Auditory: External Otitis, Cerumen & Foreign Bodies, Acute Otitis Media, Otitis Media with Effusion, Chronic Otitis Media &Mastoiditis, Meniere Disease, Benign Paroxysmal Positional Vertigo, and Conductive Hearing Loss

What is external otitis?

it is inflammation or infection of the auricle and ear canal

What caused external otitis?

• swimming

• trauma

• piercings 

• bacterial infection

What are some signs and symptoms of external otitis?

• otalgia (ear pain)

• swelling of outer ear

• muffled hearing

• fever

What are some labs and diagnostic tests for external otitis?

• otoscopic examination

• culture & sensitivity tests

What are some nursing actions and interventions for patients with external otitis?

• administer antibiotics when ordered

• administer corticosteroids when ordered

• apply moist heat to affected ear

What are some teachings for patients with external otitis?

• tell pt. to take antibiotics for 7 to 14 days

• tell pt. to take corticosteroids for 7 to 14 days 

• tell pt. to use moist heat on affected ear

• tell pt. they can take ibuprofen for ear pain at home

• tell pt. to apply ear drops at room temperature and the tip of the applicator cannot touch the ear

• tell pt. to stay laying on their side for at least 2 minutes after applying ear drops

What is cerumen & foreign bodies in the ear?

it is a cerumen impaction or object within the ear causing blockage

What are some signs and symptoms of cerumen impaction in the ear?

• discomfort in affected ear

• decreased hearing in affected ear

• tinnitus

• vertigo

Who should remove a foreign body in a patient’s ear?

a primary health provider should remove a foreign body in a ear

What are some nursing actions and interventions for a patient with cerumen impaction?

• irrigate with body temperature solution

• use lubricant drops to soften cerumen before irrigation

What are some teachings for a patient with a cerumen impaction?

• tell pt. to clean ear with washcloth and fingers

• tell pt. to not use cotton-tipped applicators

What is acute otitis media?

it is an infection of the tympanic membrane, ossicles and space of the middle ear

When does acute otitis media occur?

it usually occurs during childhood

What signs and symptoms of acute otitis media?

• inflamed tympanic membrane

• red, bulging tympanic membrane

• pain within the ear

• fever

• malaise (fatigue)

• drainage from ear

• reduced hearing in affected ear

What are some surgical interventions for acute otitis media?

• myringotomy

• tympanostomy tube

What are some nursing actions and interventions for acute otitis media?

• give oral antibiotics when ordered

• apply ear drops when ordered

• assess tympanic membrane 

• give antihistamines or corticosteroids if cause is allergies

What is some teachings for patients with acute otitis media?

• tell pt. to apply ear drops when ordered

• tell pt. to apply ear drops at room temperature 

• tell pt, to not touch applicator tip to ear

• tell pt. to stay laying on their side for at least 2 minutes after applying ear drops

What is otitis media with effusion?

it is inflammation of the middle ear with collection of fluid in the middle ear space

What can cause otitis media with effusion?

• acute otitis media

• sinus infection

What are some signs and symptoms of otitis media with effusion?

• feeling of fullness in affected ear

• sounds of popping within affected ear

• decreased hearing in affected ear

What are some teachings for patients with otitis media with effusion?

• tell pt. that it will resolve without treatment

• tell pt. that it may occur for weeks or months

What is chronic otitis media & mastoiditis?

it is purulent exudate and inflammation involving ossicles, auditory tube and mastoid bone

What are some signs and symptoms of chronic otitis media & mastoiditis?

• painless

• hearing loss in affected ear

• nausea

• vomiting

What is a complication of chronic otitis media and mastoiditis?

cholesteatoma is a complication

What are some labs and diagnostic tests for chronic otitis media and mastoiditis?

• otoscopic exam

• culture & sensitivity

• audiogram

• x-ray

• CT

• MRI

What are some surgical interventions for chronic otitis media and mastoiditis?

