Chapter 43: Caring Clients with Ear Disorders

Acoustic neuromas are benign tumors of which of the following cranial nerves? a. VIII b. VII c. VI d. V

a 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 precautions should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance? a. Grasp the siderails when rising to a standing position. b. Keep his or her eyes closed. c. Refrain from looking at one place. d. Immobilize the head to reduce the risk of falling

a The nurse should have the client use firm supports, such as siderails, whenever arising. There is no need to limit the client's gaze or head movements. Keeping the eyes closed can exacerbate disorientation.

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear? a. External ear b. Middle ear c. Inner ear d. Tympanic membrane

c 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.

Which nursing diagnosis takes highest priority for a client admitted for evaluation for Ménière's disease? a. Acute pain related to vertigo b. Imbalanced nutrition: Less than body requirements related to nausea and vomiting c. Risk for deficient fluid volume related to vomiting d. Risk for injury related to vertigo

d Vertigo, the chief finding in Ménière's disease, is a severe, rotational whirling sensation that typically causes the client to fall when attempting to stand or walk. Because client safety is paramount, the nursing diagnosis of Risk for injury related to vertigo takes priority. Vertigo doesn't cause pain. Although nausea and vomiting may lead to inadequate nutrition and fluid loss, these problems are secondary to client safety.

Health teaching for a patient who suffers from motion sickness would include recommending the use of which one of the following over-the-counter drugs? a. Scopolamine b. Phenergan c. Dramamine d. Ephedrine

Scopolamine and Phenergan are popular anticholinergics; ephedrine is a popular sympathomimetic. Dramamine and Antivert are over-the-counter antihistamines that act by blocking the conduction of the vestibular pathway of the inner ear.

A client is newly diagnosed with benign paroxysmal positional vertigo. Which is the priority nursing intervention? a. Attempt the Epley/canalith repositioning procedure. b. Administer meclizine for 1 to 2 weeks. c. Teach balance exercises. d. Encourage bed rest.

d Bed rest is recommended for clients with acute symptoms. Best rest can ease the symptoms while keeping the client safe. Epley/canalith repositioning procedures may be used to resolve attacks of vertigo. The client will usually vomit and may need to be medicated with an antiemetic before the procedure can be tried. Clients with acute vertigo may be medicated with meclizine for 1 to 2 weeks, but because safety is a concern, encouraging bed rest would be the highest priority. Balance exercises would not be taught until the acute symptoms have eased. These exercises will help the brain compensate for the vestibular disorder.

After mastoid surgery, an 81-year-old client has been identified as needing assistance in her home. What would be a primary focus of this client's home care? a. Preparation of nutritious meals and avoidance of contraindicated foods b. Ensuring the client receives adequate rest each day c. Helping the client adapt to temporary hearing loss d. Assisting the client with ambulation as needed to avoid falling

d The caregiver and client are cautioned that the client may experience some vertigo and will therefore require help with ambulation to avoid falling. The client should not be expected to experience hearing loss and no foods are contraindicated. Adequate rest is needed, but this is not a primary focus of home care.

Which condition is characterized by the formation of abnormal spongy bone around the stapes? a. Otosclerosis b. Middle ear effusion c. Chronic otitis media d. Otitis externa

a Otosclerosis is more common in females than males and is frequently hereditary. A middle ear effusion is denoted by fluid in the middle ear without evidence of infection. Chronic otitis media is defined as repeated episodes of acute otitis media, causing irreversible tissue damage and persistent tympanic membrane perforation. Otitis externa refers to inflammation of the external auditory canal.

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

a 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.

A nurse practitioner explains to a patient recently diagnosed with noise-induced hearing loss that the basic altered physiology in the ear is the result of: a. Damage to the hair cells inside the cochlea. b. Stenosis of the semicircular canals. c. Hardening of the tympanic membrane. d. Malfunctioning of the incus and the staples.

a About 25% of all Americans who have a hearing loss have noise-induced hearing loss caused by damage to the hair cells found inside the cochlea. These cells convert sound energy into electrical signals that travel to the brain. Once damaged, they cannot be repaired.

