Chapter 59: Assessment and Management of Patients with Hearing and Balance Disorders

A client is diagnosed as having serous otitis media. When describing this condition to the client, which of the following would be most accurate? 1. "You have some fluid that has collected in your middle ear but no infection." 2. "It has resulted from the several recurrent episodes of acute otitis media you've had." 3. "You have a common infection in one of the bones of your face." 4. "Your eardrum has ruptured because of the extreme pressure in your middle ear from the infection."

1. "You have some fluid that has collected in your middle ear but no infection." Explanation: Serous otitis media involves fluid, without evidence of active infection, in the middle ear. Recurrent episodes of acute otitis media leads to chronic otitis media. An infection of the temporal bone (temporal bone osteomyelitis) is a serious but rare external ear infection called malignant external otitis. Rupturing of the eardrum refers to tympanic membrane perforation.

The nurse is caring for a client who just returned from a trip requiring an airline flight. The client reported ear pain upon descent. The nurse is correct in stating which site as being the pressure equalizer in the ear? 1. Eustachian tube 2. Auricle 3. Tympanic membrane 4. Labyrinth

1. Eustachian tube Explanation: The eustachian tube extends from the floor of the middle ear to the pharynx. It equalizes air pressure in the middle ear. The auricle is the fleshy portion of the outer ear which funnels sound waves to the inner ear. The tympanic membrane is the eardrum. The labyrinth is the inner ear which contains fluid.

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing which effect? 1. Facial nerve paralysis 2. Nystagmus 3. Motor impairment 4. Diplopia

1. Facial nerve paralysis Explanation: If untreated, squamous cell carcinomas of the ear can spread through the temporal bone, causing facial nerve paralysis and hearing loss.

The nurse is preparing teaching for a client with Ménière's disease. Which dietary instruction will the nurse emphasize? Select all that apply. 1. Limit alcohol intake 2. Drink water liberally 3. Limit intake of salt 4. Include pickled vegetables 5. Eat meals at regular intervals

1. Limit alcohol intake 2. Drink water liberally 3. Limit intake of salt 5. Eat meals at regular intervals Explanation: Most clients with Ménière's disease can be successfully treated with diet and medication. Dietary teaching should include limiting alcohol intake as it may change the volume and concentration of the inner ear fluid and worsen symptoms. The client should be instructed to drink plenty of fluids every day. Water and low-sugar beverages are recommended along with limiting beverages with caffeine because of the diuretic effect. Foods high in salt should be avoided and meals should be eaten at regular intervals to ensure that the fluid level remains consistent in the ear. Pickled vegetables like sauerkraut, olives and pickles have a high sodium content and should be avoided. Sodium causes fluid retention and can make symptoms worse.

Hearing aids help with which of the following problems? 1. Makes sounds louder 2. Improves discrimination of words 3. Improves understanding of speech 4. Improves communication skills

1. Makes sounds louder Explanation: A hearing aid makes sounds louder, but it does not improve a patient's ability to discriminate words or understand speech. Hearing aids amplify all sounds, including background noise, which may be disturbing to the wearer. It does not improve communication skills.

A client comes to the emergency department, reporting that a bee has flown into his ear and is stuck. The client reports a significant amount of pain. Which of the following would be most appropriate to use to remove the bee? 1. Mineral oil 2. Irrigation 3. Hair pin 4. Tweezers

1. Mineral oil Explanation: An insect in the ear canal can be dislodged by instilling mineral oil, which kills the insect and allows removal. Irrigation is contraindicated because the insect would swell. Hair pin or tweezers should not be used due to the risk for trauma.

Which of the following describes vertigo? Select all that apply. 1. Misperception of motion 2. Spinning sensation 3. Objects are moving around him or her 4. Syncope 5. Fainting

1. Misperception of motion 2. Spinning sensation 3. Objects are moving around him or her Explanation: Vertigo is defined as the misperception or illusion of motion of the person or their surroundings. Most people with vertigo describe a spinning sensation or say they feel as though objects are moving around them. Syncope, fainting, and loss of consciousness are not forms of vertigo and usually indicate disease in the cardiovascular system.