What are some nursing actions and interventions for chronic otitis media and mastoiditis?

• give otic or systemic antibiotics when ordered

• drain ear

• during post-op, do dressing care & keep suture line dry

What are some teachings for patients with chronic otitis media and mastoiditis?

• tell pt. post-op they may experience impaired hearing

• teach pt. how to change packing or dressing

• tell pt. to keep ear clean & dry

What is Meniere disease?

it is accumulation of endolymph in the membranous labyrinth

What are some signs and symptoms of Meniere disease?

• episodic vertigo (pt. suddenly falls; pt. describes it as being pulled down by one ear)

• drowsiness

• tinnitus

• ear pressure 

• feeling of fullness in affected ear

What are some surgical interventions for Meniere disease?

• Decompression & shunting

• vestibular nerve section

• ablation of labyrinth

• gentamicin injection through the tympanic membrane

What are some nursing actions and interventions for Meniere disease during acute vertigo attacks?

• give antihistamines, anticholinergics, or Benzos to decrease vertigo and lessen nauseous & vomiting 

• make sure pt. has an IV for medications

• put pt. in a quiet, dark room

• put pt. on fall risk precautions

What are some nursing actions and interventions for Meniere disease between attacks?

• give diuretics when ordered

• administer antihistamines when ordered

What is some teaching for patients with Meniere disease?

• let pt. know there is no cure

• tell pt. to not make sudden head movements

• tell pt. to go into a dark & quiet room 

• tell pt. to have a low sodium diet

• tell pt. to limit caffeine intake

• teach vestibular exercises

What is benign paroxysmal positional vertigo?

it is vertigo caused by free-floating debris in the semicircular canal

What can trigger benign paroxysmal positional vertigo?

it can be triggered by positional changes

What is a nursing intervention for benign paroxysmal positional vertigo?

do Epley maneuver with pt.

What is conductive hearing loss?

it is outer/ middle ear problems impair transmission of sound waves

What are the types of conductive hearing loss?

• impacted cerumen

• otitis media

• tympanic membrane perforation

• otosclerosis (bones of the inner ear harden & do not move like they should)

• allergies

• benign tumors

What is a diagnostic test for conductive hearing loss?

audiogram (air-bone gap)

What is presbycusis?

it is hearing loss due to aging

What is tinnitus?

it is ringing in the ears

What causes decline in balance, slowing of motor responses and musculoskeletal limitations in regard to hearing in the geriatric population?

atrophy of vestibular structures

What are some diagnostic studies done to test for hearing loss?

• audiometry

• electrocochleography

• tympanometry

• tuning fork tests

What is audiometry?

it is a screening that tests for hearing acuity to hear frequencies

What is electrocochleography?

it records electroactivity on the cochlea & the auditory nerve

What is tympanometry?

it checks the middle ear & the mobility of the tympanic membrane

What is a tuning fork?

it compares hearing by bone conduction & air conduction

What picture depicts external otitis?

What picture depicts acute otitis media?

What picture depicts tympanostomy tube for reoccurring acute otitis media?

What picture depicts otitis media with effusion?

What picture depicts a cholesteatoma due to chronic otitis media and mastoiditis?

What can happen if a cholesteatoma forms due to chronic otitis media and mastoiditis?

it can cause erosion of bones around the ear

• needs to be surgically removed immediately

What are some things that can cause conductive hearing loss?

• impacted cerumen

• otitis media

• tympanic membrane perforation

• otosclerosis (bones of the inner ear harden & don’t move like they are supposed to)

• allergies

• benign tumor(s)

What is central hearing loss?

it is the inability to interpret sound because of problem in the brain (CNS)

What is functional hearing loss?

• emotional or psychologic cause

• no physical reason for hearing loss but abnormal subjective hearing tests

• psychologic counseling

What is a cochlear implant?

it is an implant that bypasses damaged/missing portions and directly activates CN VIII

What picture depicts a cochlear implant?