External Otitis

Pathophysiology and Etiology

Microorganisms: Staphylococcus aureus is the most common bacterial cause, while fungi like Candida albicans and Aspergillus thrive in the warm, moist climate of the ear canal.

Trauma: Picking the ear or using sharp objects (e.g., hairpins) often causes the initial break in the skin.

Piercings: Piercing the cartilage in the upper auricle increases the risk for infection.

Malignant External Otitis: A serious infection caused by P. aeruginosa that mainly occurs in older patients with diabetes and can spread to the parotid gland and temporal bone

Clinical Manifestations

Otalgia (Ear Pain): This is an early sign; patients may have significant pain with chewing, moving the auricle, or pressing on the tragus.

Hearing Changes: Swelling of the ear canal can muffle hearing.

Drainage: Discharge may be serosanguineous (blood-tinged) or purulent (white to thick green).

Systemic Symptoms: Fever occurs if the infection spreads to the surrounding tissue.

Medication Administration (Otic Drops)

Temperature: Drops should be at room temperature; cold drops can cause vertigo due to semicircular canal stimulation, while heated drops can burn the tympanic membrane.

Asepsis: Wash hands before and after; the dropper tip should not touch the ear to prevent contaminating the bottle.

Technique: Position the ear so drops run into the canal, and have the patient remain in that position for 2 minutes to allow the medication to spread

Patient Education for Prevention

Avoid Insertions: Do not put anything in the ear canal (like cotton-tipped applicators) unless requested by a healthcare provider.

Moisture Control: Keep ears as dry as possible. Use earplugs if prone to swimmer's ear and turn the head to each side for 30 seconds after swimming to let water run out.

Drying Technique: A hair dryer set to low and held at least 6 inches from the ear can speed water evaporation.

A patient presents to the clinic with severe ear pain that increases when the nurse pulls on the pinna. The nurse recognizes this as a hallmark sign of which condition?

A. Otosclerosis

B. Ménière disease

C. External otitis

D. Acoustic neuroma

Answer: C. Otalgia (ear pain) is an early sign of external otitis, and the patient may have significant pain with moving the auricle or pressing on the tragus

Which organism is identified as the most common bacterial cause of external otitis?

A. Pseudomonas aeruginosa

B. Candida albicans

C. Staphylococcus aureus

D. Aspergillus

Answer: C. Staphylococcus aureus is the most common bacterial cause of external otitis.

A patient is diagnosed with "swimmer's ear." The nurse understands that this condition is often caused by which of the following?

A. A viral infection of the inner ear

B. Changes in the flora of the external canal due to chemicals or contaminated water

C. Calcification of the ossicles in the middle ear

D. A benign tumor on the vestibulocochlear nerve

Answer: B. Swimming may change the flora of the external canal because of chemicals and contaminated water, resulting in "swimmer's ear".

The nurse is providing discharge teaching to a patient with external otitis. What should the patient be instructed to avoid doing at home?

A. Using a hair dryer on a low setting

B. Applying moist heat for pain relief

C. Using cotton-tipped applicators to dry the ear

D. Reporting itching to the healthcare provider

Answer: C. Patients should be taught to avoid drying their ears with cotton-tipped applicators, as their use can cause serious injury to the tympanic membrane (TM) and ossicles.

A patient is prescribed otic (ear) drops for an infection. To prevent the occurrence of vertigo during administration, which action should the nurse take?

A. Heat the drops in the microwave for 10 seconds

B. Ensure the drops are at room temperature

C. Administer the drops while the patient is standing

D. Refrigerate the drops for one hour before use

Answer: B. Eardrops should be at room temperature because cold drops can cause vertigo due to stimulation of the semicircular canals.

Which serious infection of the external ear occurs mainly in older patients with diabetes?

A. Acute otitis media

B. Malignant external otitis

C. Benign paroxysmal positional vertigo

D. Otosclerosis

Answer: B. Malignant external otitis is a serious infection caused by P. aeruginosa that occurs mainly in older patients with diabetes.