Which of the following is an involuntary rhythmic movement of the eyes that is also associated with vestibular dysfunction? 1. Nystagmus 2. Vertigo 3. Tinnitus 4. Presbycusis

1. Nystagmus Explanation: Nystagmus is an involuntary rhythmic movement of the eyes; pathologically it is an ocular disorder but is also associated with vestibular dysfunction. Nystagmus can be horizontal, vertical, or rotary, and can be caused by a disorder in the central or peripheral nervous system. Vertigo is defined as the misperception or illusion of motion of the person or their surroundings. Tinnitus is ringing in the ears. Presbycusis is a progressive hearing loss.

Which of the following tests uses a tuning fork between two positions to assess hearing? 1. Rinne 2. Whisper 3. Watch tick 4. Weber

1. Rinne Explanation: In the Rinne test, the examiner shifts the stem of a vibrating tuning fork between two positions to test air conduction of sound and bone conduction of sound. The whisper test involves covering the untested ear and whispering from a distance of 1 or 2 feet from the unoccluded ear; it assesses the ability of the patient to repeat what was whispered. The watch tick test relies on the ability of the patient to perceive the high-pitched sound made by a watch held at the patient's auricle. The Weber test uses bone conduction to test lateralization of sound.

A nurse is caring for a 24-year-old female client diagnosed with otosclerosis. Which teaching by the nurse is most accurate? 1. Symptoms may be accelerated by pregnancy. 2. Medications can interfere with birth control pills. 3. Menstrual periods may be longer and more severe. 4. Females otosclerosis is linked with infertility.

1. Symptoms may be accelerated by pregnancy. Explanation: The etiology of otosclerosis is unknown; however, it is more common in females than males and usually occurs in the second or third decade of life. It is accurate to instruct females that symptoms of otosclerosis seem to be accelerated during pregnancy.

Which statement describes benign paroxysmal positional vertigo (BPPV)? 1. The vertigo is usually accompanied by nausea and vomiting; generally, however, hearing is not impaired. 2. The onset of BPPV is gradual. 3. BPPV is caused by tympanic membrane infection. 4. BPPV is stimulated by the use of certain medications, such as acetaminophen.

1. The vertigo is usually accompanied by nausea and vomiting; generally, however, hearing is not impaired. Explanation: BPPV is a brief period of incapacitating vertigo that occurs when the position of the client's head is changed with respect to gravity. The vertigo is usually accompanied by nausea and vomiting; however, generally, hearing impairment does not occur. The onset of BPPV is sudden and followed by a predisposition to positional vertigo, usually for hours to weeks but occasionally months or years. BPPV is thought to be caused by the disruption of debris within the semicircular canal. This debris forms from small crystals of calcium carbonate from the inner ear structure, the utricle. BPPV is frequently stimulated by head trauma, infection, or other events.

Acoustic neuromas are benign tumors of which of the following cranial nerves? 1. VIII 2. VII 3. VI 4. V

1. VIII Explanation: Acoustic neuromas are slow-growing, benign tumors of cranial nerve VIII, usually arising from the Schwann cells of the vestibular portion of the nerve.

Which instructions regarding swimming should the nurse give to a client who is recovering from otitis externa? 1. Wear soft plastic earplugs. 2. Wear a scarf. 3. Avoid cold water. 4. Insert a loose cotton earplug in the external ear.

1. Wear soft plastic earplugs. Explanation: The nurse should advise the client to wear soft plastic earplugs to prevent trapping water in the ear while swimming. Cotton can be used, but if so it needs to be covered in petroleum jelly to prevent water from entering the external canal. Wearing a scarf does not help prevent or treat otitis externa. Swimming in cold water is not related to otitis externa.

A nurse needs to change a dressing on an abdominal wound for a patient who is hearing-impaired and whose speech is difficult to understand. Which of the following is the best approach for the nurse? 1. Write down the steps of the procedure for the patient to read before beginning the treatment. 2. Change the dressing while the patient is reading the steps of the treatment because distraction decreases anxiety. 3. Use nonverbal signals of agreement (head nodding), even if unsure, to instill confidence and trust. 4. Minimize misunderstandings by completing the patient's sentences (e.g., fill-in-the-blanks) to decrease the patient's embarrassment.

