Sensory System & Neurological System Part D: Sensory: Care of the Ears

Flashcards for Sensory System & Neurological System Part D: Sensory: Care of the Ears

Sound waves travel by air conduction

They are picked up by the auricles and auditory canal, strike the tympanic membrane, causing it to vibrate, and are transmitted to the liquid medium of the inner ear where the vibration is picked up by tiny hair cells of the cochlea which initiate nerve impulses.

Nerve impulses from the cochlea

Carried by nerve fibers to the main branch of CN VIII (acoustic) and then to the brain.

Audiometer

Produces tones at varying intensities to which the client can respond for a hearing assessment.

Weber test

Test for conductive hearing loss.

Rinne test

Test for sensorineural hearing loss.

External Otitis

Inflammation or infection of the epithelium of the auricle and ear canal.

Assessment findings for External Otitis

Pain, increased by manipulation of auricle or tragus, feeling of fullness, foul-smelling white to purulent drainage, red swollen ear canal with discharge.

Treatment for External Otitis

Analgesics, antibiotics (otic drops), warm compresses, avoid cotton tip applicators.

Cerumen in ear canal

Can cause discomfort and decrease hearing.

Foreign Body in the external ear

Objects that become foreign bodies in ear canal: cleaning objects, insects, beans.

Nursing intervention for impacted cerumen

Irrigation for cerumen removal.

Acute otitis media

Infection of tympanum, ossicles, and middle ear space.

Clinical manifestations of acute otitis media

Pain, fever, malaise, decreased hearing.

Treatment for acute otitis media

Antibiotics; last resort: surgery.

Chronic otitis media

Untreated or repeated OM, or OM with effusion (inflammation with fluid in middle ear).

Clinical manifestations of chronic otitis media

Patient may report tinnitus, headache, malaise, fever, nausea, vomiting, dizziness.

Nursing diagnoses related to Otitis Media

Infection due to otitis media, pain due to ear infection.

Otitis Media (OM)

Infection of the middle ear; primarily affects young children and infants.

Contributing factors for development of OM

Age, attendance in daycare, viral infections, positioning with feeding, allergies.

Acute Otitis Media (AOM)

Usually follows URI and appears suddenly; associated with other signs of illness; parts of middle ear are infected and swollen; fluid is trapped behind eardrum.

Symptoms of Acute Otitis Media (AOM)

Tugging or pulling at ear, fussiness and crying, trouble sleeping, fluid draining from ear-yellowish green, purulent, foul smelling may indicate ruptured ear drum, clumsiness or problems with balance, trouble hearing or responding to quiet sounds

Otitis Media with effusion

Presence of fluid behind TM without signs of infection; often follows AOM; resolves usually in 1-3 months.

Assessment findings for Otitis Media with Effusion

Decreased hearing (popping or snapping sound), TM-Decreased mobility/retracted or bulging, Hearing loss (Conductive).

Recurrent Otitis Media

More than 3 episodes over 6-month period.

Myringotomy Surgical Opening

An incision is made into posterior inferior aspect of tympanic membrane for relief of persistent effusion

Post Op instructions Myringotomy with tympanostomy tubes

Small amt reddish drainage normal first few days. Report any fever, Discuss water in ears with physician.

Tinnitus

Ringing in the ear(s).

Treatment for Tinnitus

Therapy focuses on masking tinnitus by use of background sound, noisemakers, music during sleep; ear mold hearing aids can amplify sounds to drown out tinnitus during day.

Meniere's disease

A progressive disorder leading to an accumulation of endolymph in the membranous labyrinth that leads to hearing and balance problems.

Symptoms of Meniere's Disease

Tinnitus, one-sided sensorineural auditory, headache, fullness of ear, hearing loss, vertigo.

Teaching points for patients with Meniere's Disease

Move head slowly; reduce sodium; stop smoking; comply with drug therapy.

Dietary and behavioral changes for Meniere's Disease

Limiting dietary salt 1-2 gm Na/d and taking diuretics help some people control dizziness.

Conductive Hearing Loss

Due to any physical obstruction, inflammation to transmission of sound waves to nerve fibers.

Causes of Conductive Hearing Loss

Chronic OM, Otosclerosis, impacted cerumen, foreign body in the ear canal, inflammatory process or obstruction (tumors)

Otosclerosis

Most common cause of hearing loss in young adults- Decreased transmission of vibration to the inner ear fluids due to spongy bone preventing development

Sensorineural Hearing Loss

Due to damage to inner ear, in 8th CN (vestibulocochlear).

Causes of Sensorineural Hearing Loss

Noise exposure, genetic, age (presbycusis), ototoxic drugs.

Ototoxic Drugs

Antibiotics: Amikacin, Chloramphenicol, Erythromycin, Gentamycin, Streptomycin sulfate, Tobramycin sulfate, Vancomycin; Diuretics: Furosemide(Lasix); Nonsteroidal anti-inflammatory: Ibuprofen, Indomethacin, Naproxen, Salicylates (Aspirin); Chemotherapy Drugs: Cisplatin

Instructions when using Hearing Aids

Encourage to begin using hearing aid slowly to adjust to device, adjust volume to minimal hearing level to prevent feedback squeaking, teach to concentrate on sounds to be heard/filter out background noises, instruct to clean ear mold with mild soap/water, avoid excessive wetting of hearing aid, clean ear cannula of hearing aid with toothpick or pipe cleaner.