When instilling eardrops, how long should the nurse instruct the patient to remain in the side-lying position to allow the medication to spread?

A. 30 seconds

B. 2 minutes

C. 5 minutes

D. 10 minutes

Answer: B. The patient should stay in position for 2 minutes to allow the drops to spread throughout the canal.

A patient has impacted cerumen (earwax) and requires irrigation. Which solution temperature is most appropriate for this procedure?

A. Ice cold

B. Room temperature

C. Body temperature

D. Extremely hot

Answer: C. An impaction should be removed by irrigating the canal with body-temperature solutions.

While assessing a patient with acute otitis media, which otoscopic finding should the nurse expect?

A. A shiny, pearl-gray translucent membrane

B. A red, bulging, and painful tympanic membrane

C. A reddish blush seen through the membrane

D. A clear canal with no landmarks visible

Answer: B. In acute otitis media, pressure from inflammation pushes on the tympanic membrane (TM), causing it to become red, bulging, and painful.

A patient reports a "plugged" feeling in the ear and a sensation of popping after a recent cold but denies any pain or fever. The nurse suspects which condition?

A. Malignant external otitis

B. Otitis media with effusion

C. Acoustic neuroma

D. Ménière disease

Answer: B. Symptoms of otitis media with effusion include a "plugged" feeling or popping and decreased hearing, typically without pain or fever.

Which surgical procedure involves an incision in the tympanic membrane to release pressure and exudate?

A. Myringotomy

B. Mastoidectomy

C. Stapedectomy

D. Labyrinthectomy

Answer: A. A myringotomy involves an incision in the TM to release increased pressure and exudate from the middle ear.

The nurse is caring for a patient after a tympanoplasty. Which instruction should be included in the postoperative teaching?

A. Resume swimming in the local pool in one week

B. Sleep on the operated ear to promote drainage

C. Cough or sneeze with the mouth open

D. Blow the nose forcefully to clear the eustachian tube

Answer: C. After ear surgery, patients should keep their mouth open if they need to cough or sneeze.

A young adult is diagnosed with otosclerosis. The nurse understands this is a hereditary disease that results in which of the following?

A. Inflammation of the external ear canal

B. Spongy bone growth that prevents stapes movement

C. Excessive production of endolymph in the inner ear

D. A tumor on the cranial nerve VIII

Answer: B. Otosclerosis is a hereditary disease where spongy bone develops, preventing movement of the footplate of the stapes.

During an assessment for otosclerosis, the nurse notes a reddish blush of the tympanic membrane. What is this sign called?

A. Rinne sign

B. Weber sign

C. Schwartz sign

D. Epley sign

Answer: C. Otoscopic examination in otosclerosis may reveal a reddish blush of the TM known as Schwartz sign.

Which clinical manifestation is a classic sign of Ménière disease?

A. Sudden hearing loss that resolves in 24 hours

B. Episodic vertigo, tinnitus, and ear pressure

C. Purulent drainage from the external canal

D. Pain when pulling on the auricle

Answer: B. Ménière disease involves hearing and balance problems, including episodic vertigo, tinnitus, and ear pressure or fullness.

A patient with Ménière disease is experiencing a "drop attack." How should the patient describe this sensation?

A. A feeling of being pulled to the ground

B. A sudden loss of consciousness

C. Intense itching in the ear canal

D. Hearing their own voice loudly

Answer: A. Patients with Ménière disease may have "drop attacks," which is a feeling of being pulled to the ground.

Which medication class is used during an acute attack of Ménière disease to decrease vertigo and nausea?

A. Systemic antibiotics

B. Antihistamines and benzodiazepines

C. Beta-adrenergic blockers

D. Loop diuretics

Answer: B. During acute attacks, antihistamines (e.g., meclizine) and benzodiazepines (e.g., lorazepam) can decrease vertigo and nausea

What is the primary cause of vertigo in Benign Paroxysmal Positional Vertigo (BPPV)?

A. A bacterial infection of the middle ear

B. Free-floating debris ("ear rocks") in the semicircular canal

C. An accumulation of endolymph fluid

D. Compression of the trigeminal nerve by a tumor

Answer: B. In BPPV, free-floating debris in the semicircular canal causes vertigo with specific head movements.

