Ear Disorders Study Notes

Objectives:
- Differentiate between conductive and sensorineural hearing loss.
- Describe care for hearing aids.
- Provide communication tips for hearing-impaired clients.
- Discuss infectious and non-infectious disorders of the ear.

External Ear: Pinna, helps in hearing and equilibrium.
Tympanic Membrane: Separates external ear from middle ear.
Middle Ear: Air-filled chamber in the temporal bone.
Inner Ear: Series of canals, contains receptors for gravity and orientation (upright vs. down).

Otoscope: Visualizes tympanic membrane, which appears pearly pink/pale.
- Adult technique: Pull ear up and backward.
- Child technique: Pull ear down and backward.
Whispered Voice Test: Patient repeats whispered simple words from a distance of one foot.
Tuning Fork Tests:
- Weber Test: Assesses auditory acuity; helps differentiate hearing loss type:
- Normal: Hearing is equal in both ears.
- Conductive: Louder in affected ear.
- Sensorineural: Louder in unaffected ear.
- Rinne Test: Distinguishes conductive vs. sensorineural:
- Conductive: Heard longer by bone conduction.
- Sensorineural: Heard longer by air conduction.
Audiometric Test: Measures the lowest intensity audible to the patient.

Refer to Foundation Book, Page 1846 for differences.
Conductive Hearing Loss: Blockage before inner ear; causes include:
- Fluid, foreign objects, allergies, ruptured eardrum, impacted earwax.
Sensorineural Hearing Loss: Damage to cranial nerve VIII or cochlea; causes include:
- Aging, noise exposure, ototoxic medications, tumors.

Otitis Externa (Swimmer's Ear):
- Inflammation of external ear (pinna, ear canal).
- Caused by:
- Allergic reactions (cosmetics, headphones, earrings).
- Bacterial agents (Pseudomonas, Streptococcus, Staphylococcus).
- Viral (herpes simplex, varicella zoster) and fungal infections (Candida).
Symptoms: Pain, fullness, erythema, possible discharge.
Malignant External Otitis:
- Rare, potentially lethal; symptoms include:
- Fullness in ear, pain with ear manipulation, canal inflammation, edema, temporary hearing loss.
- Drainage may be purulent or serous; green/odorous with Pseudomonas.
- Management:
- Oral analgesics, corticosteroids, antimicrobial agents, systemic antibiotics.
- Patient education on cleaning, ear drops, water prevention.
Otitis Media:
- Inflammation and infection of middle ear; most common ear infection.
- Types:
- Acute (up to 3 weeks), Chronic (long-lasting).
- Common in children (shorter Eustachian tubes).
- Symptoms: Fullness, pain, tinnitus, fever.
- Signs in Children: Pulling at ears, decreased appetite, fever (around 104°F).
- Treatment: Antibiotics, ibuprofen, Tylenol; avoid water exposure.
- Myringotomy: Surgical insertion of tubes for fluid drainage.
- Antibiotics used post-op, must monitor for ototoxicity.

Meniere's Disease:
- Inner ear disorder affecting hearing and equilibrium.
- Symptoms: Vertigo, tinnitus, gradual hearing loss, nausea, vomiting, diaphoresis, nystagmus.
- Only one ear usually involved; excess lymph in inner ear.
- Requires two or more episodes to diagnose.
- Management:
- Avoid caffeine/nicotine; diuretics may reduce lymph volume.
- Medications: Meclizine, Dramamine, Benadryl, Valium, anti-emetics.
- Low sodium diet.
- Surgical options may involve labyrinthectomy (loss of balance).

Stapedectomy: Removal of stapes, insertion of prosthesis.
- Post-op management includes bed rest and gradual activity resumption.
Tympanoplasty: Repair of ruptured eardrum; post-op requires head elevation.
Cochlear Implants: Device for profound hearing loss, stimulates auditory nerve fibers.

Strategies:
- Face the client, minimize distractions.
- Get attention before speaking.
- Speak clearly and at a moderate pace, avoid covering mouth.
- Repeat important information.

Cerumen Removal: Debrox (not for perforated eardrums or discharge).
Cholamphenicol: Antibiotic-steroid mixture, avoid prolonged use.
Cortisporin: Antibiotic-steroid for swimmer's ear, caution with ototoxicity.
Ototoxic Medications: Furosemide, aspirin, ibuprofen, gentamicin.

Comprehensive understanding of ear disorders aids in effective diagnosis, treatment, and patient communication.