Ch. 48 - Assessment and Care of Patients with Ear and Hearing Problems

The nurse is talking to a patient about ear hygiene safety. Which statement by the patient indicates a need for further teaching? "I irrigate my ears with tap water." "I use a bobby pin to remove earwax." "I never clean my ears with a cotton swab." "After I shower, I dry my ears using my fingertip and a towel."

"I use a bobby pin to remove earwax." Rationale Nothing smaller than the patient's own fingertip should be inserted into the ear canal. Use of a bobby pin or cotton swab can scrape the skin of the canal, push cerumen up against the eardrum, and even puncture the eardrum. Using the fingertip and a towel and irrigating the ear canal with tap water are acceptable. p. 987

The nurse is reviewing postoperative instructions with a patient undergoing stapedectomy. Which statement by the patient indicates a need for further teaching? "I will have to take antibiotics after the surgery." "I should not drink from a straw for several weeks." "I may have problems with vertigo after the surgery." "I will be able to hear as soon as my dressing is removed."

"I will be able to hear as soon as my dressing is removed." Rationale Hearing is initially worse after a stapedectomy. The patient should be informed that improvement in hearing may not occur until 6 weeks after surgery. At first, the ear packing interferes with hearing. Swelling in the ear after surgery reduces hearing, but this condition is temporary. Vertigo, nausea, and vomiting are common after surgery because of the nearness of the surgical site to inner ear structures. Patients should not drink through a straw for 2 to 3 weeks after surgery. Antibiotics are used to reduce the risk for infection. p. 1000

The nurse is caring for a patient who has undergone a myringotomy. Which instruction should the nurse provide to the patient? -"Use a straw while drinking." -"Avoid foods that may make you cough." -"Blow your nose with your mouth closed." -"Put cotton-coated balls in your ear when you leave the house."

-"Avoid foods that may make you cough." Rationale Myringotomy is a surgical procedure to drain fluids from the middleear. Excessive coughing can damage the operated-upon eardrums; therefore, foods that may initiate cough are avoided in order to prevent excessive coughing. A straw should not be used for at least 2 to 3 weeks after surgery to prevent damage to the surgical site. Blowing the nose with the mouth closed can lead to eardrum damage; therefore, the nurse would instruct the patient to blow the nose while the mouth is open. The nurse instructs the patient to keep cotton balls in the affected ear at all times for 6 weeks to keep the ear dry.

The nurse is educating a patient on the prevention of ear infections. Which patient statement requires further nursing teaching? -"I'll open my mouth while sneezing." -"I'll block one nostril while blowing my nose." -"I'll keep the volume of my headphones at the lowest setting." -"I'll avoid using cotton-tipped swabs to clean the external ear canal."

-"I'll block one nostril while blowing my nose." The nostril should not be blocked while the nose is being blown; this could result in trauma and infection to the ear. Sneezing increases pressure inside the ear; the pressure can be reduced if the patient opens the mouth while sneezing. The volume of the patient's headphones should be at the lowest setting possible to avoid trauma to the ear. Small objects such as cotton swabs, matchsticks, and toothpicks should not be used to clean the ear; these may cause injury and infection to the ear. p.1000

he nurse is examining the ear of an Asian patient during a routine health assessment. What is the most accurate statement about the patient's earwax? -The patient is likely to have moist earwax. -Asian patients often have impacted earwax. -Earwax may be light brown to gray in color. -This patient is likely to require frequent ear irrigations.

-Earwax may be light brown to gray in color. Rationale Asian patients are likely to have earwax that is light brown to gray in color. Their earwax is typically dry. Moist or dry earwax does not indicate infection; it is a genetically inherited trait. Asian patients often have dry earwax, but moist earwax seen in Euro-Americans and African Americans is impacted more easily than dry earwax. Because Asian patients are more likely to have dry ear wax, they are not likely to require frequent ear irrigations as patients with moist earwax do. p. 989

The nurse is teaching a patient who will soon be fitted for a hearing aid about proper care and use. Which statement by the patient indicates that teaching was effective? -"Background noises will be difficult for me to hear." -"I should wear my hearing aid only to work at first." -"I should just get a smaller hearing aid because I don't have much money." -"Listening to the radio and television will help me get used to new sounds."

