Ears

do you experience spinning, dizziness, or feel unbalanced?

Vertigo (true spinning motion) may be associated with an inner ear problem. It is termed subjective vertigo when clients feel that they are spinning around and objective vertigo when clients feel that the room is spinning around them. It is important to distinguish vertigo from dizziness. Benign paroxysmal positional vertigo (BPPV) can occur at any age, but often occurs in persons over 50 and is more common in women. Often the cause is unknown, but head injury or damage to balance organs can underlie BPPV. Crystals in the otolith organs in the ear monitor head position relative to gravity. These crystals become dislodged and create dizziness along with vertigo (sense of spinning), nausea, and vomiting. Dizziness and vertigo in rare cases are associated with serious disease.

Presbycusis

age related hearing loss

Romberg test

assesses ability of vestibular apparatus in inner ear to help maintain standing balance Ask the client to stand with feet together, arms at sides, and eyes open, then with the eyes closed. *abnormal finding* -Client moves feet apart to prevent falls or starts to fall from loss of balance. This may indicate a vestibular disorder.

3 types of hearing loss

conductive: when hearing loss is due to problems with the ear canal, ear drum, or middle ear and its little bones (the malleus, incus, and stapes). sensorineural;when hearing loss is due to problems of the inner ear, also known as nerve-related hearing loss. mixed; refers to a combination of conductive and sensorineural hearing loss. This means that there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve.

Microtia

ears smaller than 4 cm vertically -ears do not fully develop

causes of Sensorineural hearing loss

ototoxic drugs, genetic hearing loss, aging, head trauma, malformation of the inner ear, and loud noise exposure -most common type of hearing loss

Do you spend a lot of time swimming or in water? How do you protect your ears when you swim?

-Otitis externa, often referred to as swimmer's ear, can occur when water stays in the ear canal for long periods of time, providing the perfect environment for germs to grow and infect the skin. -S/s itchiness inside the ear, redness and swelling of the ear, pain in the ear when pressure is applied or the ear is pulled on, drainage of pus -

Inspect the tympanic membrane (eardrum)

-Red, bulging eardrum and distorted, diminished, or absent light reflex—acute otitis media -Yellowish, bulging membrane with bubbles behind—serous otitis media -Bluish or dark red color—blood behind the eardrum from skull trauma -White spots—scarring from infection -Perforations—trauma from infection -Prominent landmarks—eardrum retraction from negative ear pressure resulting from an obstructed eustachian tube -Obscured or absent landmarks—eardrum thickening from chronic otitis media

caring for your ears

-earwax should not be removed unless it causes problem -nothing should be inserted into the ears -A few drops of mineral oil, baby oil, glycerin, or commercial drops may be placed in the ear to moisten the earwax to allow it to naturally work its way out of the ear

causes of conductive hearing loss

-fluid in middle ear, middle ear infection (otitis media), allergies (serous otitis media), eustachian tube dysfunction, perforated eardrum, benign tumors, impacted cerumen, infection in the ear canal (external otitis) or presence of a foreign body

A client with acute otitis media would have

-red, bulging eardrum, with absent light reflex. -A pearly, translucent membrane, with no bulging is a normal finding in the tympanic membrane. -A yellowish, bulging membrane, with bubbles is seen in serous otitis media. -A gray, translucent membrane, with no retraction is a normal finding in the tympanic membrane.

what people are most at risk for otitis media

Age (between 6 months and 2 years especially, due to size and shape of eustachian tubes) Group childcare Babies fed from a bottle, especially lying down Seasons of fall and winter, due to exposure to colds, flu, and increased allergens Poor air quality, especially irritants in the air (e.g., cigarette smoke) Family history Cleft palate Down syndrome Ethnicity (Alaskan Indians and Inuits have higher incidence) Enlarged adenoids

any ear drainage?

Drainage (otorrhea) usually indicates infection. -Purulent, bloody drainage suggests an infection of the external ear (external otitis). -Purulent drainage associated with pain and a popping sensation is characteristic of otitis media with perforation of the tympanic membrane.

any ear pain?

Earache (otalgia) can occur with ear infections, cerumen blockage, sinus infections, or teeth and gum problems. Pain caused by "swimmer's ear" differs from pain felt in middle ear infections. Pain that occurs when manipulating, or wiggling, the pinna may suggest otitis externa (swimmer's ear) Clients with ear infections may experience nausea and dizziness.

A 52-year-old client fails the Romberg test. The nurse explains that this might indicate a dysfunction in what part of the ear?

Failure of the Romberg test may indicate dysfunction in the vestibular portion of the inner ear, semicircular canals, and vestibule.

Tophi

Hard external ear nodules associated with deposits of uric acid crystals in advanced gout

Sensourineural Hearing Loss

Hearing loss caused by damage to the inner ear or the nerve from the ear to the brain -permanent

are all sounds affected?

Presbycusis often begins with a loss of high-frequency sounds (a woman's voice) followed later by the loss of low-frequency sounds.

Which assessment data is consistent with otitis media with effusion?

Redness and bulging of the eardrum are characteristic of otitis media with effusion. -Clear or bloody discharge occurs with rupture of the tympanic membrane. -Dense white patches on the tympanic membrane are noted with scarring of the tympanic membrane.

any ringing, roaring, or crackling in your ears?