1. Write down the steps of the procedure for the patient to read before beginning the treatment. Explanation: Written communication is an excellent resource and means of mutual understanding. Distraction is not appropriate because a hearing-impaired person needs the care provider's full attention. Do not pretend to understand or complete the person's sentences for them.

A client has a history of hearing loss and is returning for an annual hearing examination. During client education, the nurse explains that hearing involves which areas of the ear? 1. all sections 2. outer section 3. middle section 4. inner section

1. all sections Explanation: Sound is perceived because of a chain reaction involving all three areas of the ear.

During assessment for cranial nerve functions, the client closes the eyes and begins to fall to one side. Which cranial nerve alteration causes this response? 1. cranial nerve VIII 2. optic nerve 3. cranial nerve VII 4. facial nerve

1. cranial nerve VIII Explanation: Nerve receptors for balance are found both in the vestibule and semicircular canals. They transmit information about motion through the vestibular nerve, which joins with the cochlear nerve to form the eighth cranial nerve (formally called the auditory or acoustic nerve).

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing 1. facial nerve paralysis. 2. nystagmus. 3. motor impairment. 4. diplopia.

1. facial nerve paralysis. Explanation: If untreated, squamous cell carcinomas of the ear can spread through the temporal bone, causing facial nerve paralysis and hearing loss.

A client who has a lengthy history of progressive hearing loss is very forthright about the condition, and the nurse wants to develop a communication strategy for this client's hospital stay. Which communication strategy has proven to be the most effective? 1. the one the client will use 2. speech reading 3. signing 4. writing

1. the one the client will use Explanation: Although there are several communication strategies for clients with significant hearing loss, the only effective method is the one the client will consistently use.

The nurse identifies the nursing diagnosis of deficient knowledge related to a new hearing aid for a client. After teaching a client about caring for his new hearing aid, the nurse determines that the outcome has been achieved when the client states which of the following? 1. "I need to wipe the ear mold daily with a moist washcloth." 2. "I need to keep my ear canal clean and dry." 3. "I should wash the receiver with soap and water once a week." 4. "I should insert the ear mold when it is wet."

2. "I need to keep my ear canal clean and dry." Explanation: The client demonstrates understanding of the care of a hearing aid when stating the need to keep the ear canal clean and dry. The ear mold is the only part of the hearing aid that can be washed frequently, that is daily with soap and water. It should be allowed to dry completely before it is snapped into the receiver or inserted into the ear.

The nurse is supervising a family member who instilling ear drops into the client's ear. Which of the following statements, made by the family member, would require further nursing instruction? 1. "Turn your head to the side so I can put these drops in." 2. "These drops are cold from being on the window sill." 3. "Let me put this cotton ball in your ear because I put the drop in." 4. "I squeeze the dropper to put a drop of medicine in the ear."

2. "These drops are cold from being on the window sill." Explanation: When the family member states that the drops are cold, the nurse would encourage the family member to place the bottle in a warm bath or warm the bottle in their hands. Cold or hot liquids, instilled in the ear, may cause dizziness and potential for injury.

High doses of which medication can produce bilateral tinnitus? 1. Meclizine 2. Aspirin 3. Promethazine 4. Dimenhydrinate

2. Aspirin Explanation: At high doses, aspirin toxicity can produce bilateral tinnitus. Meclizine and dimenhydrinate are used for nausea and vomiting related to motion sickness. Antiemetics, such as promethazine suppositories, help control nausea and vomiting and vertigo through an antihistamine effect.

The nurse and a colleague are performing the Epley maneuver with a client who has a diagnosis of benign paroxysmal positional vertigo. The nurses should begin this maneuver by performing what action? 1. Placing the client in a prone position 2. Assisting the client into a sitting position 3. Instilling 15 mL of warm normal saline into one of the client's ears 4. Assessing the client's baseline hearing by performing the whisper test

2. Assisting the client into a sitting position Explanation: The Epley maneuver is performed by placing the client in a sitting position, turning the head to a 45-degree angle on the affected side, and then quickly moving the client to the supine position. Saline is not instilled into the ears and there is no need to assess hearing before the test.