-"Listening to the radio and television will help me get used to new sounds." Rationale Listening to television and the radio and reading aloud can help the patient get used to new sounds. With hearing aids, background noises are amplified so the patient must learn to concentrate and filter out background noises. The patient should start using the hearing aid slowly, at first wearing it only at home and only during part of the day. The cost of smaller hearing aids is actually greater than for larger ones. p. 999

What is the normal decibel level of conversational speech? 20 40 60 90

-60 Rationale The intensity of conversational speech is 60 decibels. Whispering sounds have an intensity of 20 decibels. The average sound in an office is 40 decibels. The sound generated by a motorcycle is about 90 decibels. p. 990

Which statement about the Meniett device used in the treatment of Ménière's disease is accurate? -The device improves hearing loss. -Long-term success in control of vertigo is 50%. -Low pressure is applied to the inner ear 5 times a day. -A tympanostomy tube must first be placed in the affected ear.

-A tympanostomy tube must first be placed in the affected ear. Rationale The Meniett device, a nonsurgical treatment, applies low-pressure micropulses to the inner ear for 5 minutes three times daily. This action displaces inner ear fluid and relieves manifestations. Placement of a tympanostomy tube in the eardrum of the affected ear is needed to use this therapy. Long-term success in control of vertigo is over 80%. Hearing loss is not improved with this therapy. p. 996

A patient reports pain, itching, and a feeling of fullness in the ear. On further assessment, the nurse observes the presence of wax in the ear. Which intervention would be beneficial for this patient? Suction drainage Applying lidocaine Use of an earwick Applying a ceruminolytic product

-Applying a ceruminolytic product Rationale Pain, itching, and fullness in the ear may occur because of the presence of wax in the ear. A ceruminolytic product, such as Cerumenex, may be used to soften the wax before removal. Suction drainage is beneficial for pus collection in the ear. Applying lidocaine can provide relief from pain, but it does not help remove wax from the ear. An earwick is cotton gauze placed in the ear to prevent the flow of medication from the ear. p.994

What is the purpose of tympanometry testing? -Assesses the understanding of speech -Assesses the hearing acuity of the patient -Assesses the patency of the external canal -Assesses the patency of the eustachian tube

-Assesses the patency of the eustachian tube Rationale Tympanometry is used to assess the patency of the eustachian tube in the ear. Different audiometry tests are used to assess hearing acuity. Otoscopic assessment can provide information about the patency of the external ear canal. Speech discrimination testing is a type of speech audiometry test done to assess the patient's understanding of speech. p. 991

What preoperative measure must the patient take before undergoing a tympanoplasty? Restrict fluid intake. Consume a protein-rich diet. Irrigate the ear with sterile water. Avoid people with upper respiratory infections.

-Avoid people with upper respiratory infections. Rationale The nurse should instruct the patient to reduce the risk for infection by avoiding people with upper respiratory infections. The patient must drink adequate amounts of fluids and consume a well-balanced diet. Before surgery, the ear should be irrigated with a solution of equal parts vinegar and sterile water to restore normal ear pH. p. 999

What safety measure must a patient take who recently underwent a myringotomy? -Avoid air travel for a week. -Avoid showering for several days. -Blow the nose with the mouth closed. -Drink through a straw for 2 to 3 weeks.

-Avoid showering for several days Rationale The nurse should teach the postoperative patient to avoid showering for several days and to keep the head dry to help keep the external ear and canal free of other substances while the incision is healing. The patient must avoid air travel for 2 to 3 weeks to avoid pressure on the eardrums. The patient should avoid drinking through a straw for 2 to 3 weeks to prevent pressure in the ear. The patient should blow the nose gently without occluding either nostril, with the mouth open to prevent pressure buildup in the middle ear. p. 993

What is the spiral-shaped organ present in the ear? Incus Cochlea Mastoid process Tympanic membrane

-Cochlea The cochlea is the spiral-shaped organ in the inner ear. The incus (anvil) is a small bone in the middle ear. The mastoid process is the bony ridge located over the temporal bone behind the pinna. The tympanic membrane, or eardrum, is a structure that separates the external ear from the middle ear. p. 986

Which type of drug therapy does the nurse anticipate giving to a patient with Ménière's disease to decrease endolymph volume? Diuretics Antipyretics Nicotinic acid Antihistamines

-Diuretics Rationale Mild diuretics are prescribed to decrease endolymph volume. Antihistamines help reduce the severity of or stop an acute attack, and antipyretics control fever and pain, but they do not decrease endolymph volume. Nicotinic acid has been found to be useful because of its vasodilatory effect, but it does not decrease endolymph volume. p. 996

A patient is scheduled for electronystagmography (ENG). What does this procedure entail? -ENG determines diseases in the middle ear. -Electrodes are taped to the skin behind the ear. -ENG determines abnormalities in the brainstem. -Electrodes are placed on the scalp during the test.

