Inner Ear Disorders

If someone has an inner ear problem with vestibular labyrinth what will they experience

vertigo

If someone has an inner ear problem with Auditory labyrinth what will they experience

sensorineural hearing loss

tinnitus (ringing in ear)

What is Meniere’s Disease

• accumulation of endolymph in membranous labyrinth; progressive

• etiology: unknown; genetic and environmental factos

• Age 30-60; women more than men

Meiniere’s disease symptoms

• excess fluid and pressure → hearing and balance problems

• disability: sudden, severe attacks of vertigo, nausea, vomitting, sweating; unpredictable

• prior to attack: fullness in ear, tinnitus, and muffled hearing

• some experience feelings of: being pulled to the ground “drop attack” or whirling in space

• last hours → days; several time/year; variable

Nursing and interprofessional management: Menieres’s disease

• Diafnostic tests

  • audiogram- low frequency sensorineural hearing loss

  • spontaneous vertigo on two occasions

  • abnormal vestibular test

  • glycerol test ( help confirm disease by temporarily reducing fluid pressure in the inner ear)

• no cure; treatments to reduce frequency and severity of vertigo attacks

What can we do for people with acute meniers disease attack

• decrease abnormal sensations, nausea, and vomitting; coticosteriods, antihistamines, anticholinergics and benzodiazepines

• vertigo: bed rest, sedation, antiemetics or antivertigo

Management for meiners disease

• between attacks: diuretics, corticosteriods, low-sodium diet, and stress reduction

• surgircal intervention:

  • decompression

  • vestibular nerve section

  • ablation of labyrinth

• gentamicin injections

Nursing care for menieres disease

• Vertigo: dark, quiet room; avoid sudden movements; close eyes during vertigo; avoid fluroescent, flickering lights and TV; emesis basin

• Patient safety

  • fall precautions: side rails up, bed low position, call for help for OOB, assist with ambulation

• Monitor I and O: parenteral medication ; and fluid administration

• Paitent education: protect from injury/falls

Hearing loss: conductive

• external and middle ear

• decrese sound intensity and/or distortion

• sound transmission to inner ear impaired

• patients actually hear better in noisy environment

• caused by: otitis media with effusion, impacted cerumen, perforation TM, ostosclerosis, narrowing of external auditory canal

• patient often speaks softly

Hearing loss: sensorineural

• inner ear

• distortion or faintness of sound

• alter ability to understand speech

• complete hearing loss

• results in ability to hear sound but unable to understand speech

• can lead to misunderstaning by others

• sounds muffled; difficult to understand, especially high pitched sounds

• audiogram- loss indecibel levels

• hearing aids make sounds louder but not clearer

Hearing loss: central

• impaired auditory pathways in the brain

• problems with understanding the meaning of words heard

• unable to interpret sounds

Hearing loss and deafness: causes external ear

• impacted cerumen (wax)

• foreign bodies

• external otitis (inflammation)

Hearing loss and deafness: causes middle ear

• otitis media (inflammation)

• serous otitis

• ostosclerosis

• tympanic membrane trauma

• cholesteatoma

• acoustic neruoma

Hearing loss and deafness: causes inner ear

• meiners disease

• noise-induced hearing loss

• presbycusis

• ototoxicty

What is sensorineural hearing loss caused by

• impairment of the inner ear

• vestibulocochlear nerve (CN VIII) damage

• congenital and heredirary factors

• noise exposure

• aging (presbysusis)

• meiners disease

• trauma

• ototoxicty

What are ototoxic drugs for sensorineural hearing loss

• aspirin

• antibiotics

• loop diuretics

• NSAIDs

• antimalaraial agents

• chemotherapy drugs

What is mixed hearing loss

both conductive and sensorineural causes

Central and functional hearing loss

• central- problem in CNS; unable to interpret sound

  • refer to hearing and speech service

• functional- can be psychologically or emotionally related

  • refer for psychological counseling

Genetic hearing loss

• herefitary hearing loss

  • non-syndromic- gene mutations

  • alters cochlear function

  • increase risk of ototoxcity

  • structural malformations

• syndromic- 400 synfroms that include hearing loss along with other clinical abnormalities

Weber test

• patient indicate where vibrating tuning fork is

• Normal: midline tone, and sound heard equally

• conductive loss in 1 ear: sound will be heard louder in that ear

• sensorineural loss: sound is louder in the normal (undaffected) ear

Nursing care for those with hearing loss

• make sure the patient understands teaching (teach back)

• sign language

• patients may deny impairment

• irritability and frustration with speech and understanding

• withdrawl, depression cognitve decline as advances

Presbycusis

• age related hearing loss

• loss of peripheral auditory sensitivity

• decline in word recognition

• psychologic and communication issues

• diminished ability to under speech

  • can’t differntiate consonants