Which terms refers to the progressive hearing loss associated with aging? a. Presbycusis b. Exostoses c. Otalgia d. Sensorineural hearing loss

a Age-related changes of both the middle and inner ear result in hearing loss. Exostoses refer to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. Otalgia refers to a sensation of fullness or pain in the ear. Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing and/or cranial nerve VIII.

A client diagnosed with arthritis has been taking aspirin and now reports experiencing tinnitus and hearing loss. What should the nurse teach this client? a. The hearing loss will likely resolve with time after the drug is discontinued. b. The client's hearing loss and tinnitus are irreversible at this point. c. The client's tinnitus is likely multifactorial, and not directly related to aspirin use. d. The client's tinnitus will abate as tolerance to aspirin develops.

a Tinnitus and hearing loss are signs of ototoxicity, which is associated with aspirin use. In most cases, this will resolve upon discontinuing the aspirin. Many other drugs cause irreversible ototoxicity.

Which of the following nurse's actions carries the greatest potential to prevent hearing loss due to ototoxicity? a. Ensure that clients understand the differences between sensory hearing loss and conductive hearing loss. b. Educate clients about expected age-related changes in hearing perception. c. Educate clients about the risks associated with prolonged exposure to environmental noise. d. Be aware of clients' medication regimens and collaborate with other professionals accordingly.

d A variety of medications may have adverse effects on the cochlea, vestibular apparatus, or cranial nerve VIII. All but a few, such as aspirin and quinine, cause irreversible hearing loss. Ototoxicity is not related to age-related changes, noise exposure, or the differences between types of hearing loss.

The nurse is discharging a client home after mastoid surgery. What should the nurse include in discharge teaching? a. "Try to induce a sneeze every 4 hours to equalize pressure." b. "Be sure to exercise to reduce fatigue." c. "Avoid sleeping in a side-lying position." d. "Don't blow your nose for 2 to 3 weeks."

d The client is instructed to avoid heavy lifting, straining, exertion, and nose blowing for 2 to 3 weeks after surgery to prevent dislodging the tympanic membrane graft or ossicular prosthesis. Side-lying is not contraindicated; sneezing could cause trauma.

An older adult with a recent history of mixed hearing loss has been diagnosed with a cholesteatoma. What should this client be taught about this diagnosis? Select all that apply a. Cholesteatomas are benign and self-limiting, and hearing loss will resolve spontaneously. b. Cholesteatomas are usually the result of metastasis from a distant tumor site. c. Cholesteatomas are often the result of chronic otitis media. d. Cholesteatomas, if left untreated, result in intractable neuropathic pain. e. Cholesteatomas usually must be removed surgically.

c, e Cholesteatoma is a tumor of the external layer of the eardrum into the middle ear, often resulting from chronic otitis media. They usually do not cause pain; however, if treatment or surgery is delayed, they may burst or destroy the mastoid bone. They are not normally the result of metastasis and are not self-limiting.

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

d 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.

A client is being prepared for a cochlear implant. Which client statement would alert the nurse to the need for additional teaching? a. "I'm going to be able to hear normally again." b. "I'll have a small incision behind my ear." c. "I'll wear an external transmitter and microphone." d. "I'll be able to hear medium and loud sounds for once."

a A cochlear implant does not restore normal hearing. Rather, it helps the person detect medium to loud environmental sounds and conversation. A small receiver is implanted in the temporal bone through a postauricular incision with electrodes placed into the inner ear. The microphone and transmitter are worn on an external unit.

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? a. the one the client will use b. speech reading c. signing d. writing

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

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? a. Mineral oil b. Irrigation c. Hair pin d. Tweezers

a 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 statement describes benign paroxysmal positional vertigo (BPPV)? a. The vertigo is usually accompanied by nausea and vomiting. b. The onset of BPPV is gradual. c. BPPV is caused by tympanic membrane rupture. d. BPPV is stimulated by the use of certain medications, such as acetaminophen.

a 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, hearing impairment does not generally occur. The onset of BPPV is sudden and followed by a predisposition for 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 is formed from small crystals of calcium carbonate from the inner ear structure, the utricle. BPPV is frequently stimulated by head trauma, infection, or other events.