A mother brings her daughter to the clinic for an evaluation because the child is complaining of ear pain. Which of the following would lead the nurse to suspect that the child is experiencing otitis externa and not otitis media? 1. Fever 2. Aural tenderness 3. Bulging eardrum 4. Ear drainage

2. Aural tenderness Explanation: A client with otitis externa typically experiences aural tenderness. This finding is usually absent in clients with otitis media. Fever and ear drainage may be present with either otitis externa or otitis media. A bulging eardrum would suggest otitis media.

A client you are caring for has a hearing loss. The client tells you he is self-conscious about his hearing loss. What advice should the nurse give a self-conscious client with hearing loss to protect his self-esteem? 1. Pretend to follow conversations by nodding the head. 2. Be forthright and inform others about the hearing deficit. 3. Follow lip movements closely. 4. Avoid excess socializing.

2. Be forthright and inform others about the hearing deficit. Explanation: The nurse should encourage clients with a hearing loss to be forthright and inform others about their hearing deficit. Clients should be advised not to hide the fact that they do not understand what has been said and should be encouraged to maintain friendships because a physical impairment is unlikely to affect genuine friendships.

Which is a correct rationale for encouraging a client with otitis externa to eat soft foods? 1. Chewy foods, such as red meat, may react with prescribed analgesics and antibiotics. 2. Chewing may cause discomfort. 3. Chewing may lead to further complications, such as otitis media. 4. Chewing may cause excessive drainage.

2. Chewing may cause discomfort. Explanation: The nurse encourages a client with otitis externa to eat soft foods or consume nourishing liquids because chewing may cause discomfort. Chewing will not react with the prescribed medications or cause complications such as otitis media and excessive drainage.

A nurse is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal? 1. Umbo in the center of the tympanic membrane 2. External auditory canal erythema 3. Tympanic membrane pearly gray 4. Manubrium superior to the umbo

2. External auditory canal erythema Explanation: An erythematous external auditory canal would be considered an abnormal finding. The tympanic membrane is normally pearly gray and translucent. The umbo, which is located in the center of the eardrum, extends from the superior manubrium.

Which precaution should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance? 1. Recommend that the client keep his or her eyes closed 2. Have the client wait for help before moving 3. Restrict the client from focusing on one spot 4. Encourage the client to move the head slowly

2. Have the client wait for help before moving. Explanation: The nurse should have the client wait to move until help arrives. Safety measures such as assisted ambulation are implemented to prevent falls and injury. The client should restrict movement. The client should keep his or her eyes open and focus on one spot to reduce vertigo.

The nurse recognizes which methods are not correct for removing a foreign body from the ear? 1. Irrigation 2. Manual pressure 3. Suction 4. Instrumentation

2. Manual pressure Explanation: The three standard methods for removing foreign bodies are the same as those for removing cerumen: irrigation, suction, and instrumentation. Manual pressure is not a correct method for removing a foreign body from the ear.

A client has undergone diagnostic testing and has been diagnosed with otosclerosis. What ear structure is primarily affected by this diagnosis? 1. Malleus 2. Stapes 3. Incus 4. Tympanic membrane

2. Stapes Explanation: Otosclerosis involves the stapes and is thought to result from the formation of new, abnormal bone, especially around the oval window, with resulting fixation of the stapes.

A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following? 1. Tinnitus 2. Vertigo 3. Nausea 4. Ear fullness

2. Vertigo Explanation: Although tinnitus, nausea, vomiting and ear fullness may be noted, vertigo is usually the most troublesome and common complaint associated with Meniere's disease.

When preparing a teaching plan for a client diagnosed with otitis externa, the nurse instructs the client to avoid any water sport for which duration? 1. 3 to 5 days 2. 5 to 7 days 3. 7 to 10 days 4. 10 to 14 days

3. 7 to 10 days Explanation: A client with otitis externa should refrain from any water sport for approximately 7 to 10 days to allow the canal to heal completely. Otherwise, recurrence is highly likely.

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear? 1. External ear 2. Middle ear 3. Inner ear 4. Tympanic membrane

3. Inner ear Explanation: A client with vertigo experiences problems with the inner ear, which is responsible for maintaining equilibrium. The external ear collects sound; the middle ear conducts sound. The tympanic membrane (eardrum) vibrates in response to sound stimulation.

