Review of Ear Anatomy, Physiology, and Disorders

Middle Ear

• Small air-filled chamber.
• Located within the temporal bone.

Inner Ear (Labyrinth)

• The labyrinth is a series of canals and flesh.
• Cochlea: Resembles a snail shell and contains the organ of Corti (organ of hearing).

Hearing Examination

• Otoscope and Opacoscopy: Used to visualize the external auditory canal and tympanic membrane.
  • Normal tympanic membrane: Disc-shaped and pearl pink.
  • Procedure: Pull the ear upward and backward for adults, downward and back for children (similar to administering ear drops).
• Whispered Voice Test:
  • Examiner stands 12-24 inches to the side and whispers simple words.
  • Patient repeats the words.
  • Accuracy of 50% is considered normal but not a routine test.
• Tuning Fork Tests:
  • Weber's Test: Assesses auditory acuity to determine conductive (middle ear problem) vs. sensorineural loss (inner ear or auditory nerve).
    • Tuning fork placed on the center of the forehead or maxillary incisors.
    • Normal: Sound is equally loud in both ears.
  • Rinne Test: Distinguishes between conductive and sensorineural hearing loss.
    • Tuning fork placed at the external auditory meatus.
  • Nursing Responsibility:
    • Explain the purpose and procedure to the patient.
    • Patient concentrates and uses hand signals to indicate when/where the sound is heard.
• Audiometry:
  • Determines the degree and type of hearing loss.
  • Determines the lowest intensity of sound perceived.
  • Distinguishes differences in frequencies and speech tones.
• Vestibular Testing:
  • Evaluates balance and equilibrium systems.
  • Problems manifest as nystagmus or vertigo.
  • Romberg's Test: Measures the ability to maintain balance with eyes open and closed.
    • Normal: Maintain balance.
    • Abnormal: Loss of balance.
  • Past Point Testing: Measures the ability to place a finger accurately on a selected body point.

Hearing Loss (Deafness)

• Hearing impairment: Decreased auditory acuity.
• Can affect speech development, socialization, and may lead to social withdrawal, isolation, and depression.
• Types of Hearing Loss:
  • Conductive: Due to foreign bodies, otosclerosis, or stenosis of the external auditory canal.
  • Sensorineural: Due to trauma, infections, ototoxic drugs, or congenital conditions.
  • Mixed: Combination of conductive and sensorineural.
  • Congenital: Present from birth (e.g., trauma during birth, lack of oxygen, syphilis).
  • Functional: No organic cause; related to emotional or psychological factors.
  • Central: Due to brain issues like stroke or trauma.

Facilitating Communication with Impaired Hearing

• Face the patient when speaking.
• Speak clearly in a normal tone (avoid shouting).
• Move closer to the better ear.
• Avoid covering the mouth; use simple phrases.

Hearing Aids

• Care of Hearing Aids (Do's and Don'ts):
  • Handle with care.
  • Wash ear mold/plug daily with mild soap and water (but do not submerge).
  • Turn off and open battery compartment when not in use.
  • Reinsert the mold if whistling occurs.
  • Do not wear in the bath/shower or overnight.
  • Do not ignore whistling.

External Otitis (Swimmer's Ear)

• Causes: Bacterial, fungal, viral, trauma, allergic reactions (nickel), chemicals (hairspray, cosmetics).
  • Common agents: Staphylococcus, Streptococcus, Candida, Herpes Simplex Virus.
• Trauma from cleaning with cotton swabs or bobby pins can cause this.
• Clinical Manifestations:
  • Pain with auricle movement or chewing.
  • Headaches.
  • Scaling, pruritus, edema, watery discharge.
  • Crusting, purulent or serosanguineous discharge (green if Pseudomonas is present).
• Medical Management:
  • Oral analgesics.
  • Corticosteroids, antimicrobials, antibiotics, or antifungals.
• Nursing Interventions:
  • Clean ear canal properly.
  • Apply heat for pain relief.