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing which effect? a. Facial nerve paralysis b. Nystagmus c. Motor impairment d. Diplopia

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

The physician suggests that a client use meclizine as treatment for his motion sickness. The nurse explains the rationale for this drug based on an understanding of which of the following as the drug's action? a. Blocks conduction of the vestibular pathways b. Antagonizes the response of histamine c. Depresses the central nervous system d. Lowers endolymphatic system pressure

a Meclizine blocks the conduction of the vestibular pathway in the inner ear to provide some relief of nausea and vomiting. Anticholinergic agents, such as scopolamine, antagonize the histamine response. Meclizine does not depress the central nervous system. Diuretics help to lower the pressure of the endolymphatic system in Meniere's disease.

An older adult client reports pain in the ears and an unusual sense of fullness. The client also indicates not hearing as well as in the past. On inspection, the nurse notes that there is an accumulation of earwax in the client's ears. The client is suffering from: a. otalgia. b. otitis externa. c. otosclerosis. d. tinnitus.

a Otalgia is ear pain or an earache. Otalgia has several causes, one of which is accumulated earwax.

A client has been diagnosed with otosclerosis. The nurse explains to the client that this is a common cause of hearing impairment among adults and is the result of a bony overgrowth of the: a. stapes b. labyrinth c. tympanic membrane d. incus

a Otosclerosis is the result of a bony overgrowth of the stapes and a common cause of hearing impairment among adults.

The nurse is caring for a patient with Ménière's disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack? a. Meclizine (Antivert) b. Furosemide (Lasix) c. Cortisporin otic solution d. Gentamicin (Garamycin) intravenously

a Pharmacologic therapy for Ménière's disease consists of antihistamines, such as meclizine, which shortens the attack (NIDCD, 2010).

The parent of a young client with severe hearing loss is quite concerned about the child's future independence because of impaired hearing. Which type of hearing loss is usually irreversible? a. sensorineural b. conductive c. tinnitus d. noise exposure

a Sensorineural hearing loss usually is irreversible.

A client with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the client? a. Sit or stand in front of the client when speaking. b. Use exaggerated lip and mouth movements when talking. c. Stand in front of a light or window when speaking. d. Say the client's name loudly before starting to talk.

a Standing directly in front of a hearing-impaired client allows him or her to lip-read and see facial expressions that offer clues to what is being said. Using exaggerated lip and mouth movements can make lip-reading more difficult by distorting words. Backlighting can create glare, making it difficult for the client to lip-read. To get the attention of a hearing-impaired client, gently touch the client's shoulder or stand in front of the client.

A nurse is preparing a plan of care for a client with otitis externa. Based on the typical assessment findings, which of the following would the nurse most likely identify as the priority nursing diagnosis? a. Acute pain related to inflammation b. Risk for infection related to drainage from the ear canal c. Disturbed sensory perception: auditory related to sensorineural hearing loss. d. Hyperthermia related to elevated temperature secondary to infection

a The client with otitis externa typically reports pain as well as aural tenderness, making the nursing diagnosis of acute pain the priority. A major component of therapy is relief of the pain and discomfort with analgesics and antibiotics and corticosteroid agents to soothe the inflamed tissues. Inflammation is present, which could lead to infection, but this would not be the priority. Typically, clients with otitis externa experience a conductive hearing loss. Fever may or may not be present.

Why should the nurse encourage a client with otitis externa to eat soft foods? a. Chewing may cause discomfort. b. Chewing may lead to further complications, such as otitis media. c. Chewing may cause excessive drainage. d. Chewy foods, such as red meat, may react with the prescribed analgesics and antibiotics.

a The nurse encourages a client with otitis externa to eat soft foods or consume nourishing liquids because chewing may cause discomfort.

Which nursing intervention is appropriate for a client who plans to use a hearing aid? a. Describe the various types of hearing aids that are available b. Advise the client to purchase a hearing aid that is unnoticeable c. Advise the client to purchase from a company salesman d. Advise the client to purchase the hearing aid from a mail order catalog

a The nurse should describe the various types of hearing aids that are available, some of which fit almost unnoticeably in the ear. The nurse should emphasize the importance of avoiding the purchase of a hearing aid from a mail order catalog or a company salesman. In addition, the nurse should encourage the client to be forthright and inform others about the hearing deficit, rather than trying to hide it.

