Chapter 59: Assessment and Management of Patients With Hearing and Balance Disorders
A client is being prepared for a cochlear implant. Which client statement would alert the nurse to the need for additional teaching? a) "I'll be able to hear medium and loud sounds for once." b) "I'll wear an external transmitter and microphone." c) "I'll have a small incision behind my ear." d) "I'm going to be able to hear normally again."
"I'm going to be able to hear normally again." Explanation: 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 is being discharged home after surgery involving the middle ear. Which of the following client statements demonstrates understanding of the instructions? a) "I need to report any crackling sounds in my affected ear to the physician right away." b) "If I sneeze or cough during the first few weeks, I should keep my mouth open." c) "After the first 48 hours, I can bend over to pick things up if I need to." d) "I need to wait at least 1 week before washing my hair so that water doesn't enter my ear."
"If I sneeze or cough during the first few weeks, I should keep my mouth open." * After middle ear surgery, the client needs to sneeze or cough with an open mouth for a few weeks after surgery, wait 2 to 3 days to shampoo the hair (making sure that the ear is protected), and avoid bending at the waist, straining or lifting heavy objects for a few weeks. Poppling or crackling sounds or sensations in the operative ear are normal for the first 3 to 5 weeks after surgery.
Self-Care After Middle Ear or Mastoid Surgery
- Avoid nose blowing for 2-3 weeks after surgery. - Sneeze and cough with the mouth open for a few weeks after surgery. - Avoid heavy lifting (>10 pounds), straining, and bending over for a few weeks after surgery. - Be aware that popping and crackling sensations in the operative ear are normal for approximately 3-5 weeks after surgery. - Note that temporary hearing loss is normal in the operative ear due to fluid, blood, or packing in the ear. - Avoid getting water in the operative ear for 2 weeks after surgery. - You may shampoo the hair 2-3 days postoperatively if the ear is protected from water by saturating a cotton ball with petrolatum jelly (or some other water-insoluble substance) and loosely placing it in the ear.
Meniere's disease management
- diet and medication - low-sodium diet (1,000 to 1,500 mg/day or less) * Sodium and fluid retention disrupts the delicate balance between endolymph and perilymph in the inner ear
Meniere's disease manifestation
- fluctuating, progressive hearing loss - tinnitus - feeling of pressure or fullness - episodic, incapacitating vertigo that may be accompanied by nausea and vomiting
Reduce complications following middle ear surgery by
- not blowing the nose or getting water in the operative ear for 2-3 weeks - keeping the mouth open when sneezing or coughing, not lifting (>10 lbs), bending or straining - promptly reporting excessive purulent ear drainage
A patient is postoperative day 6 following tympanoplasty and mastoidectomy. The patient has phoned the surgical unit and states that she is experiencing occasional sharp, shooting pains in her affected ear. How should the nurse best interpret this patient's complaint? A) These pains are an expected finding during the first few weeks of recovery. B) The patient's complaints are suggestive of a postoperative infection. C) The patient may have experienced a spontaneous rupture of the tympanic membrane. D) The patient's surgery may have been unsuccessful.
A *For 2 to 3 weeks after surgery, the patient may experience sharp, shooting pains intermittently BECAUSE the eustachian tube opens and allows air to enter the middle ear. *Infection = Constant, throbbing pain accompanied by fever, and should be reported to the primary care provider. * The patient's pain does not suggest tympanic perforation
The nurse is providing discharge education for a patient with a new diagnosis of Ménière's disease. What food should the patient be instructed to limit or avoid? A) Sweet pickles B) Frozen yogurt C) Shellfish D) Red meat
A *The patient with MÈniËre's disease should avoid foods high in salt and/or sugar; sweet pickles are high in both.
A patient diagnosed with arthritis has been taking aspirin and now reports experiencing tinnitus and hearing loss. What should the nurse teach this patient? A) The hearing loss will likely resolve with time after the drug is discontinued. B) The patient's hearing loss and tinnitus are irreversible at this point. C) The patient's tinnitus is likely multifactorial, and not directly related to aspirin use. D) The patient'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
The nurse in the ED is caring for a 4 year-old brought in by his parents who state that the child will not stop crying and pulling at his ear. Based on information collected by the nurse, which of the following statements applies to a diagnosis of external otitis? A) External otitis is characterized by aural tenderness. B) External otitis is usually accompanied by a high fever. C) External otitis is usually related to an upper respiratory infection. D) External otitis can be prevented by using cotton-tipped applicators to clean the ear.