You are doing discharge teaching with a client after a stapedectomy. Why would it be important for you to advise the client to refrain from blowing the nose? 1. It may cause sudden headaches. 2. It may cause vertigo. 3. It may dislodge the prosthesis. 4. It may cause excessive drainage.

3. It may dislodge the prosthesis. Explanation: The nurse should advise a client who has undergone a stapedectomy to refrain from blowing the nose because it may dislodge the prosthesis. It does not lead to sudden headaches, vertigo, or excessive drainage.

You are doing discharge teaching with a client after a stapedectomy. Why would it be important for you to advise the client to refrain from blowing the nose? 1. It may cause sudden headaches. 2. It may cause vertigo. 3. It may dislodge the prosthesis. 4. t may cause excessive drainage.

3. It may dislodge the prosthesis. Explanation: The nurse should advise a client who has undergone a stapedectomy to refrain from blowing the nose because it may dislodge the prosthesis. It does not lead to sudden headaches, vertigo, or excessive drainage.

The nurse is assessing a client with multiple sclerosis who is demonstrating involuntary, rhythmic eye movements. What term will the nurse use when documenting these eye movements? 1. Vertigo 2. Tinnitus 3. Nystagmus 4. Astigmatism

3. Nystagmus Explanation: Nystagmus refers to involuntary rhythmic eye movement. Vertigo is an illusion of movement where the individual or the surroundings are sensed as moving. Tinnitus refers to a subjective perception of sound with internal origin. Astigmatism is a defect in visual acuity.

What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids? 1. Purulent otitis media 2. Infectious otitis media 3. Serous otitis media 4. Sterile otitis media

3. Serous otitis media Explanation: Serous otitis media, a collection of pathogen-free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids. The other options are distractors for this question. Purulent otitis media usually results from the spread of microorganisms from the eustachian tube to the middle ear during upper respiratory infections.

Postoperative nursing assessment for a patient who has had a mastoidectomy should include observing for facial paralysis, which might indicate damage to which cranial nerve? 1. First 2. Fourth 3. Seventh 4. Tenth

3. Seventh Explanation: Injury to the seventh cranial nerve, also known as the facial nerve, is a complication of a mastoidectomy, although rare. Hearing loss of less than 30 dB is a more common complication.

A nurse is preparing to perform the whisper test to assess a client's gross auditory acuity. Which of the following would be most appropriate for the nurse to do? 1. Stand at a position diagonal to the client. 2. Have the client use a finger to occlude the ear to be tested. 3. Stand about 1 to 2 feet away from the ear to be tested. 4. Speak a phrase in a low normal tone of voice.

3. Stand about 1 to 2 feet away from the ear to be tested. Explanation: When performing the whisper test, the nurse covers the untested ear with the palm of the hand and then whispers softly from a distance of 1 to 2 feet from the unoccluded ear and out of the client's sight. The client with normal hearing can correctly repeat what was whispered.

What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides? 1. Signs of hypotension 2. Reduced urinary output 3. Tinnitus and sensorineural hearing loss 4. Impaired facial movement

3. Tinnitus and sensorineural hearing loss Explanation: It is important that nurses are knowledgeable about the ototoxic effects of certain medications such as salicylates, loop diuretics, quinidine, quinine, and aminoglycosides. Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. Hypotension, reduced urinary output, and impaired facial movement are not signs of ototoxicity.

Which action by the nurse has the highest priority when caring for a client diagnosed with vertigo? 1. Encourage the client to keep his or her eyes open. 2. Administer antivertiginous medication as ordered. 3. Encourage the client to stare straight ahead, focusing on one object. 4. Educate the client on using the call light for assistance with ambulation.

4. Educate the client on using the call light for assistance with ambulation. Explanation: The client should restrict movement and change positions slowly to prevent an injury related to the vertigo. The prevention of injury related to the vertigo should be the highest priority nursing intervention; therefore, the nurse needs to teach the client about using the call light for assistance with ambulation. All other interventions are appropriate but do not address safety. The client should keep his or her eyes open and focus on one spot to reduce vertigo.