Instructing a class of sixth graders on the importance of protecting their hearing by avoiding excessive noise, the nurse lists the activities that can destroy hearing. On the list are loud concerts, loud mP3 player volume, loud headphones, etc. The nurse also indicates the signs of hearing impairment so the students can help protect their friends. What are signs of diminished hearing? Select all that apply. a. turning the head b. asking for words to be repeated c. leaning back during conversation d. clear speech

a, b The nurse observes for signs of hearing impairment such as frequently asking that words be repeated.

A client who has been diagnosed with Ménière's disease is experiencing symptoms so severe that it is becoming difficult to make plans outside of the home and to work a full-time job. The nurse has asked the client to describe the symptoms. Which would be included? Select all that apply. a. headache b. dizziness c. nystagmus d. low blood pressure e. vision loss

a, b, c Clients often experience tinnitus and hearing loss that lasts for several hours as well as headaches and abdominal discomfort. Vertigo is the most incapacitating symptom; clients report whirling dizziness and the need to lie down. Nystagmus of the eyes may result from an imbalance in vestibular control of eye movements. Low blood pressure and vision loss are not associated symptoms.

Which of the following describes vertigo? Select all that apply. a. Misperception of motion b. Spinning sensation c. Objects are moving around him or her d. Syncope e. Fainting

a, b, c 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.

A nurse is providing education to a client receiving antibiotic treatment for otitis media. The client has been treated for otitis media in the past and is known for being noncompliant with prescribed medications. The nurse reinforces the importance of completing all of the prescribed antibiotics and explains to the client that the pathogen may become unresponsive to treatment if prescription is not taken in full. The nurse explains further that pathogens that are unresponsive to antibiotic therapy can spread, causing which potentially serious complications? Select all that apply. a. mastoiditis b. labyrinthitis c. meningitis d. pericarditis

a, b, c, Because the middle ear connects with the mastoid process, a part of the temporal bone, pathogens that are unresponsive to antibiotic therapy can spread, causing mastoiditis. Pathogens can travel deeper in the inner ear causing labyrinthitis. Infection may extend to the meninges, causing meningitis. Pericarditis is not a known complication from otitis media.

High doses of which medication can produce bilateral tinnitus? a. Meclizine b. Aspirin c. Promethazine d. Dimenhydrinate

b 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.

A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following? a. Tinnitus b. Vertigo c. Nausea d. Ear fullness

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

The nurse is planning the care of a client who is adapting to the use of a hearing aid for the first time. What is the most significant challenge experienced by a client with hearing loss who is adapting to using a hearing aid for the first time? a. Regulating the tone and volume b. Learning to cope with amplification of background noise c. Constant irritation of the external auditory canal d. Challenges in keeping the hearing aid clean while minimizing exposure to moisture

b Each of the answers represents a common problem experienced by clients using a hearing aid for the first time. However, amplification of background noise is a difficult problem to manage and is the major reason why clients stop using their hearing aid. All clients learning to use a hearing aid require support and coaching by the nurse and other members of the health care team. Clients should be encouraged to discuss their adaptation to the hearing aid with their audiologist.

A nurse is planning preoperative teaching for a client with hearing loss due to otosclerosis. The client is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the client's preoperative teaching? a. The procedure is an effective, time-tested treatment for sensory hearing loss. b. The client is likely to experience resolution of conductive hearing loss after the procedure. c. Several months of postprocedure rehabilitation will be needed to maximize benefits. d. The procedure is experimental, but early indications suggest great therapeutic benefits.

b Stapedectomy is a very successful time-tested procedure, resulting in the restoration of conductive hearing loss. Lengthy rehabilitation is not normally required.