Which maneuver is effective in providing symptom relief for patients with BPPV by moving ear debris?

A. Weber maneuver

B. Rinne maneuver

C. Epley maneuver

D. Schwartz maneuver

Answer: C. The Epley maneuver, or canalith repositioning procedure, is effective in providing relief for many BPPV patients.

A patient is diagnosed with an acoustic neuroma. The nurse knows this tumor is located on which cranial nerve?

A. CN V (Trigeminal)

B. CN VII (Facial)

C. CN VIII (Vestibulocochlear)

D. CN X (Vagus)

Answer: C. An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve (CN VIII) enters the internal auditory canal.

A patient reports a rapid, unexplained loss of hearing in one ear over two days. How should the nurse categorize this situation?

A. A normal age-related change

B. A medical emergency

C. A typical symptom of impacted wax

D. A result of gradual presbycusis

Answer: B. Sudden hearing loss, or sudden deafness, is a medical emergency, and the patient should see an HCP at once.

Which type of hearing loss occurs when sound waves are not accurately transmitted through the outer or middle ear?

A. Sensorineural hearing loss

B. Conductive hearing loss

C. Central hearing loss

D. Functional hearing loss

Answer: B. Conductive hearing loss occurs when outer or middle ear problems impair the transmission of sound waves to the inner ear.

A patient with conductive hearing loss often demonstrates which speech characteristic?

A. Shouting to be heard

B. Speaking very softly

C. Using sign language exclusively

D. Repeating every word twice

Answer: B. The patient with conductive hearing loss often speaks softly because hearing their own voice (conducted by bone) seems loud.

Sensorineural hearing loss is primarily caused by damage to which structure?

A. The tympanic membrane

B. The auditory ossicles

C. The inner ear or vestibulocochlear nerve

D. The external auditory canal

Answer: C. Sensorineural hearing loss is caused by damage in the inner ear or the vestibulocochlear nerve (CN VIII).

The nurse is communicating with a hearing-impaired patient. Which verbal aid should the nurse use?

A. Shout loudly into the patient's ear

B. Exaggerate facial expressions while speaking

C. Speak normally and slowly

D. Use long, complex sentences to provide more context

Answer: C. When communicating with a hearing-impaired patient, the nurse should speak normally and slowly and not shout.

Noise-induced hearing loss can be caused by chronic exposure to noise levels above which decibel (dB) level?

A. 20 dB

B. 40 dB

C. 70 dB

D. 110 dB

Answer: C. Health teaching about avoiding continued exposure to noise levels greater than 70 dB is essential to prevent hearing loss

Which vaccine can prevent sensorineural deafness caused by fetal damage if a mother is infected during pregnancy?

A. Tetanus

B. MMR (Measles, Mumps, Rubella)

C. Hepatitis B

D. Pneumococcal

Answer: B. Rubella infection during pregnancy can cause sensorineural deafness; therefore, the MMR vaccine is promoted for prevention.

A patient is prescribed a cochlear implant. The nurse understands the ideal candidate for this device is someone who:

A. Was born profoundly deaf

B. Has conductive hearing loss due to impacted wax

C. Acquired speech and language before becoming deaf

D. Refuses to use any other assistive listening devices

Answer: C. The ideal patient for a cochlear implant is one who became deaf after they acquired speech and language.

Presbycusis is hearing loss associated with aging. Which sounds typically become the hardest for these patients to hear first?

A. Low-pitched vowels

B. High-frequency consonants

C. Household background noise

D. Their own heartbeat

Answer: B. In presbycusis, the person hears vowels but cannot distinguish consonants because they are in the high-frequency range.

A patient is recovering from ear surgery. Which activity should they be taught to avoid for 6 weeks?

A. Sleeping on their back

B. Air travel and swimming

C. Washing their hands

D. Eating solid foods

Answer: B. After ear surgery, patients should avoid air travel and keep their ear dry (no swimming) for 6 weeks.