Chapter 48

external otitis s/s- tx-

swimmers ear red, swollen, tender, temporary hearing loss, itching, pain, movement of pinna or tragus tx: apply heat 20 mins 3 times a day; topical ABX

Rinne test

tuning fork on bone and within air to see which pt can hear better

drug therapy for menieres disease purpose

used to decrease vertigo, N/V, and restore balance

weber test

vibrating fork on top of pt head whichever ear can hear better lateralization is when right or left side is heard louder

Function of the ear:

vibrations move from stapes to cochlea receptors in cochlea change vibrations into AP which are conducted to brain as nerve impulses

tx of cerumen or foreign bodies-

watchful waiting, manual removal or use of ceruminolytic agents water and hydrogen peroxide at body temp (50-70ml max) curemenex softens wax prior to removal or glycerin drops or mineral oil at bedtime

The nurse is caring for a client who has experienced an increased frequency in menieres disease attacks. When the client asks will I have to have surgery what is the nurses best response

you sound like you are concerned about having surgery different types of surgery can be considered with your health care provider

A client is diagnosed with a disorder involving the inner ear. Which is the most common client complaint associated with a disorder involving this part of the ear?

Tinnitus

How should the nurse communicate with a client who is deaf

by using pictures and writing if the client can see

Otitis media: acute- chronic-

-purulent drainage of inflammatory middle ear and ossicles -multiple acute episodes, more injury with longer duration presence of biofilm (bacteria)

hearing loss is of ____ db that can't be heard

45-50

During the physical assessment, the nurse notices that the patient's right external ear is deformed. What is the appropriate nursing action?

Ask the patient about kidney or urinary tract problems. (The external ear develops in the embryo at the same time as the kidneys and urinary tract. Thus any person with a defect of the external ear should be examined for possible problems of the kidneys and urinary systems.)

diagnosing acoustic neuroma

CT, MRI, or cerebrospinal fluid assay (increase pressure & protein)

The nurse is caring for a client following craniotomy for removal of an acoustic neuroma. Assessment of which cranial nerve would identify a complication specifically associated with this surgery?

Cranial Nerve 7 Facial nerve

What is the priority nursing intervention when providing care to a patient with hearing loss?

Ensuring that the patient can directly visualize you when you provide instructions

The nurse is caring for a client with tinnitus. Which client statement requires nursing teaching

I take aspirin every day to help reduce my risk for having a stroke

The patient's daughter asks what she can do to better communicate with her mother. What teaching will the nurse provide?

Promote family dialogue about hearing aids.

The nurse understands that a patient with a long history of heart failure is at risk for developing hearing loss if:

The patient has received multiple doses of furosemide.

pure tone audiometry: tympanometry

assesses mobility of otitis media; this test distinguishes middle ear problems (osteosclerosis, ossicular disarticulation, otitis media, perforation of eardrum)

acoustic neuroma

benign tumor on the auditory nerve (8th cranial nerve) s/s- vertigo, tinnitus, and progressive sensorineural hearing loss

surgical removal for acoustic neuroma

craniotomy (hearing lost try to keep facial nerve CN 7 intact)

sensorineural hearing loss

defect in the cochlea, 8th cranial nerve, or the brain due to exposure ot loud noise damaging cochlear hair

sensorineural hearing loss presbycusis-

degeneration of cochlear cells, loss of elasticity of basilar membrane or decrease in blood supply to inner ear deficient in B12 and folic acid -Monitor HIV and DM patients who have peripheral neuropathy

lab for hearing loss: WBC-

determines if otitis media is present

Auditory brainstem evoked response-

diagnose conductive and sensorineural hearing loss; used for patient who can't recognize stimuli from normal hearing exam

Assessment of balance: ENG-

electronystagmagrophy; assess for central and peripheral disease of the vestibular system in the ear by detecting and recording nystagmus (involuntary eye movement)

Assessment of balance: caloric testing

evaluates vestibular (inner ear) portions of auditory nerve water into ear at body temp and normal response is nystagmus and vertigo within 20-30 seconds

Meniere's disease define- who's at risk- s/s-

excess endolymphatic fluid that distorts inner ear canal men 20-50 y/o, includes tinnitus and one sided sensorineural hearing loss HA, fullness in head, hearing loss, vertigo

audiometry determines if

hearing loss is only conductive

Audioscopy

hearing test Normal 40 decibles @ 500, 1000, 2000, 4000

frequency

highness or lowness of tones (hertz) greater the number of vibrations the higher frequent pitch

mastoiditis

infection of the mastoid air cells caused by progressive otitis media tx with ABX before mastoidits can occur if not managed it can lead to brain assess, meningitis or death

Health promotion of otitis media

keep up with vaccines (pneumonia & flu)

threshold of hearing

lowest level of intensity at which speech/tones are heard is 0db normal speech is 60db too loud is 110db 20db whisper

pressure pulse treatment for menieres disease

menniet device, low pressure device to inner ear several times a day to decrease fluid

audiometry

most reliable, measure hearing acuity

surgical management of otitis media:

myringotomy (surgical opening of eardrum) grommet placed in eardrum for continuous drainage can't shower for several days, don't drive, take ABX

conductive hearing loss

obstruction of sound wave transmission such as foreign body in the external canal, a retracting or bulging tympanic or fused bony ossicles

how long does it take ear perforations to heal

one-two weeks (repeated perforations hear slower & buildup scar tissue)

conductive hearing loss pathophysiology

ostosclerosis: overgrowth of bone on ossicles sound waves blocked, abnormal tympanic

nonsurgical management of otitis media:

quiet, bedrest, low heat, systemic ABX

tx of mastoiditis

radical mastoidectomy with tympanoplasty (removal and reconstruction)

labryinthectomy

resection of vestibular nerve or total removal of the labrynth lose hearing on surgical side

Tinnitus

ringing in ears, diagnostic test can't confirm but is used to rule out other hearing disorders therapy focuses on ways to mask tinnitus

s/s of cerumen or foreign bodies in the ear

sense of fullness in ear, with or without hearing loss, ear pain, itchy, dizzy, bleeding

Imaging of the ear CT- MRI-

shows structure and tumors soft tissue changes

Intensity

sound in decibles (dB)

s/s of mastoiditis

swelling behind the ear, pain with movement, cellulitis, push ear sideways and down, lymph nodes enlarged, low grade fever, malaise, drainage, hearing loss CT shows fluid in air cells of mastoid process