Auditory

what are the 3 parts of the ear?

external, middle, and inner

what are the external structures of the ear?

• auricle

• external acoustic meatus (external auditory canal)

• tympanic membrane (eardrum)

what is the function of the external ear?

transmit sound to the eardrum

what are the structures of the middle ear?

• tympanic membrane

• auditory ossicles (malleus, incus, and stapes) = vibration of the tympanic membrane causes these bones to move and transmit sound waves to the oval window

what are the structures of the inner ear?

conductive hearing loss occurs when conditions in the outer or middle ear impair the transmission of sounds through the air to the inner ear

what are the structures of the inner ear?

look at pic

presbycusis

hearing loss due to aging

tinnitus

ringing in the ears

vertigo

the sense of the person or objects around a person is moving/spinning

dizziness

sensation of being off balance that occurs when standing or walking

nystagmus

twitching of the eyeball or blurring of the vision with head or eye movement

subjective data

• good health history

• medications

• surgeries

• health perception - management

objective data

• initial assessment

• external structures (ear, auditory canal, tympanum)

diagnostic studies

• audiometry - pure-tone audiometry

• specialized tests - CT and MRI

external otitis

• inflammation or imfection of the epithelium of the auricle and ear canal

_____ _____ is typically the first sign of external otitis

ear pain

• swelling, muffled hearing, and drainage

how to manage external otitis?

• otoscopic exam

• think about patient’s pain

• hand hygiene

• medications (ear drops like antibiotics and corticosteroids, and analgesics)

*make sure the ear drops are room temperature!

other external ear and canal problems

• impacted cerumen and foreign bodies (healthcare provider should remover impacted objects)

• trauma

• malignancy of external ear

_____ cancer is only common cancer of the ear

skin

otitis media

acute:

• tympanic membrane is red, bulging, and painful

• oral antibiotics and eardrops

with effusion:

• collection of fluid in middle ear space

• normally resolves without treatment

chronic:

• often painless

• hearing loss, nausea, dizziness

nursing management of chronic otitis media

• goal is to clear of infection, repair, perforations, and preserve hearing

• surgery is often necessary (tympanoplasty = reconstruction of the TM and/or ossicles) and mastoidectomy

• expect post-op hearing loss due to cotton packing in the ear and PT teaching

otosclerosis

• most common cause of hearing loss in adults

• diagnosed by Schwartz’s sign and Rinne test

• medications = oral sodium fluoride with Vit D and calcium carbonate

• hearing aids

• surgery

inner ear problems

• vertigo

• sensorineural hearing loss

• tinnitus

meniere’s disease

• progressive

• normally inly affects one ear

• women more likely to be affected

• hearing and balance

nursing management for meniere’s disease

• no cure

• glycerol test

• treatment aims to reduce number and severity of vertigo attacks (corticosteroids, antihistamines, and anticholinergics)

• safety

benign paroxysmal positional vertigo (BPPV)

• common cause of vertigo

• debris from auricle in the inner ear

• dizziness occurs with specific movements

• epley maneuver

acoustic neuroma

• benign tumor where the vestibulocochlear nerve enters the internal auditory canal

• sensorineural hearing loss (unilateral and progressive, tinnitus, vertigo, decrease in touch sensation)

• surgery (watch for CSF from the nose)

what are the types of hearing loss?

• conductive

• sensorineural

• mixed

tinnitus

medications: salicylates, loop diuretics, quinidine, quinine, or aminoglycosides

prevention: sudden or chronic exposure

assistive devices

• hearing aids: experiment with quiet volumes at home first, clean ear tips, implantable

• speech reading

• sign language

• cochlear implants

• assistive listening devices (direct amplified devices, amplified telephone receivers, flashing systems, and bluetooth)