-ENG determines abnormalities in the brainstem. Rationale ENG determines abnormalities of the brainstem by detecting and recording involuntary eye movements or nystagmus. The electrodes are taped to the skin near the eyes, not behind the ear. The electrodes are placed on the scalp during an auditory brainstem-evoked response test, not ENG. ENG does not determine diseases in the middle ear; rather it determines diseases of the vestibulocochlear apparatus present in the inner ear. p. 991

What are causes of conductive hearing loss? Select all that apply. Diabetes mellitus Impaction of cerumen Presence of a foreign body Prolonged exposure to noise Ruptured tympanic membrane

-Impaction of cerumen -Presence of a foreign body -Ruptured tympanic membrane Rationale Conductive hearing loss occurs when sound waves are blocked from contact with inner ear nerve fibers due to external ear or middle ear disorders. Some of the causes include cerumen impaction, presence of a foreign body in the external ear, and a ruptured tympanic membrane. Diabetes mellitus and prolonged exposure to noise damage the inner ear sensory nerve fibers leading to sensorineural hearing loss. p. 997

The nurse documents the presence of hyperacusis in a patient. What does this condition indicate? -Sensation of being "off-balance" or dizziness -Presence of irregular, painless nodules on the pinna -Intolerance of sound levels that do not bother others -Presence of small, crusted, and indurated lesions on the pinna that fail to heal

-Intolerance of sound levels that do not bother others Hyperacusis is the intolerance of sound levels that do not bother others. The sensation of being "off-balance" or dizziness is recorded as "vertigo." In patients with chronic gout, collections of uric acid crystals result in irregular, painless nodules on the pinna called "tophi." Small, crusted, and indurated lesions on the pinna that fail to heal could be squamous cell carcinoma. p. 988

A patient with a hearing problem is scheduled to undergo electronystagmography (ENG). What statement about ENG is correct? -It detects abnormalities in the cerebellum. -It requires the patient to do simple math problems. -It detects only peripheral disease of the vestibular system. -The patient must abstain from caffeinated beverages for 12 hours before the test.

-It requires the patient to do simple math problems. ationale During ENG, the patient is asked to do simple math problems in order to keep the patient alert. This test is sensitive in detecting both central and peripheral diseases of the vestibular system in the ear. Caffeinated beverages are not allowed for 24 to 48 hours before the test. ENG detects abnormalities present in the vestibulocochlear apparatus, cerebral cortex, auditory nerve, or brainstem, but not in the cerebellum. p. 991

How can a patient best adjust to a new hearing aid? Start by wearing it all day. Start by wearing it to bed. Practice by wearing it outside the home. Listen to the radio to get used to new sounds.

-Listen to the radio to get used to new sounds Rationale The nurse should suggest that the patient with a new hearing aid listen to radio or television or read out loud to get used to new sounds. The patient must first practice wearing it for a few hours each day at home. A hearing aid amplifies background sound, so the patient must learn to concentrate and filter it out. Wearing the hearing aid to bed will not provide any benefit. p. 999

Which type of water should be used by a patient for ear irrigation to remove cerumen? Hot Cold Saline Lukewarm

-Lukewarm Rationale The ear is a sensitive organ, so lukewarm water should be used for irrigation to remove cerumen. The use of hot water can cause burns, and the use of cold water may cause nausea and dizziness. The use of saline water is not necessary for irrigation of the ear. p. 987

What comfort measures may the patient with external otitis find helpful? -Minimizing head movements -Applying a warm wet towel over the ear -Applying heat for 10 minutes twice a day -Using a heating pad on a medium setting

-Minimizing head movements Rationale The patient with external otitis should minimize head movements to reduce pain. The patient should apply heat for 20 minutes three times a day. The patient should apply towels warmed with water wrapped in a plastic bag over the ear. The patient can also use a heating pad on a low setting to provide relief from pain. p. 993

Which statement about eardrum perforation is correct? -Perforation from chronic otitis media heals quickly. -Marginal perforation does not interfere with hearing. -Most eardrum perforations heal within a week or two. -A small inferior pars tensa perforation interferes with hearing.

