Hearing Loss & Balance Disorders

Hearing loss

• Prevalence increases with age and men>women; 50% over the age of 70

• Increased incidence with age—presbycusis

• Risk factors include exposure to excessive noise levels

• Types

  • Conductive: caused by external of middle ear problem

  • Sensorineural: caused by damage to the cochlea or vestibulocochlear nerve

  • Mixed: both conductive and sensorineural

  • Functional (psychogenic): caused by emotional problem

What are the manifestations of hearing loss?

• Early symptoms

  • Tinnitus: perception of sound; often “ringing in the ears”

  • Increased inability to hear in a group

  • Turning up the volume on the TV

• Impairment may be gradual and not recognized by the person experiencing the loss

  • As hearing loss increases, person may experience deterioration of speech, fatigue, indifference, social isolation or withdrawal, and other symptoms

Guidlines for comminicating with hearing impaired persons

• Determine how the person prefers to communicate

• Use a low-tone, normal voice

• Speak slowly and distinctly

• Reduce background noise and distractions

• Face the person and get their attention

• Speak into the less impaired ear

• Use gestures and facial expressions

• If necessary, write out information or obtain a sign language translator

What are the conditions of the external ear? (skip for exam 3)

• Cerumen impaction causing pain/fullness in the ear

  • Removal may be by irrigation, suction, or instrumentation

  • Gentle irrigation should be used with lowest pressure, directing stream behind the obstruction. Glycerin, mineral oil, half-strength hydrogen peroxide in glyceryl may help soften cerumen

• Foreign bodies

  • Removal may be by irrigation, suction, or instrumentation

  • Objects that may swell (e.g., vegetables or insects) should not be irrigated

  • Foreign body removal can be dangerous and may require extraction in the operating room

• External otitis

  • Inflammation caused by bacteria Staphylococcus or Pseudomonas, or fungal infection from Aspergillus

  • Manifestations: pain and tenderness, discharge, edema, erythema, pruritus, hearing loss, feelings of fullness in the ear

  • Therapy is aimed at reducing discomfort, reducing edema, and treating the infection

  • A wick may be inserted in the canal to keep it open and facilitate medication administration

• Malignant external otitis: rare, progressive infection that affects the external auditory canal, surrounding tissues, and skull

Conditions of middle ear (Don’t focus)

• Tympanic membrane perforation caused by infection/trauma

• Acute otitis media

  • Most frequently seen in children

  • Pathogens are most commonly bacterial or viral

  • Manifestations: otalgia (ear pain), fever, and hearing loss

  • Treatment

    • Antibiotic therapy

• Myringotomy or tympanotomy

• Serous otitis media: fluid in the middle ear without evidence of infection

• Chronic otitis media

  • Result of recurrent acute otitis media

  • Chronic infection damages the tympanic membrane, ossicle, and involves the mastoid

  • Treatment

    • Prevent by treatment of acute otitis

    • Tympanoplasty, ossiculoplasty, or mastoidectomy

What are the middle ear surgical procedures? (Don’t focus on)

• Tympanoplasty

  • Reconstruction of the tympanic membrane

• Ossiculoplasty

  • Reconstruction of the bones of the middle ear

  • Prostheses are used to reconnect the ossicles to reestablish sound conduction

• Mastoidectomy

  • Removal of diseased bone, mastoid air cells, and cholesteatoma to create a noninfected, healthy ear

  • Cholesteatoma: benign tumor, an ingrowth of skin that causes persistently high pressure in the middle ear, which causes hearing loss and neurologic disorders and destroys structures

Nursing interventions for the patient undergoing mastoid surgery

• Reduction of anxiety

  • Reinforce information and patient education

  • Provide support and allow to discuss anxieties

• Relieving pain

  • Medicate with analgesics for ear discomfort

  • Note: Occasional sharp, shooting pains may occur as the eustachian tube opens and allows air into the middle ear

  • Constant throbbing pain and fever may indicate infection

• Preventing injury

  • Safety measures such as assisting with ambulation

  • Provide antiemetics or antivertigo medications

• Improving communication and hearing

  • Note: Hearing may reduce for several weeks after surgery because of edema, accumulation of blood and fluid in the middle ear, and dressings and packings

  • Use measures to improve hearing and communication

• Preventing infection

  • Prevent contamination of ear with water from showers, washing hair, and so on

What are some conditions of the inner ear?

• Disorders of the vestibular system may increase the risk of falls

• Dizziness: any altered sense of orientation in space

• Vertigo: the illusion of motion or a spinning sensation

• Nystagmus: involuntary rhythmic movement of the eyes associated with vestibular dysfunction

• Tinnitus: ringing in the ears

• Labyrinthitis: inflammation of the labyrinth

• Benign positional vertigo (BBPV)

• Ototoxicity → “Ear poisioning” caused usally by meds or chemicals

  • What are the ototoxic meds

• Acoustic neuroma: tumor of the VIII cranial nerve

Hearing aids and some common issues

Device through which speech and environmental sounds are received by a microphone, converted to electrical signals, amplified, and reconverted to acoustic signals

Motion sickness (S&S, management)

• A disturbance of equilibrium caused by a conflict in motion receptor stimuli

• S&S: sweating, pallor, nausea, and vomiting caused by vestibular overstimulation

• Management: antihistamines (dimenhydrinate or meclizine); anticholinergics (scopolamine patches) → help with secetions in end of life

Ménière Disease

• Abnormal inner ear fluid balance caused by malabsorption of the endolymphatic sac or blockage of the endolymphatic duct; cochlear and vestibular

• Manifestations: a triad of symptoms: 1. episodic vertigo, 2. tinnitus, and 3. fluctuating sensorineural hearing loss; feeling of pressure, nausea and vomiting

• Treatment

  • Low-sodium diet (1000 to 1500 mg/day or less)

  • Antihistamines like Meclizine (Antivert); tranquilizers (diazepam/valium), antiemetics (promethazine), and diuretics (HCTZ, triamterene, spironolactone)

  • Surgical management to eliminate attacks of vertigo; endolymphatic sac decompression, middle and inner ear perfusion, and vestibular nerve sectioning