Chapter 59
The result of recurrent AOM causing irreversible tissue pathology and persistent perforation of the tympanic membrane.
Chronic Otitis Media
Repeated episodes of acute otitis media causing irreversible tissue damage and persistent tympanic membrane perforation
Chronic otitis media
Antihistamines Tranquilizers Antiemetiv agens Diuretic therapy Intake of foods containing potassium.
Pharmacologic Therapy For Meniere's Disease
Term used to describe frequency A tone with 100 Hz is considered of low pitch Tone of 10,000 Hz is considered of high pitch
Pitch
Surgical procedures: Tympanoplasty Ossiculoplasty Mastoidectomy used if medical tx are ineffective
Surgical management of Chronic Otitis Media
Fluctuating, progressive sensorineural hearing loss Tinnitus or a roaring sound A feeling of pressure of fullness in the ear Episodic, incapacitating vertigo, often accompanied by N/V
Symptoms of Meniere's disease
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?
Client has cerumen in the ear.
Symptoms may be minimal Varying degrees of hearing loss Persistent or intermittent, foul-smelling otorrhea. No pain Otoscopic exam - perforation, cholesteatoma can be identified as a white mass behind the tympanic membrane or coming through to the external canal from a perforation
Clinical Manifestations of Chronic Otitis Media
Sudden onset of incapactating vertigo, usually with N/V, various degrees of hearing loss, and possibly tinnitus. First episode is usually the worst
Clinical Manifestations of Labyrinthitis
Hearing loss Fullness in the ear or a sensation of congestion Popping and crackling noises that occur as the eustachian tube attempts to open
Clinical Manifestations of Serous Otitis Media
Pain Discharge from the external auditory canal Aural tenderness (usually not present in middle ear infections) Occasionally fever Cellulitis Lymphadenopathy Pruritis Hearing loss or a feeling of fullness Otoscopic exam- ear canal is erythematous & edematous. Discharge may be yellow or green & foul-smelling In fungal infections, hairlike black spores may even be visible
Clinical manifestations of External Otitis
Organs for hearing
Cochlea
Usually results from an external ear disorder, such as impacted cerumen, or a middle ear disorder, such as otitis media or otosclerosis.
Conductive Hearing Loss
Loss of hearing in which efficient sound transmission to the inner ear is interrupted by some obstruction or disease process
Conductive hearing loss
Refers to an inflammation of the external auditory ear canal. Causes include water int he ear canal (Swimmers ear); trauma to the skin of the ear canal, permitting entrance of organisms into the tissues; and systemic conditions, such as vitamin deficiency and endocrine disorders.
External otitis
Several ototoxic substances Thyroid disease Hyperlipidemia Vitamin b12 deficiency Psychological disorders (eg, depression, anxiety) Fibromyalgia Otologic disorders (Meniere's disease, acoustic neuroma) Neurologic disorders (head injury, multiple sclerosis)
Factors that contribute to the development of Tinnitus
Illusion of movement in which the individual or the surroundings are sensed as moving
Vertigo
______ is the most troublesome complaint related to Meniere's disease.
Vertigo
Provides the greatest success rate (approx 98%) in eliminating the attacks of vertigo.
Vestibular Nerve Sectioning
Affects hearing and balance Little is known about the disorder Most common causes: mumps, rubella, rubeola, and influenza
Viral Labyrinthitis
Treatment is based on the patient's symptoms
Viral Labyrinthitis
Uses bone conduction to test lateralization of sound. A person with conduction hearing loss, such as from otosclerosis or otitis media, hears the sound better in the affected ear. A person with sensorineural hearing loss, resulting from damage to the cochlear or vestibulocochlear nerve, hears the sound in the better-hearing ear.
Weber Test
Incision in the tympanic membrane
myringotomy (ie, tympanotomy)
Involuntary rhythmic eye movement
nystagmus
loss of hearing related to damage of the end organ for hearing or cranial nerve VIII, or both
sensorineural hearing loss
Refers to the # of sound waves emanating from a source per second, measured as cycles per second, of Hertz (Hz). The normal human ear perceives sound ranging in frequency from 20 to 20,000 Hz. Speech range: 500 to 2000 Hz
Frequency
is nonorganic and unrelated to detectable structural changes in the hearing mechanisms; it is usually a manifestation of a emotional disturbance
Functional (or psychogenic) hearing loss
Use a low-tone, normal voice Speak slowly & distinctly Reduce background noises & distractions Face person & get their attention Speak into less impaired ear Use gestures & facial expressions If necessary, write out the info or use a sign language translator
Guidelines for communication with the hearing impaired
Can also trigger changes in attitude, the ability to communicate, the awareness of surroundings, and even the ability to protect oneself, affecting a person's qualify of life.
Hearing Impairment
The surgical reconstruction of the middle ear bones to restore hearing. Prostheses made of materials such as Teflon, stainless steel, and hydroxyapatite are used to reconnect the ossicles, thereby reestablishing the sound conduction mechanism.
