment look like specifically for vertigo?

Bed rest, dark/quiet room, avoiding sudden movements, close eyes during attack, avoid fluorescent/flickering lights and tv, sedation, antiemetics or antivertigo medications, emesis basin

When can surgical interventions be done to help with Meniere’s disease?

if attacks are severe or seriously debilitating but uncommonly done due to loss of hearing

What are gentamicin injections?

Potential but rare treatment for Meniere’s disease because it is autotoxic and can cause inner ear damage

What are nursing priorities for a patient with Meniere’s disease?

Patient safety! Fall precautions, monitor I&Os, exercises for balance, education about safety at home (lighting, rugs, etc.)

What is the biggest risk for hearing loss?

Age

What is conductive hearing loss?

external and middle ear problem causing sound transmission to the inner ear to be impaired; patients hear better in a louder environment; sound is loud in their own head

What are signs that someone may have conductive hearing loss?

They can hear better through bone than air during their audiogram, patient speaks softly

What does treatment look like for conductive hearing loss?

Treat the underlying cause or they need hearing aids

What is sensorineural hearing loss?

permanent inner ear problem resulting in the ability to hear sound but unable to understand speech due to muffled sound

What is the treatment for sensorineural hearing loss?

Hearing aids (but… they make sounds louder but not clearer)

What are signs of ototoxicity?

Tinnitus and vertigo

What is mixed hearing loss?

Both conductive and sensorineural causes

What is the Weber test?

Stem of vibrating tuning fork placed on midline of skull or forehead, patient is then asked to indicate where sound is heard best

What is the Rinne Test?

Compares hearing by bone conduction and air conduction, tuning fork is then held against the mastoid bone; sound is no longer perceived behind the ear, the still-vibrating fork is moved close to the pinna; patient reports when sound next to the ear canal is no longer heard

Is the Weber or Rinne test better at diagnosing conductive or sensorineural hearing loss?

Conductive hearing loss

What is the most preventable cause of hearing loss

Loud noise

At what decibel should someone wear ear protection?

>70 decibels

What type of patient would a cochlear implant be best used for?

Someone who developed speech and language before losing their hearing and becoming Deaf

Why do patients with presbycusis struggle to communicate?

They struggle to hear consonants but can hear vowels so they only hear parts of words