Otitis Media

• Inflammation/infection of the middle ear.
• Causes: Streptococcus pneumoniae, H. influenzae, Klebsiella, Pseudomonas, allergies, viruses (more common in children due to shorter, straighter eustachian tubes).
• Purulent Otitis Media: Secondary bacterial infection with purulent exudate behind the tympanic membrane.
• Clinical Manifestations:
  • Ear tugging (in children).
  • Fullness in the ear.
  • Pain, hearing loss, tinnitus.
• Medical Management:
  • Antibiotic therapy and analgesics.
  • Nasal decongestants and sedatives (for children).
  • Needle aspiration or myringotomy to relieve pressure.
• Nursing Interventions:
  • Provide clear, effective communication.
  • Ensure completion of antibiotic course.
  • Instruct patient to blow nose gently.
  • Change cotton in the outer ear at least twice a day after myringotomy.
• Trimethoprim sulfamethoxazole (Bactrim) should not be given to pregnant patients.

Labyrinthitis

• Inflammation of the inner ear canals, usually due to a viral upper respiratory infection.
• Causes: Certain drugs, foods, tobacco, and alcohol.
• Clinical Manifestations:
  • Sudden and severe vertigo, nausea, vomiting, nystagmus, photophobia, headache, and ataxic gait.
• Medical Management:
  • Treat symptoms with medications like Dramamine or meclizine for vertigo.
  • Parenteral fluids and antibiotics.
• Nursing Interventions:
  • Keep side rails up and patient in bed.
  • Supervise ambulation; ensure the patient asks for assistance.

Vertigo

• Nursing Interventions:
  • Low-salt diet.
  • Supervise ambulation.

Obstruction of the Ear

• Causes: Foreign objects, bugs, cerumen impaction.
• Medical Management:
  • Removal of cerumen by irrigation or cerumen spoon.
  • Remove foreign objects with forceps (if visible).
  • Smother insects with oily substance and remove with forceps.
  • Carbamide peroxide 6.5% to soften cerumen.
  • Surgical removal if necessary.
• Nursing Interventions:
  • Assist with ear irrigation. Instill medications.

Otosclerosis

• Chronic progressive deafness due to spongy bone formation around the oval window.
• Autosomal dominant genetic disease; pregnancy can trigger rapid onset.
• Clinical Manifestations:
  • Slow progressive conductive hearing loss and low to medium-pitched tinnitus; deafness around ages 11-20.
• Diagnosis:
  • Otoscopy: Pink blush (Schwartze's sign) may be seen through the eardrum.
  • Rinne Test: Bone conduction lasts longer than air conduction.
• Medical Management:
  • Fluoride, vitamin D, and calcium carbonate supplementation.
  • Hearing aids or surgical treatment (stapedectomy).

Meniere's Disease

• Nursing Interventions and Patient Teaching:
  • Low salt diet.
  • During acute attack: quiet, darkened room, comfortable position.
  • Avoid reading, smoking, and triggers that exacerbate symptoms.
  • Safety precautions due to vertigo (side rails, lower bed, assistance with ambulation).

Stapedectomy

• Removal of the stapes of the middle ear, insertion of a graft and prosthesis to restore hearing.
• Nursing Intervention: External ear packing for 5-6 days.
• Patient remains in bed for 24 hours with operative side facing upward. Resume activity gradually.
• Patient Teaching After Ear Surgery:
  • Change cotton in the ear daily.
  • Open mouth when sneezing or coughing; blow nose gently (one side at a time) for one week.
  • Keep the ear dry for six weeks; avoid washing hair for one week; protect the ear when outdoors; wear a cap during showers.
  • Avoid physical activity for one week; no exercises for three weeks; return to work in one week.
  • Avoid exposure to people with URTIs and airplane flights for one week.

Taste and Smell

• Sweet: Responds to sugar.
• Sour: Responds to acid.
• Salt: Responds to metal ions.
• Bitter: Responds to alkaline and basic ions.
• Savory (Umami): Responds to flavors similar to meat broth, amino acids, glutamic acid, or aspartic acid.