Ringing in the ears (tinnitus) may be associated with excessive earwax buildup, high blood pressure, or certain ototoxic medications (such as streptomycin, gentamicin, kanamycin, neomycin, ethacrynic acid, furosemide, indomethacin, or aspirin), loud noises, or other causes.

Rinne test

Strike a tuning fork and place the base of the fork on the client's mastoid process . Ask the client to tell you when the sound is no longer heard. *abnormal finding* Although AC > BC in normal hearing, the Rinne test is used to determine the cause of the hearing loss (conduction or sensorineural) once it is determined that there is a hearing loss. If the cause is sensorineural, the finding will also be AC > BC. With conductive hearing loss, bone conduction (BC) sound is heard longer than or equally as long as air conduction (AC) sound (BC ≥ AC). AC= air conduction BC=bone conduction

weber test

Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear/both ear the sound can be heard from. *abnormal finding* -With conductive hearing loss, the client reports lateralization of sound to the poor ear—that is, the client "hears" the sound in the poor ear. The good ear is distracted by background noise and conducted air, which the poor ear has trouble hearing. Thus the poor ear receives most of the sound conducted by bone vibration. -With sensorineural hearing loss, the client reports lateralization of sound to the good ear. This is because of limited perception of the sound due to nerve damage in the bad ear, making sound seem louder in the unaffected ear.

whisper test

Test in which an examiner whispers a sentence and asks the patient to repeat it to evaluate loss of high-frequency sounds. -2 syllable word *abnormal finding* Unable to repeat the two-syllable word after two tries indicates hearing loss and requires follow-up testing by an audiologist.

Do you work or live in an area with frequent or continuous loud noise? How do you protect your ears from the noise?

Continuous loud noises can cause a hearing loss unless the ears are protected with ear guards. -Clients exposed to high noise levels need to be informed of their options for using hearing protective devices

what people are most at risk for hearing loss

-Aging -Heredity -Occupational loud -Recreational noises and exposure to explosive noises -Ototoxic medications -Illnesses, especially with high fever (e.g., meningitis)

Inspect the auricle, tragus, and lobule

-Ears are smaller than 4 cm or larger than 10 cm. -Malaligned or low-set ears may be seen with genitourinary disorders or chromosomal defects. -Microtia is a congenital deformity in which the external ear and sometimes the ear canal are not fully developed. -Macrotia is a congenital excessive enlargement of the external ear. -Ear malformations are often related to other congenital anomalies such as face, jaw, dental, and kidney disorders -Enlarged preauricular and postauricular lymph nodes—infection -Tophi (nontender, hard, cream-colored nodules on the helix or antihelix, containing uric acid crystals)—gout -Blocked sebaceous glands—postauricular cysts -Ulcerated, crusted nodules that bleed—skin cancer (most often seen on the helix due to skin exposure) -Redness, swelling, scaling, or itching—otitis externa -Pale blue ear color—frostbite

Inspect the external auditory canal

-Foul-smelling, sticky, yellow discharge—otitis externa or impacted foreign body -Bloody, purulent discharge—otitis media with ruptured tympanic membrane -Blood or watery drainage (cerebrospinal fluid)—skull trauma -Impacted cerumen blocking the view of the external ear canal—conductive hearing loss -Reddened, swollen canals—otitis externa -Exostoses (nonmalignant nodular swellings) -Polyps may block the view of the eardrum

has hearing loss affected your ADL's?

-Hearing loss or ear pain may interfere with the client's ability to perform usual ADLs. Clients may not be able to drive, talk on the telephone, or operate machinery safely because of decreased hearing acuity.

Palpate the auricle and mastoid process.

A painful auricle or tragus is associated with otitis externa or a postauricular cyst. Tenderness over the mastoid process suggests mastoiditis. Tenderness behind the ear may occur with otitis media.

changes in hearing

A sudden decrease in ability to hear in one ear may be associated with otitis media or cerumen impaction. -Sudden sensorineural hearing loss (SSHL) or sudden deafness (up to a 3-day period) may be a medical emergency and thus should be referred for immediate follow-up. -Causes vary from unknown etiology to infections, trauma, toxicity, and other neurologic or circulatory disorders

client education for hearing loss

Avoid sound exposure louder than a washing machine (A good rule of thumb is to avoid noises that are too loud, too close, or last too long.) -Avoid recreational risks that involve loud sounds or risks of head or ear injury. -Avoid listening to extremely loud music for long periods of time. -Wear hearing protectors and take breaks from the noise in loud noise environments. -Have hearing checked periodically, especially after age 50. If hearing loss is detected, obtain and use devices to improve hearing. -Immunize children against childhood diseases, including measles, meningitis, rubella, and mumps. -Avoid the use of ototoxic drugs unless prescribed by a qualified health care worker and properly monitored for correct dosage. -If you have a newborn, avoid feeding from bottle while infant is lying on back. Have newborn infant screened for hearing. -Get treatment for ear infections as soon as they are noticed; follow up with health care provider after symptoms seem to be gone to make sure there is no fluid left in the ear.