A Patients with otitis externa usually exhibit pain, discharge from the external auditory canal, and aural tenderness. *Otitis Media: Fever and accompanying upper respiratory infection *Cotton-tipped applicators can actually cause external otitis so their use should be avoided
The nurse is discussing the results of a patient's diagnostic testing with the nurse practitioner. What Weber test result would indicate the presence of a sensorineural loss? A) The sound is heard better in the ear in which hearing is better. B) The sound is heard equally in both ears. C) The sound is heard better in the ear in which hearing is poorer. D) The sound is heard longer in the ear in which hearing is better.
A (A patient whose Sensorineural hearing loss is conductive hears the sound better in the affected ear.)
A patient with mastoiditis is admitted to the post-surgical unit after undergoing a radical mastoidectomy. The nurse should identify what priority of postoperative care? A) Assessing for mouth droop and decreased lateral eye gaze B) Assessing for increased middle ear pressure and perforated ear drum C) Assessing for gradual onset of conductive hearing loss and nystagmus D) Assessing for scar tissue and cerumen obstructing the auditory canal
A (The facial nerve runs through the middle ear and the mastoid; therefore, there is risk of injuring this nerve during a mastoidectomy. When injury occurs, the patient may display mouth droop and decreased lateral gaze on the operative side)
A hearing-impaired patient is scheduled to have an MRI. What would be important for the nurse to remember when caring for this patient? A) Patient is likely unable to hear the nurse during test. B) A person adept in sign language must be present during test. C) Lip reading will be the method of communication that is necessary. D) The nurse should interact with the patient like any other patient.
A (The healthy tympanic membrane appears pearly gray and is positioned obliquely at the base of the ear canal)
The advanced practice nurse is attempting to examine the patient's ear with an otoscope. Because of impacted cerumen, the tympanic membrane cannot be visualized. The nurse irrigates the patient's ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. What nursing intervention is most important to minimize nausea and vertigo during the procedure? A) Maintain the irrigation fluid at a warm temperature. B) Instill short, sharp bursts of fluid into the ear canal. C) Follow the procedure with insertion of a cerumen curette to extract missed ear wax. D) Have the patient stand during the procedure.
A (Warm water = prevent nausea) *Instill gentle = prevent damage eardrum *Cerumen curette is removed by HCP
A mother brings her daughter to the clinic for an evaluation because the child is complaining of ear pain. Which of the following would lead the nurse to suspect that the child is experiencing otitis externa and not otitis media? a. Fever b. bulging eardrum c. Ear drainage d. Aural tenderness
A client with otitis externa typically experiences aural tenderness. This finding is usually absent in clients with otitis media. * Fever and ear drainage may be present with either otitis externa or otitis media. * A bulging eardrum would suggest otitis media.
The nurse is providing care for a patient who has benefited from a cochlear implant. The nurse should understand that this patient's health history likely includes which of the following? Select all that apply. A) The patient was diagnosed with sensorineural hearing loss. B) The patient's hearing did not improve appreciably with the use of hearing aids. C) The patient has deficits in peripheral nervous function. D) The patient's hearing deficit is likely accompanied by a cognitive deficit. E) The patient is unable to lip-read.
A,B *Hearing aid not work -> Cochlear implant
Ménière's Disease
Abnormal inner ear fluid balance cause by malabsorption of the endolymphatic sac or blockage of the endolymphatic duct
___________ testing is done in a sound proof room and is the single most important diagnostic test for detecting hearing loss
Audiometry
A patient is scheduled to have an electronystagmography as part of a diagnostic workup for Ménière's disease. What question is it most important for the nurse to ask the patient in preparation for this test? A) Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces? B) Do you currently take any tranquilizers or stimulants on a regular basis? C) Do you have a history of falls or problems with loss of balance? D) Do you have a history of either high or low blood pressure?
B *Electronystagmography measures changes in electrical potentials created by eye movements during induced nystagmus. Medications such as tranquilizers, stimulants, or antivertigo agents are withheld for 5 days before the tes *Balance is impaired by MÈniËre's disease; therefore, a patient history of balance problems is important, but is not relevant to test preparation. *Hypertension or hypotension, while important health problems, should not be affected by this test.
A group of high school students is attending a concert, which will be at a volume of 80 to 90 dB. What is a health consequence of this sound level? A) Hearing will not be affected by a decibel level in this range. B) Hearing loss may occur with a decibel level in this range. C) Sounds in this decibel level are not perceived to be harsh to the ear. D) Ear plugs will have no effect on these decibel levels.
