Patho Ear

conduction hearing loss

sound cannot get in to make vibrations to transmit sound waves to cochlear nerve

• excess cerumen (wax)

• foreign bodies

• scar tissue/adhesions/perforation impair tympanic membrane

treatment for conduction hearing loss

remove/fix obstruction

sensorineural hearing loss

disconnect within the inner ear prohibits sounds from being transmitted to the brain

• congential abnormalities

• infection

• ototoxic drug

• presbycusis

presbycusis

age-related hearing loss

ototoxic drugs

can cause temp or perm hearing loss; antibiotics (streptomycin, neomycin, vancomycin), analgesics (aspirin and ibuprofen), diuretic (furosemide), some antineoplastics (cancer meds)

tinnitus

ringing in the ears; early sign of toxicity

interventions for all kinds of hearing loss

hearing aids, lip reading, ASL, cochlear implants, therapy with a speech-language pathologist

Otitis Externa (Swimmer's Ear)

inflammatory condition of external ear canal

patiophysiology of otitis externa

usually bacterial, can be fungal infection -> inflammatory response

clinical manifestations of otitis externa

erythema and edema of ear canal; ear pain, purulent discharge, hearing deficit; increased pain with movement of pinna

management of otitis externa

acetaminophen or NSAIDs, topical antibiotic

otitis media

inflammation of middle ear (space behind tympanic membrane)

epidemiology of otitis media

most common childhood PCP visit, prevalence of 20% in first year of life, up to 90% of US kids have at least 1 documented case by age 2

pathophysiology of otitis media

dysfunction of the Eustachian tube -> accumulation of pathogens from nasopharynx

clinical manifestations of otitis media

otalgia (ear pain), fever, irritability, anxorexia (loss of appetite), rubbing the ears, crying, otorrhea (ear drainage)

otitis media treatment

routine anitbiotic use is questioned - antibiotic overuse -> antibiotic resistance concerns; antibiotics if bilateral (both ears), unilateral w/ severe symptoms, oral amoxiccilion; insertion of drainage tubes through TM to facilitate drainage

otosclerosis

excess bone in middle ear - stapes becomes fixed and blocks sound conduction to the cochlea; genetic factor, primarily in young adult females

otosclerosis clinical manifestations

hearing loss

otosclerosis treatment

hearing aids, surgical removal of stapes with prothestic replacement to restore sound transmsission

Ménière's disease

inner ear, cyclical 'attacks' with period of relief between, exact cause unknown

pathophysiology of Ménière's disease

excessive endolymph stretches membrane and interferes with hair cells in cochlea and vestibule; rupture of labyrinth membrane may allow perilymph and endolymph to mix, increasing volume of fluid and causing an 'attack'

clinical manifestations for Ménière's disease

vertigo, fluctuating hearing loss, low-tone, roaring tinnitus, ear fullness

management of Ménière's disease

prevention - avoid triggers (chocolate, caffeine, smoking) manage accompanying symptoms (N, V, inflammation), Rx - vestuibulosuppresants - meclizine

meclizine hydrochloride therapeutic class

vestibulosuppresant

meclizine hydrochloride pharmacological class

nonselective H1 antagonist, central anticholinergic

meclizine hydrochloride indication

motion sickness, vertigo, nausea

MOA meclizine hydrochloride

unknown, thought to suppress vesitublar receptors and inhibit N and vertigo

route of meclizine hydrochloride

oral

side effects meclizine hydrochloride

drowsiness, antichloingeric (can't see, spit, pee, poo) effects urinary retention, dry mouth, blurred vision, headache)

adverse effects meclizine hydrochloride

rare

nursing consideration meclizine hydrochloride

avoid driving, alcohol and sedating medications; use with caution in glaucoma and BPH

ear drop instillations

patient upright, tilt head toward unaffected side

kids <3 pull down and back on auricle

adults pull up and out on pinna

ear drops should be aimed at

side of ear and allowed to run down into ear - avoid fall directly on TM

do not ___________ ear dropper

contaminate

avoid instilling medications that are ____ to prevent discomfort and dizziness

cold