Conditions of the Ear

Cerumen Impaction

occurs when earwax accumulates and blocks the external auditory canal.

Clinical Manifestations of Cerumen Impaction

Otalgia

Sensation of fullness in the ear

Ear pain

Hearing loss

Local irritation

Tinnitus

Otalgia

pain in the ear

Irrigation

Suction

Instrumentation

Cerumen and foreign objects may be removed through:

Ear Irrigation

flushing the ear canal with warm water to remove impacted cerumen. It is commonly used when cerumen is not tightly packed in the external auditory canal.

Perforated eardrum

Inflamed external ear

Otitis externa

Gentle irrigation with warm water may be used if the patient does not have:

behind the obstructing cerumen.

For successful removal, the water stream should flow

Use Warm water, Gentle irrigation, Low pressure

Do not use Cold or Warm water, and forceful irrigation

What to use in performing irrigation.

Dizziness

Vertigo

Nausea

Vomiting

Effects of cold water irrigation

Burning

Pain

Tissue irritation

Effects of hot water irrigation

Warmed glycerin

Mineral oil

Half-strength hydrogen peroxide

Before irrigation, cerumen may be softened by instilling a few drops of:

Cerumen curette

Aural suction

Binocular microscope for magnification

If irrigation and softening methods are unsuccessful, cerumen may be removed using instruments such as:

External Otitis / Otitis Externa

inflammation of the external auditory canal. It is commonly known as swimmer's ear when related to water exposure. The most common pathogens are Staphylococcus aureus, Pseudomonas species, and Aspergillus.

Aural tenderness

Pain upon palpation of the ear. usually present in external ear infection but usually not present in middle ear infection.

Tympanic Membrane Perforation

a tear or opening in the eardrum usually caused by infection or trauma.

Tympanoplasty

surgical repair or reconstruction of the tympanic membrane. Tissue, commonly Temporalis fascia, is placed across the perforation to allow healing. It may be performed to Prevent infection from water entering the ear, Improve hearing, and Permanently close the perforation

Acute Otitis Media

an acute infection of the middle ear. It usually lasts less than 6 weeks. Most common in children. Pathogens usually enter the middle ear after eustachian tube dysfunction. a purulent exudate is usually present in the middle ear.

Lasts from 2 weeks to 3 months.

Subacute Otitis Media

Myringotomy / Tympanotomy

Surgical incision into the eardrum to allow for drainage and relieve pressure. The incision usually heals within 24 to 72 hours

Ventilating / Pressure-Equalizing Tube

The tube temporarily replaces the function of the eustachian tube by equalizing pressure. The tube may stay in place for 6 to 18 months. It is later extruded through normal skin migration of the tympanic membrane.

Serous Otitis Media

also called middle ear effusion, is the presence of fluid in the middle ear without active infection. It is commonly caused by negative pressure in the middle ear due to eustachian tube obstruction. The tympanic membrane may appear dull and usually shows conductive hearing loss

Chronic Otitis Media

repeated episodes of acute otitis media causing irreversible tissue damage and persistent tympanic membrane perforation. Chronic infection may Destroy the ossicles, Involve the mastoid, or Lead to cholesteatoma formation. Pain is usually absent unless acute mastoiditis occurs.

Cholesteatoma

a cystlike lesion involving the middle ear. It is formed from skin and sebaceous material. commonly caused by a chronic retraction pocket of the tympanic membrane. This creates persistently high negative pressure in the middle ear.

Tympanoplasty

Ossiculoplasty

Mastoidectomy

Surgical Management of Chronic Otitis Media

Ossiculoplasty

surgical reconstruction of the middle ear bones. It is done to restore hearing by reestablishing the sound conduction mechanism.

Mastoidectomy

surgical removal of diseased mastoid air cells. Remove cholesteatoma. Gain access to diseased structures, Create a dry, healthy, noninfected ear, and Reconstruct ossicles if possible

Otosclerosis

an ear disorder involving abnormal bone formation around the stapes, especially near the oval window. This causes fixation of the stapes. Because the stapes cannot vibrate properly, sound transmission from the malleus and incus to the inner ear is reduced.

Stapedectomy

Stapedotomy

Surgical Management of Otosclerosis

Stapedectomy

involves removing the stapes superstructure and part of the footplate. A tissue graft and prosthesis are inserted. The prosthesis bridges the gap between the incus and the inner ear to improve sound conduction.

Stapedotomy

involves drilling a small hole into the stapes instead of removing it. A prosthesis is inserted into the hole. it improves sound conduction by bridging the gap between the incus and the inner ear.

Dizziness

a general term used to describe an altered sensation of orientation in space. It is often described as Lightheadedness, Feeling unsteady, Feeling faint, or Feeling off balance

Vertigo

the false sensation or illusion of motion. Patients may describe it as Spinning sensation, Feeling like the surroundings are moving, or Feeling like objects are moving around them

Syncope

means fainting or loss of consciousness. It usually suggests a problem with the cardiovascular system.

Motion Sickness

a disturbance of equilibrium caused by conflict in motion receptor stimuli. It happens when the brain receives mixed signals from the eyes, inner ear, and body movement receptors. symptoms are caused by vestibular overstimulation

OTC Antihistamines

Anticholinergics

Management of Motion Sickness

Ménière's Disease

an inner ear disorder caused by abnormal inner ear fluid balance. It may result from Malabsorption in the endolymphatic sac or Blockage in the endolymphatic duct. It is associated with endolymphatic hydrops.