-Most eardrum perforations heal within a week or two. Rationale Most eardrum perforations heal within a week or two without treatment. Perforations from chronic otitis media heal slowly with scarring, and depending upon the amount of ossicle damage, hearing may or may not return. Patients with marginal perforation report significant hearing loss. Patients with a small inferior pars tensa perforation do not report interference with hearing. Central perforations heal more quickly than marginal perforations. p. 995

What assessment findings are usually present with sensorineural hearing loss? Select all that apply. Occasional dizziness External canal that appears normal Hearing well in a noisy environment Obstruction upon otoscopic examination Tympanic membrane that appears normal

-Occasional dizziness -External canal that appears normal -Tympanic membrane that appears normal Rationale A patient with sensorineural hearing loss usually has occasional dizziness. Otoscopic examination reveals a normal appearance of the external canal and tympanic membrane. The patient with conductive hearing loss hears best in a noisy environment, and otoscopic examination reveals obstruction in the external canal. p. 997

Which statement about the involvement of genetic factors in hearing problems is correct? -Patients with Down syndrome develop hearing loss as children. -Patients with a mutation in gene GJB2 have elevated connexin-26 levels. -Patients with osteogenesis imperfecta have bilateral hearing loss by their 30s. -Patients with a mutation in gene GJB2 on chromosome 7 have hearing problems.

-Patients with osteogenesis imperfecta have bilateral hearing loss by their 30s. Rationale Patients with osteogenesis imperfecta have bilateral and progressive hearing loss by their 30s. Some genetic problems can lead to progressive hearing loss in adults. Patients with Down syndrome develop hearing loss as adults. Patients with a mutation in gene GJB2 on chromosome 1 have hearing problems as well as decreased connexin-26 levels. p. 988

A patient reports purulent drainage from the ear and a decrease in pain. What does the nurse expect to find during an otoscopic examination? Perforated eardrum Red, thickened eardrum Presence of pus behind the eardrum Dilated blood vessels of the eardrum

-Perforated eardrum Rationale The patient has acute otitis media and the nurse should expect to find a perforated or ruptured eardrum. When the eardrum ruptures, the patient experiences a marked reduction in pain because the pressure on the middle ear structures is relieved. In the third stage of acute otitis media, the eardrum becomes red and thickened and pus is seen behind the membrane. In the early stage of otitis media, the patient has only vague ear discomfort. However, as the condition progresses, the blood vessels of the eardrum become dilated. p. 992

Which technique is the correct way to instill eardrops? -Check to see whether the eardrum is intact before instillation. -Rinse the ear canal with hydrogen peroxide before instillation. -Maintain the head in the same position for 2 minutes after instillation. -Place the medication bottle in a bowl of warm water before instillation.

-Place the medication bottle in a bowl of warm water before instillation. Rationale To instill eardrops, place the bottle (with the top on tightly) in a bowl of warm water for 5 minutes. This warms the medication and makes instillation more comfortable for the patient. The head should be gently moved back and forth five times after instillation to ensure proper distribution. It is not necessary to rinse the ear canal with hydrogen peroxide or check to see whether the eardrum is intact before instillation. p. 993

What is the proper technique for assessing an adult patient's ear with an otoscope? -Place the otoscope in the nondominant hand. -Pull the pinna up and back with the nondominant hand. -Maintain distance between the otoscope and the patient's head. -Hold the otoscope right side up when inserting it into the ear canal.

-Pull the pinna up and back with the nondominant hand. Rationale In the adult, pulling the pinna up and back allows the ear canal to straighten. The otoscope should be held upside down, like a large pen. The distance between the otoscope and the patient's head is very short. The otoscope should be held in the dominant hand. p. 989

What otoscopic examination finding helps the nurse to identify mastoiditis in a patient with ear pain? -Retracted eardrum with clear landmarks -Red, dull, thick, and immobile eardrum with perforations -Red, thickened, and bulging eardrum with loss of landmarks -Red, visible pulsations of a mass extending to the external ear canal