During a physical assessment, a client reports discomfort when the auricle of the left ear is moved. Which condition will the nurse suspect the client is experiencing? 1. Mastoiditis 2. Acute otitis media 3. Impacted cerumen 4. External otitis media

4. External otitis media Explanation: The external ear is examined by inspection and direct palpation. Manipulation of the auricle does not normally elicit pain. If this maneuver is painful, acute external otitis is suspected. Tenderness on palpation in the area of the mastoid may indicate acute mastoiditis. Tenderness of the auricle is usually absent in acute otitis media. Impacted cerumen does not cause discomfort.

The nurse is caring for a client in the triage section of a walk-in clinic. Which triad of common symptoms suggests a diagnosis of Ménière disease? 1. Blurred vision, vertigo, nausea 2. Syncope, vertigo, ear pain 3. Disorientation, vertigo, nausea 4. Hearing loss, vertigo, tinnitus

4. Hearing loss, vertigo, tinnitus Hearing loss, vertigo, and tinnitus are common symptoms of many disease processes but, when placed together, indicate Ménière disease. The other options do not include the accurate triad of symptoms.

The nurse is working in the emergency department when a physician asks for help as the client is performing a Romberg test. In which position would the nurse stand to be most helpful? 1. The nurse would stand directly in front of the client. 2. The nurse would stand between the client and physician. 3. The nurse would stand across the room but in direct alignment from the client. 4. The nurse would stand laterally to the client, opposite side to where the physician is standing.

4. The nurse would stand laterally to the client, opposite side to where the physician is standing. Explanation: The Romberg test is used to evaluate a person's ability to sustain balance. The client stands with the feet together and arms extended. In the event that the client begins to sway (an abnormal result), the nurse is most helpful to stand on the lateral side of the client, opposite side to where the physician is standing to ensure that the client does not fall.

When discussing diseases of the middle ear, the nursing instructor distinguishes the different types of otitis media. What generally causes purulent otitis media? 1. Irritation associated with respiratory allergies and enlarged adenoids 2. Bronchial tree 3. Outer ear 4. Upper respiratory infections

4. Upper respiratory infections Explanation: Purulent otitis media usually results from the spread of microorganisms from the eustachian tube to the middle ear during upper respiratory infections. It is not caused from the bronchial tree, the outer ear or irritation associated with respiratory allergies, and enlarged adenoids.

When caring for a client after ear surgery, what is an important aspect of nursing care? 1. Assess social support. 2. Feed small frequent meals to minimize nausea. 3. Fit for a hearing aid. 4. Validate client's feelings of discomfort.

4. Validate client's feelings of discomfort. Explanation: Validate client's feelings of discomfort. This measure promotes the nurse-client relationship and reassures the client that his or her needs are important.

A nurse is preparing a presentation for a local community about hearing loss and prevention. Which of the following would the nurse integrate into the presentation as the most effective preventive measure? 1. Maintaining daily hygiene for the ears 2. Having yearly audiometric testing 3. Obtaining prompt treatment for ear infections 4. Wearing ear protection when exposed to noise

4. Wearing ear protection when exposed to noise Explanation: Noise is a serious and very common factor associated with hearing loss. Hearing loss from noise is permanent, because noise destroys the hair cells in the organ of Corti. Therefore, wearing ear protection when exposed to noise is the most effective preventive measure available. Although appropriate ear hygiene and prompt treatment for infections are important, protecting the ears from noise is the priority. Audiometric testing is the single most important diagnostic instrument for detecting hearing loss; however, routine testing each year is not a current recommendation.

Audiometry confirms a client's chronic progressive hearing loss. Further investigation reveals ankylosis of the stapes in the oval window, a condition that prevents sound transmission. This type of hearing loss is called: 1. functional hearing loss. 2. fluctuating hearing loss. 3. sensorineural hearing loss. 4. conductive hearing loss.

4. conductive hearing loss. Explanation: Conductive hearing loss results from interference with the conduction of sound waves (sound transmission) from the tympanic membrane to the inner ear. The stapes must move freely for sound to be transmitted. Bone tissue overgrowth causes the stapes to become fixed or immobile (ankylosed) in the oval window, preventing sound transmission.