Endolymphatic Hydrops

dilation of the endolymphatic space of the inner ear; the pathologic correlate of Meniere's disease. may cause: Increased pressure in the inner ear or Rupture of the inner ear membrane

Episodic vertigo

Tinnitus

Fluctuating sensorineural hearing loss

Ménière's disease is characterized by a classic triad:

Cochlear Ménière's Disease

also called cochlear hydrops, is a variant of traditional Ménière's disease characterized by isolated inner-ear fluid swelling. Patients experience fluctuating hearing loss, ringing in the ears (tinnitus), and aural fullness, but without the severe, spinning vertigo typical of standard Ménière's

Vestibular Ménière's Disease

a chronic inner ear disorder characterized by recurrent, severe vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness. Caused by a buildup of fluid (endolymph) in the inner ear.

Dietary Guidelines for Ménière's Disease

Limit foods high in salt (1000 to 1500 mg/day or less).

Limit foods high in sugar.

Be aware of hidden salt and sugar in foods.

Eat meals and snacks at regular intervals.

Avoid skipping meals.

Eat fresh fruits, vegetables, and whole grains.

Limit canned, frozen, and processed foods high in sodium.

Drink plenty of fluids daily.

Choose water, milk, and low-sugar fruit juices.

Limit coffee, tea, and soft drinks.

Avoid caffeine because of its diuretic effect.

Limit alcohol intake.

Avoid monosodium glutamate, or MSG.

Monitor potassium intake if taking potassium-wasting diuretics.

Avoid aspirin and aspirin-containing medications.

Antihistamines

Tranquilizer

Antiemetics

Diuretics

Intratympanic Gentamicin

Pharmacologic Therapy for Ménière's Disease

Endolymphatic sac decompression

Vestibular nerve sectioning

Surgical Management of Ménière's Disease

Endolymphatic Sac Decompression

also called shunting, is a procedure used to equalize pressure in the endolymphatic space. A shunt or drain is inserted into the endolymphatic sac through a postauricular incision. This is often favored as a first-line surgical approach because it is Relatively simple, Safe, and is Possible to perform on an outpatient basis

Vestibular Nerve Sectioning

involves cutting the vestibular nerve to stop vertigo signals from reaching the brain. Cutting the nerve prevents the brain from receiving abnormal input from the semicircular canals.

Nursing Management and Patient Teaching For Dizziness and Vertigo

Change positions slowly.

Avoid sudden head movements.

Sit or lie down during vertigo attacks.

Avoid walking without assistance during severe dizziness.

Keep the environment free from fall hazards.

Use assistive devices if needed.

Report worsening symptoms.

Nursing Management and Patient Teaching For Motion Sickness

Take medication before exposure to motion.

Apply scopolamine patch 4 hours before travel.

Replace scopolamine patch every 3 days.

Avoid driving if drowsy.

Avoid operating heavy machinery if drowsy

Benign Paroxysmal Positional Vertigo (BPPV)

a brief episode of sudden, incapacitating vertigo that occurs when the position of the head changes in relation to gravity. It usually happens when the patient moves the head backward with the affected ear turned downward. believed to be caused by disrupted debris inside the semicircular canal. This debris comes from small crystals of calcium carbonate from the utricle. These crystals are sometimes called canaliths

Clinical Manifestations of BPPV

Brief episodes of vertigo

Sudden onset of dizziness

Positional vertigo

Nausea

Vomiting

Hearing loss usually does not occur

Bed Rest

Canalith Repositioning Procedure

Meclizine for 1 to 2 weeks

Management of BPPV

1. Place the patient in a sitting position.

2. Turn the head to a *45-degree angle* toward the affected side.

3. Quickly move the patient into a supine position.

4. The quick movements help reposition the canalith debris.

5. Prochlorperazine may be given 1 hour before the canalith repositioning procedure.

Canalith Repositioning Procedure:

Vestibular Rehabilitation

a management strategy used for vestibular disorders. It promotes active use of the vestibular system to help the brain compensate for balance impairment.

Tinnitus

perception of sound in one or both ears without an external sound source. It may be a symptom of an underlying ear disorder associated with hearing loss, or it may be benign.

Labyrinthitis

inflammation of the labyrinth of the inner ear. May affect hearing and balance. May be viral or bacterial.

Ramsay Hunt Syndrome

a neurological disorder caused by the reactivation of the varicella-zoster virus (the virus that causes chickenpox and shingles) in the facial nerve. It is characterized by severe ear pain, a blistering rash around the ear, and facial paralysis on the affected side. It may cause labyrinthitis.

Ototoxicity

Refers to damage to the ear caused by medications or substances. It may affect the Cochlea, Vestibular apparatus, and Cranial nerve VIII. May cause Hearing loss, Tinnitus, Balance problems, or Vertigo

Bilateral tinnitus

Aspirin toxicity can produce:

Aminoglycosides

Antineoplastic agents

Aspirin

Quinine

Common causes of ototoxicity include:

Aminoglycosides and antineoplastic agents

are a common cause of ototoxicity because they destroy hair cells in the organ of Corti.

Acoustic Neuroma

also called vestibular schwannoma, is a slow-growing benign tumor of cranial nerve VIII. It usually arises from Schwann cells of the vestibular portion of the nerve. Most are unilateral.