-Red, dull, thick, and immobile eardrum with perforations Rationale The presence of a red, dull, thick, and immobile eardrum with perforations is usually observed in mastoiditis. Red, visible pulsations of a mass extending to the external ear canal are seen in tumors of the middle ear. In the third stage of otitis media, a red, thickened, and bulging eardrum with loss of landmarks is observed. In the initial stages of otitis media, otoscopic examination reveals a retracted eardrum with clear landmarks. p. 995

What assessment findings are usually noted in a patient with external otitis? Select all that apply. Dizziness or vertigo Red, swollen, tender skin Mild itching and reduced hearing Headache and fever with nausea Pain with movement of the pinna

-Red, swollen, tender skin -Mild itching and reduced hearing -Pain with movement of the pinna Rationale The patient with external otitis has mild itching, and inflammation causes reduced hearing as if the ear is plugged. The patient also has pain with movement of the pinna or targus, especially when upward pressure is applied to the external canal. Affected skin becomes red, swollen, and tender to touch or movement. The patient with acute or chronic otitis media often has headache and fever with nausea. Dizziness or vertigo occurs as the middle ear pushes against the inner ear in the patient with otitis media. p. 993

Which statement about the intensity of sound in normal hearing is correct? -The normal ear cannot detect sounds at 0 decibels. -Soft whispers have an intensity of around 20 decibels. -Conversational speech has an intensity of 110 decibels. -A hearing aid is helpful for patients with a hearing loss of 90 decibels.

-Soft whispers have an intensity of around 20 decibels. Rationale Soft whispers are produced at an intensity of 20 decibels. A young patient with normal hearing can detect sound at 0 decibels 50% of the time. Conversational speech usually has an intensity of 60 decibels. When a patient has a hearing loss of 90 decibels, even a hearing aid may not help in detecting sounds. p. 990

On assessment, the nurse finds that an older adult patient's ability to hear high-frequency sounds is lost. The patient also has problems hearing the f, s, sh, and pa sounds. Which nursing interventions would be helpful to this patient? Select all that apply. -Speak slowly in a deeper voice. -Speak loudly to the patient and use hand gestures. -Reassure the patient that this is normal at this age. -Encourage the patient to undergo frequent ear irrigation. Provide a quiet environment and face the patient while speaking.

-Speak slowly in a deeper voice. -Encourage the patient to undergo frequent ear irrigation. Provide a quiet environment and face the patient while speaking. Rationale The nurse should emphasize beginning word sounds with a slow and deep voice. The nurse provides a calm and quiet environment and faces the patient when speaking to prevent distractions during communication. It is not appropriate for the nurse to speak loudly because the patient is experiencing difficulty hearing only certain types of sounds. The nurse does not tell the patient that the loss of ability to hear high-frequency sounds is normal at this age because it is a loss of function that alters the patient's activities. The nurse does not encourage the patient to undergo frequent ear irrigation without knowing the cause. This action may result in further damage to the ear structures. p. 987

What is the best way to communicate with a patient who has a hearing impairment? Shout instructions. Avoid hand motions. Stand in front of the patient. Converse in a dimly lit quiet room.

-Stand in front of the patient. Rationale When communicating with a patient who has hearing impairment, it is best to stand in front of the patient which allows the patient to lip read and understand facial expressions. The patient must never be shouted at, because this increases the frequency of the sound and makes it difficult to understand. Appropriate hand motions can be used to convey thoughts faster. The conversation should be held in a brightly lit room and words should be spoken clearly and slowly. p. 998

What common manifestations are present in a patient with mastoiditis? Select all that apply. Swelling behind the ear Ear pushed sideways and up Cellulitis on the external scalp Tender, enlarged lymph nodes Pain with movement of the head

-Swelling behind the ear -Cellulitis on the external scalp -Tender, enlarged lymph nodes Pain with movement of the head Rationale The patient with mastoiditis has swelling behind the ear. Cellulitis develops on the skin or external scalp as the infection spreads sideways through the skin. Lymph nodes behind the ear are tender and enlarged. The patient experiences pain with minimum movement of the tragus, pinna, or head. The ear is pushed sideways and down. p. 995

What nonsurgical management method does the nurse expect the health care provider to prescribe for a patient with acute otitis media? Moist heat Topical antibiotics Systemic antibiotic therapy Use of cotton-tipped applicators

-Systemic antibiotic therapy Rationale The health care provider will typically prescribe the use of systemic antibiotic therapy to decrease the pain of acute otitis media by reducing inflammation. A heating pad adjusted to a low setting may be used for pain relief; use of moist heat is not recommended. Topical antibiotics are not used to treat otitis media. Cotton-tipped applicators can cause injury and therefore must not be used to clean the external ear canal. p. 992

Which statement about the bones of the middle ear is correct? -The stapes transmits vibrations to the incus. -The malleus bone is also known as the stirrup. -The anvil is another name for the stapes bone. -The incus transmits vibrations from the malleus.