Ossiculoplasty
Sensation of fullness or pain in the ear
Otalgia
Inflammation of the external auditory canal
Otitis externa (ie, external otitis)
Drainage from the ear
Otorrhea
A condition characterized by abnormal spongy bone formation around the stapes
Otosclerosis
Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis
Pathogens that usually cause AOM
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?
"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."
Tympanoplasty Ossiculoplasty mastoidectomy
3 Types of Middle Ear Surgery
Cochlea Semicircular canals Cranial Nerve VII (Facial nerve) Cranial Nerve VIII (Vestibulocochlear nerve)
Anatomy of the Inner Ear
Tympanic membrane Otic capsule Ossicles: malleus, incus, and stapes
Anatomy of the Middle Ear
Small, hard, bony protrusions in the lower posterior bony portion of the ear canal
AExostoses
Antibiotic therapy Surgery - Myringotomy or tympanotomy
AOM
Drainage from the ear fever Hearing loss Tympanic membrane is erythematous and often bulging No pain with movement of auricle usually children
AOM
Inflammation in the middle ear lasting less than 6 weeks
Acute Otitis Media
An acute infection of the middle ear, usually lasting less than 6 weeks.
Acute Otitis Media (AOM)
______ Conduction is the more efficient pathway for hearing.
Air
Sounds travel over the air-filled external and middle ear through vibration of the tympanic membrane and ossicles.
Air Conduction
Hearing is conducted over 2 pathways
Air and Bone
An ingrowth oft the skin of the external layer of the eardrum into the middle ear.
Cholesteatoma
Differentiated conduction from sensorineural hearing loss
Audiogram
The patient wears earphones and signals to the audiologist when a tone is heard. When the tone is applied directly over the external auditory canal, air conduction is measured. When the stimulus is applied to the mastoid bone, bypassing the conduction mechanism (the ossicles), nerve conduction is tested. Soundproof room Responses plotted on a graph (audiogram)
Audiometry
Is a detectable electrical potential from cranial nerve VIII and the ascending auditory pathways of the brain stem in response to sound stimulation. Electrodes on pt's forehead Acoustic stimuli (clicks) in ear Results determine at which decibel level a pt hears and whether there are any impairments along the nerve pathways (tumors on cranial nerve VIII)
Auditory Brain Stem Response
Composed mainly of cartilage, except for the fat and subcutaneous tissue in the earlobe. Collects the sound waves and directs vibrations into the external auditory canal.
Auricle
Tumor of the middle ear or mastoid, or both, that can destroy structures of the temporal bone
Cholesteatoma
Sounds travel directly through bone to the inner ear, bypassing the tympanic membrane and ossicles.
Bone conduction
Partial or complete loss of the ability to hear
Deafness
Altered sensation of orientation in space
Dizziness
Tinnitus Increasing inability to hear when in a group Need to turn up the volume of the television
Early manifestations of hearing impairment and loss
Shunting, this procedure theoretically equalizes the pressure in the endolymphatic space. A shunt or drain is inserted in the endolymphatic sac through a postauricular incision.
Endolymphatic Sac Decompression
Dilation of the endolymphatic space of the inner ear; the pathologic correlate of Meniere's disease
Endolymphatic hydrops
______________ _______, a dilation in the endolymphatic space, develops, and either increased pressure in the system or rupture of the inner ear membrane occurs, producing symptoms of Meniere's disease.
Endolymphatic hydrops
The unit for measuring loudness is the decibel (dB), the pressure exerted by sound. Hearing loss is measured in decibels, a logarithmic function of intensity that is not easily converted into a percentage. Critical level of loudness is approx 30dB. Shuffling of papers is 15 dB A low conversation is 40 dB A jet plan 100 ft away, about 150 dB Sound louder than 80 dB is perceived by the human ear to be harsh and can be damaging to the inner ear.
Intensity
An inflammation of the inner ear, can be bacterial or viral in origin. Bacterial is rare bc of antibiotic therapy The infection can spread to the inner membranes of the oval or round windows.
Labyrinthitis
Inflammation of the labyrinth of the inner ear
Labyrinthitis
Objectives of this surgery is to remove the cholesteatoma, gain access to disease structures, and create a dry (non infected) and healthy ear. If possible, the ossicles are reconstructed during the initial surgical procedure. Success rate for correcting this conductive hearing loss is approx 75%. Facial nerve is at some risk for injury during surgery
Mastoidectomy
Local tx consists of careful suctioning of the ear under otoscopic guidance. Instillation of antibiotic drops or application of antibiotic powder to tx purulent discharge. Systemic antibiotics are prescribed only in cases of acute infection
Medical Management of Chronic Otitis Media
Relieving the discomfort Reducing the swelling of the ear canal Eradicating the infection
Medical Management of External Otitis
Can be successfully treated with diet & medication. Many pts can control their symptoms by adhering to a low-sodium (100 0 to 1500) diet.