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? a. Placing the client in a prone position b. Assisting the client into a sitting position c. Instilling 15 mL of warm normal saline into one of the client's ears d. Assessing the client's baseline hearing by performing the whisper test

b 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 client who has been fitted with a hearing aid comes for a follow-up evaluation. During the visit, the client states, "I've noticed that I still don't seem to hear well enough. The hearing aid doesn't seem to make the sounds louder." Which of the following might the nurse determine as the possible cause? a. Ear mold is loose. b. Client has cerumen in the ear. c. The mold is not properly fitted. d. The client has an ear infection.

b The client reports that the hearing aid is not helping, such that the sounds are not loud enough. This statement is consistent with inadequate amplification. Cerumen in the ears is a possible cause. A loose ear mold would cause a whistling noise. An improperly fitted mold or middle ear infection would lead to pain from the mold.

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

b 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 is caring for a client who has undergone a mastoidectomy. In an effort to prevent postoperative infection, what intervention should the nurse implement? a. Teach the client about the risks of ototoxic medications. b. Instruct the client to protect the ear from water for several weeks. c. Teach the client to remove cerumen safely at least once per week. d. Instruct the client to protect the ear from temperature extremes until healing is complete.

b To prevent infection, the client is instructed to prevent water from entering the external auditory canal for 6 weeks. Ototoxic medications and temperature extremes do not present a risk for infection. Removal of cerumen during the healing process should be avoided due to the possibility of trauma.

A client who is a competitive swimmer is diagnosed with swimmer's ear (otitis externa). Which instruction would be least appropriate for the nurse to include when teaching the client about this condition? a. Wear ear plugs when swimming, showering, or washing the hair. b. Use a hair dryer set on high to dry the ear canal after swimming. c. Instill alcohol drops into the external ear after swimming. d. Avoid scratching or exposing the ear to scratching or trauma.

b To prevent swimmer's ear (otitis externa), the nurse would instruct the client to wear ear plugs when swimming, showering, or washing the hair, use a hair dryer on low to dry the ear canal after swimming, instill alcohol drops into the ear after swimming to dry the canal, and avoid scratching or exposing the ear to trauma.

Which term refers to an altered sensation of orientation in space? a. Ataxia b. Tinnitus c. Dizziness d. Nystagmus

c Dizziness may be associated with inner ear disturbances. Tinnitus refers to a subjective perception of sound with internal origin. Nystagmus refers to involuntary rhythmic eye movement. Ataxia is the failure of muscle coordination and may be present in clients with vestibular disease.

Which test uses a tuning fork shifted between two positions to assess hearing? a. Whisper b. Watch tick c. Rinne d. Weber

c 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, then determining the ability of the client to repeat what was whispered. The watch tick test relies on the ability of the client to perceive the high-pitched sound made by a watch held at the client's auricle. The Weber test uses bone conduction to test lateralization of sound.

The nurse just completed educating a client on hearing aid care. Which statement by the client indicates that the teaching was effective? a. "I will wash the entire hearing aid daily with soap and water." b. "I will notify the hearing aid dealer if the hearing aid whistles." c. "I will use a small pipe cleaner to clean the cannula on the hearing aid." d. "I will dry my ears with a cotton-tipped applicator before inserting the hearing aid."

c The cannula on the hearing aid should be cleaned with a small pipe cleaner or pipe cleaner-like object. Only the ear mold should be cleaned daily using soap and water; no other part of the hearing aid should be cleaned with soap and water. The client should be taught to troubleshoot if the hearing aid whistles. Many times the client can fix the issue when this happens. The ears should not be dried using a cotton-tipped applicator because it can cause trauma and lead to otitis externa.

The nurse recognizes which methods are not correct for removing a foreign body from the ear? a. Irrigation b. Manual pressure c. Suction d. Instrumentation

c 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 with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction? a. "Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours." b. "Try to ambulate independently after about 24 hours." c. "Shampoo your hair every day for 10 days to help prevent ear infection." d. "Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."

d The nurse should instruct the client to avoid air travel, sudden movements that may cause trauma, and exposure to loud sounds and pressure changes (such as from high altitudes) for 30 days after a stapedectomy. Immediately after surgery, the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The client's first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. The client must avoid shampooing and swimming to keep the dressing and the ear dry.