-The incus transmits vibrations from the malleus. Rationale Sound vibrations from the eardrum are transmitted to the malleus. The malleus transmits vibrations to the incus, and the incus transmits them to the stapes. The stapes transmits vibrations to the cochlea in the inner ear. The malleus is also called the hammer, and the stapes is also called the stirrup. The anvil is another name for the incus. p. 984

Which statement about the inner ear is correct? -The fluids that protect the vestibule are endolymph and perilymph. -The cochlea is present between the vestibule and semicircular canals. -The vestibule contains the utricle and the saccule, which are essential for balance. -The semicircular canals are connected to the distal end of the seventh cranial nerve.

-The vestibule contains the utricle and the saccule, which are essential for balance. Rationale In the inner ear, the vestibule is a small, oval-shaped, bony chamber that contains the utricle and the saccule, which are important for balance. Semicircular canals are connected to the distal end of the eighth cranial nerve. The vestibule is located between the cochlea and semicircular canals. The fluids endolymph and perilymph protects the cochlea and semicircular canals, allowing these structures to float and be protected from abrupt head movements. p. 985

The nurse instructs a patient to block one external ear canal while the nurse stands 1 to 2 feet away. The nurse quietly whispers a statement and asks the patient to repeat it. Which diagnostic test is the nurse performing? The voice test The watch test The audioscopy test The Weber tuning fork test

-The voice test Rationale The voice test is a simple hearing acuity test. The nurse asks the patient to block one external ear canal while standing 1 to 2 feet away. Then, the nurse quietly whispers a statement and asks the patient to repeat it. The watch test is performed using a ticking watch that tests acuity for high-frequency sounds. The audioscopy test is performed using a handheld device to generate tones of varying intensity. The Weber tuning fork test is performed using a tuning fork to determine the type of hearing loss. p. 989

An older adult patient reports ear pain. To differentiate the cause, which clinical manifestation is more indicative of otitis media? Vertigo Dry, flaky cerumen Ringing in the ears Pain on movement of the tragus

-Vertigo Rationale With otitis media, as pressure on the middle ear pushes against the inner ear, the patient may develop dizziness or vertigo. Dry, flaky cerumen is normal with aging. Pain on movement of the tragus is indicative of external otitis. Ringing in the ears is more likely with Ménière's disease. p. 992

A patient who attended a rock concert the previous day was likely exposed to what intensity of sound? 100 decibels 120 decibels 140 decibels 180 decibels

120 decibels Rationale The intensity of sound generated in the front row of a rock concert is 120 decibels. Chainsaws generate sounds of 100 decibels. A jet engine produces sounds of 140 decibels. A rocket-launching pad generates sounds of 180 decibels. p. 990

What is the intensity of sound generated by car traffic? 60 decibels 70 decibels 90 decibels 100 decibels

70 decibels Rationale Car traffic produces a sound intensity of 70 decibels. This is higher than the conversational speech intensity of 60 decibels. Motorcycles produce sounds of 90 decibels. Chainsaws generate sounds of 100 decibels. p. 990

Which patients are at high risk for developing hearing problems? Select all that apply. Airline mechanic Telephone operator Drummer in a rock band Patient with Down syndrome Teenager listening to music using ear buds

Airline mechanic Drummer in a rock band Patient with Down syndrome Teenager listening to music using ear buds Rationale An airline mechanic is exposed to excessive noise and is at risk for hearing damage. A patient with Down syndrome is at risk for hearing problems because this genetic condition is associated with frequent hearing problems. A drummer in a rock band is at risk for hearing problems due to exposure to loud noise. A teenager listening to music using ear buds is at high risk because ear buds are known risk factors for increasing potential hearing loss among people who use them on a regular basis with elevated noise levels. A telephone operator is not at risk for hearing problems simply because he or she may wear headphones or audio equipment. p. 988