Medical Management of Meniere's Disease
An abnormal inner ear fluid balance caused by malabsorptionn in the endolymphatic sac or a blockage in the endolymphatic duct.
Meniere's Disease
Condition of the inner ear characterized by a triad of symptoms: episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss
Meniere's disease
Performed safely and effectively as an office procedure to evaluate suspected perilymphatic fistula and new-onset conductive hearing loss, the anatomy of the round window before transtympanic treatment os Meniere's disease, and the tympanic cavity before ear surgery to treat chronic middle ear and mastoid infections.
Middle Ear Endoscopy
fluid in the middle ear without evidence of infection
Middle ear effusion
Pts with this have conductive loss and sensorineural loss, resulting from dysfunction of air and bone conduction.
Mixed hearing loss
Surgical reconstruction of the middle ear bones to restore hearing
Ossiculoplasty
Used to investigate postural control capabilities such as vertigo. It can be used to evaluate if a person's vertigo is becoming worse or to evaluate the person's response to treatment. Pt stands on a platform, surrounded by a screen, and different conditions such as a moving platform with a moving screen or a stationary platform with a moving screen are presented.
Platform Posturography
Any vestibular suppressants, such as sedatives, tranquilizers, antihistamines, and alcohol, are withheld for 24 hours before testing.
Prep for Electronystagmography, Platform Posturography, Sinusoidal Harmonic Acceleration,
Progressive hearing loss associated with aging
Presbycusis
The sound stimulus consists of a pure or musical tone The louder the tone before the patient perceives it, the greater the hearing loss
Pure-tone audiometry
Drainage from the nose
Rhinorrhea
Useful for distinguishing between conductive and sensorineural hearing loss. A person with normal hearing reports that air-conducted sound is louder than bone-conducted sound. A person with conductive hearing loss hears bone-conducted sound as long as or longer than air-conducted sound. A person with a sensorineural hearing loss hears air-conducted sound longer than bone-conducted sound.
Rinne Test
Family history of sensorineural impairment Congenital malformations of the cranial structure Low birth weight (<1500 g) Use of ototoxic medications (eg, gentamycin, loop diuretics) Recurrent ear infections Bacterial meningitis Chronic exposure to loud noises Perforation of the tympanic membrane
Risk Factors for Hearing Loss
Balance
Semicircular canals
Involves damage to the cochlea or vestibulocochlear nerve.
Sensorineural loss
Involves fluid without evidence of active infection, in the middle earl.
Serous Otitis Media (middle ear effusion)
Used to assess the vestibulo-ocular system by analyzing compensatory eye movements in response to the clockwise and counterclockwise rotation of the chair. Helps identify disease (eg, Meniere's disease and tumors of the auditory canal) and evaluate the course of recovery.
Sinusoidal Harmonic Acceleration
The spoken word is used to determine the ability to hear and discriminate sounds and words.
Speech Audiometry
Auricle (pinna) External auditory canal Separated from the middle ear by the tympanic membrane (eardrum)
Structures of the External Ear
Endolymphatic Sac Decompression Vestibular Nerve Sectioning
Surgical Management for Meniere's Disease
Also called the end organ of hearing It transforms mechanical energy into neural activity and separates sounds into different frequencies
The organ of Corti
Irrigation Suction Instrumentation
Three Standards for removing foreign bodies and cerumen from the ear
A symptom of an underlying disorder of the ear that is associated with hearing loss. Severity may range from mild to severe. Patients describe it as a roaring, buzzing, or hissing sound in one or both ears.
Tinnitus
subjective perception of sound with internal origin; unwanted noises in the head or ear
Tinnitus
IV antibiotic therapy Fluid replacement Administration of an antihistamine (eg, Antivert) and antiemetic medications
Treatment of Bacterial Labyrinithitis
Occupations such as carpentry, plumbing, and coal mining have the highest risk of noise-induced hearing loss.
True
About 1 cm in diameter and very thin, is normally pearly gray and translucent. It protects the middle ear and conducts sound vibrations from the external canal to the ossicles.
Tympanic Membrane Eardrum
Pain Lots of drainage
Tympanic Membrane Perforation
usually caused by infection or trauma Skull fracture Explosive injury Severe blow to the ear Most perforations heal spontaneously within weeks after rupture, some may take several months to heal.
Tympanic Membrane Perforation
Measures middle ear muscle reflex to sound stimulation & compliance of the tympanic membrane by changing the air pressure in a sealed ear canal. Compliance is compared with middle ear.
Tympanogram
Most common surgery for chronic otitis media. Surgical reconstruction of the tympanic membrane. Purpose - reestablish middle ear function, close the perforation, prevent recurrent infection, and improve hearing. Outpatient Moderate sedation or general anesthesia
Tympanoplasty
Surgical repair of the tympanic membrane
Tympanoplasty
Surgical repair of the tympanic membrane
Tympanoplasy