Which test best determines hearing acuity? Otoscope Audioscopy Snellen test Electronystagmography

Audioscopy Rationale Audioscopy involves the use of a handheld device to generate tones of varying intensity to test hearing. Electronystagmography is a test that is sensitive for detecting central and peripheral disease of the vestibular system in the ear. An otoscope is used to inspect the ear canal. The Snellen test is a vision acuity test. p. 989

In what ways can trauma to the eardrum be prevented? Select all that apply. Avoid slapping over the ear. Avoid excessive nose blowing. Use ear plugs when swimming. Use ear candles to remove cerumen. Use cotton-tipped applicators to clean the ear.

Avoid slapping over the ear. Avoid excessive nose blowing. Rationale Slapping over the ear increases pressure in the ear canal and can tear the eardrum. Excessive nose blowing changes the pressure in the middle ear. High pressure damages the ossicles and can perforate the eardrum. The nose should be blown gently without occluding either nostril and with the mouth open. Ear plugs should be used when swimming to prevent external otitis, not trauma. The use of cotton-tipped applicators or ear candles to remove cerumen should be avoided to prevent trauma to the external canal. p. 995

What method is often used to extract a live insect from the ear of a patient? Instilling lidocaine in the ear Instilling mineral oil in the ear Using warm tap water to flush the ear Coaxing the insect out with a flashlight

Coaxing the insect out with a flashlight Rationale A live insect usually can either be coaxed out of the ear with a flashlight or a humming sound. If this does not work, it must be killed and taken out with ear forceps. Lidocaine, a numbing agent, can be placed in the ear canal for pain relief. Mineral oil or diluted alcohol is then instilled into the ear to suffocate and kill the insect. Warm tap water is often used for simple ear irrigation. p. 994

Patients with sensorineural hearing loss may use which methods to improve hearing? Hearing aid Myringoplasty Ossiculoplasty Cochlear implantation

Cochlear implantation Rationale Cochlear implantation can help patients with sensorineural hearing loss. A hearing aid is a miniature electronic amplifier that is useful for patients with conductive hearing loss. Hearing aids are less effective for patients with sensorineural hearing loss because they amplify background noise, making hearing worse. Myringoplasty and ossiculoplasty are types of tympanoplasty procedures used for simple reconstruction of the eardrum. These procedures help patients with conductive hearing loss. p. 999

What is an audiometry test used to assess? -Extent and type of hearing loss -Presence and location of tumors -Bony involvement in loss of hearing -Soft tissue involvement in hearing loss

Extent and type of hearing loss Rationale Audiometry determines the extent and type of hearing loss. An audiogram indicates if hearing loss is conductive or sensorineural in nature. Skull x-rays are used to determine bony involvement in hearing loss. Computed tomography (CT) and magnetic resonance imaging (MRI) help to determine soft-tissue involvement and the presence and location of tumors causing hearing loss. p. 990

Which factor is a common cause of tinnitus? Meningitis Astigmatism Otosclerosis Cerumen impaction

Otosclerosis Rationale Tinnitus is caused by underlying disorders such as otosclerosis, exposure to loud sounds, and other ear problems. Meningitis and tinnitus are complications of labyrinthitis, a complication of acute or chronic otitis media. Astigmatism is a disorder of the eye. Cerumen impaction causes a sensation of fullness in the ear with or without loss of hearing. p. 987

What is a typical cause of sensorineural hearing loss? Prolonged exposure to noise Presence of cerumen in the ear Presence of a foreign body in the ear Perforation of the tympanic membrane

Prolonged exposure to noise Rationale Prolonged exposure to noise damages the hair cells of the cochlea, resulting in sensorineural hearing loss. Sensorineural hearing loss occurs when the inner ear sensory nerve fibers that lead to the cerebral cortex are damaged. Other causes of sensorineural hearing loss include acoustic neuroma, diabetes mellitus, and presbycusis. Conductive hearing loss occurs when sound waves are blocked from contact with inner ear nerve fibers because of external ear or middle ear disorders. Presence of cerumen in the ear, perforation of the tympanic membrane, and presence of a foreign body in the ear are some of the causes of conductive hearing loss. p. 989

Malignant otitis can cause the destruction of which cranial nerve (CN)? VI IX VII VIII

Rationale Necrotizing or malignant otitis can cause the destruction of CN VII causing drooping of the mouth on the affected side. Complications of mastoiditis can damage CN VI and VII. Acoustic neuroma is a benign tumor of CN VIII that often destroys other structures as it grows. Stapedectomy is performed in an area where CN VII, VIII, and X can be damaged by trauma or by swelling after surgery. CN IX is not affected by malignant otitis. p. 993

What measure should the patient take if a hearing aid does not work? Adjust the volume to the lowest setting. Clean the sound hole with soap and water. Replace the existing battery with a new one. Rinse and clean the mold in mild soap solution

Replace the existing battery with a new one. Rationale The patient should replace the existing battery with a new one if the hearing aid does not work. The hearing aid must be adjusted at various volumes to determine if it works. It is adjusted to its lowest volume while hearing to prevent feedback squeaking. The sound hole of the hearing aid is normally cleaned with a toothpick and should not be immersed in water. The mold should be wiped clean with a mild soap solution, and must not be immersed in water. p. 999

Which rationale explains the use of mild diuretics in the treatment of Ménière's disease? They calm the patient. They have a vasodilatory effect. They reduce nausea and vomiting. They decrease endolymph volume.

They decrease endolymph volume. Rationale Mild diuretics decrease endolymph volume, which reduces the vertigo, hearing loss, tinnitus, and aural fullness associated with Ménière's disease. Antiemetics, not diuretics, are used to reduce nausea and vomiting symptoms. Nicotinic acid, not diuretics, has been found to be useful in Ménière's disease because of its vasodilatory effect. Benzodiazepines, not diuretics, can be used to calm the patient during an attack. p. 996

A patient reports a ringing sensation in the ear. What term describes this symptom? Tophi Vertigo Tinnitus Hyperacusis

Tinnitus Rationale A ringing sensation in the ear is known as tinnitus. Vertigo is the sensation of spinning movements. Hyperacusis is an intolerance to sound levels that do not bother others. Tophi are hard, irregular, painless nodules on the pinna formed due to the deposition of uric acid crystals. p. 995

What is the purpose of an otoscopic examination for older adult patients? To detect changes in balance To detect hearing loss in elderly patients To assess the patency of the external ear canal To show the structures of the ear in great detail

To assess the patency of the external ear canal Rationale Otoscopic examination is performed to examine the ear with the help of an otoscope. It helps assess the patency of the external ear canal, identify lesions or excessive cerumen in the canal, and assess the condition of the eardrum. Electronystagmography is performed to detect changes in balance. Computer tomography is done to show the structures of the ear in great detail. To determine whether the patient has hearing loss or normal hearing, pure-tone air-conduction testing is required. p. 988

What is the function of the fluid and hair cells that are present in the semicircular canals? To stimulate the eighth cranial nerve To protect and lubricate the ear canal To assist in maintaining the sense of balance To transduce sound vibrations into action potentials

To assist in maintaining the sense of balance Rationale The semicircular canals in the inner ear contain fluid and hair cells. They help in maintaining the sense of balance. The hair cells in the cochlea detect vibrations from sound and stimulate the eighth cranial nerve. The cerumen glands in the external ear secrete cerumen, which helps protect and lubricate the ear canal. The receptors located at the cochlea transduce sound vibrations into action potentials, which is a step in the hearing process. p. 986

Which factors are common causes of external otitis? Select all that apply. Insect bites Use of earrings Use of earphones Use of hair sprays Routine cerumen removal

Use of earrings Use of earphones Use of hair sprays Rationale External otitis is a painful condition caused when irritating or infective agents come into contact with the skin of the external ear. The result is either an allergic response or inflammation with or without infection. Hair sprays, earphones, and earrings are some of the causes of external otitis. Perichondritis is an infection caused by opening an area of localized pus or insect bite. Cerumen impaction may cause temporary loss of hearing but does not affect the external ear. p. 993

hich pigment-related disorder results in hearing loss caused by the loss of melanin-containing cells? Vitiligo Vertigo Tinnitus Hyperacusis

Vitiligo Rationale Vitiligo is a pigment-related disorder. It is a loss of melanin-containing cells in the inner ear that results in hearing loss. Vertigo is the sensation of spinning movement. Tinnitus is a ringing sensation in the ears. Hyperacusis is intolerance for certain sound levels. p. 987