B *Sounds louder than 80 dB will damage inner ear
A nurse is planning preoperative teaching for a patient with hearing loss due to otosclerosis. The patient is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the patient's preoperative teaching? A) The procedure is an effective, time-tested treatment for sensory hearing loss. B) The patient is likely to experience resolution of conductive hearing loss after the procedure. C) Several months of post-procedure 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
A patient has undergone diagnostic testing and has been diagnosed with otosclerosis? What ear structure is primarily affected by this diagnosis? A) Malleus B) Stapes C) Incus D) Tympanic membrane
B Otosclerosis = Stapes fixation
The nurse is admitting a patient to the unit who is scheduled to have an ossiculoplasty. What postoperative assessment will best determine whether the procedure has been successful? A) Otoscopy B) Audiometry C) Balance testing D) Culture and sensitivity testing of ear discharge
B (Ossiculoplasty is the surgical reconstruction of the middle ear bones to restore hearing) *Otoscopy: visualize the ear *Audiometry: testing hearing
The nurse is caring for a patient who has undergone a mastoidectomy. In an effort to prevent postoperative infection, what intervention should the nurse implement? A) Teach the patient about the risks of ototoxic medications. B) Instruct the patient to protect the ear from water for several weeks. C) Teach the patient to remove cerumen safely at least once per week. D) Instruct the patient to protect the ear from temperature extremes until healing is complete.
B (To prevent infection, the patient 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.)
The nurse is planning the care of a patient who is adapting to the use of a hearing aid for the first time. What is the most significant challenge experienced by a patient 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 (amplification of background noise is a difficult problem to manage and is the major reason why patients stop using their hearing aid. )
A 6-month-old infant is brought to the ED by his parents for inconsolable crying and pulling at his right ear. When assessing this infant, the advanced practice nurse is aware that the tympanic membrane should be what color in a healthy ear? A) Yellowish-white B) Pink C) Gray D) Bluish-white
C
Which of the following nursing interventions would most likely facilitate effective communication with a hearing-impaired patient? A) Ask the patient to repeat what was said in order to evaluate understanding. B) Stand directly in front of the patient to facilitate lip reading. C) Reduce environmental noise and distractions before communicating. D) Raise the voice to project sound at a higher frequency.
C *Asking the patient to repeat what was said is likely to provoke frustration in the patient. A more effective strategy would be to repeat the question or statement, choosing different words. *The nurse cannot assume that the patient reads lips. If the patient does read lips, on average he or she will understand only 50% of words accurately.
A patient has been diagnosed with hearing loss related to damage of the end organ for hearing or cranial nerve VIII. What term is used to describe this condition? A) Exostoses B) Otalgia C) Sensorineural hearing loss D) Presbycusis
C *Exostoses refer to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. *Otalgia = ear pain *Presbycusis is the term used to refer to the progressive hearing loss associated with aging. Atrophy of Cochlear
A patient is being discharged home after mastoid surgery. What topic should the nurse address in the patient's discharge education? A) Expected changes in facial nerve function B) The need for audiometry testing every 6 months following recovery C) Safe use of analgesics and antivertiginous agents D) Appropriate use of OTC ear drops
C ( Patients require instruction about medication therapy, such as analgesics and antivertiginous agents (e.g., antihistamines) prescribed for balance disturbance. OTC ear drops are not recommended and changes in facial nerve function are signs of a complication that needs to be addressed promptly. There is no need for serial audiometry testing. )
A patient has been diagnosed with serous otitis media for the third time in the past year. How should the nurse best interpret this patient's health status? A) For some patients, these recurrent infections constitute an age-related physiologic change. B) The patient would benefit from a temporary mobility restriction to facilitate healing. C) The patient needs to be assessed for nasopharyngeal cancer. D) Blood cultures should be drawn to rule out a systemic infection.
C (A carcinoma (e.g., nasopharyngeal cancer) obstructing the eustachian tube should be ruled out in adults with persistent unilateral serous otitis media. )
A child goes to the school nurse and complains of not being able to hear the teacher. What test could the school nurse perform that would preliminarily indicate hearing loss? A) Audiometry B) Rinne test C) Whisper test D) Weber test
C (A general estimate of hearing can be made by assessing the patient's ability to hear a whispered phrase or a ticking watch, testing one ear at a time) * Audiometry: HCP do it *Rinnie test, Whisper test: conductive sensorineural
An older adult with a recent history of mixed hearing loss has been diagnosed with a cholesteatoma. What should this patient 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.
You are teaching the daughter how to instill ear drops of her father to remove impacted cerumen. What is a priority action to teach this woman? a) Insert the irrigating syringe deeply. b) Refrigerate before instillation. c) Place the container in warm water before instillation. d) Direct the flow of the ear drops toward the eardrum.
C. If irrigation or instillation of liquids is ordered, the nurse should warm the liquid to body temperature by placing the container in warm water. Cold or hot liquids cause dizziness, and the potential for injury exists if the liquid is hot. * The nurse should avoid inserting the irrigating syringe too deeply so as not to close off the auditory canal. * The nurse should direct the flow toward the roof of the canal, rather than the eardrum.
Osteoclerosis
Common cause of conductive hearing loss in young adults between the ages of 20-40 years. Gradual hardening that causes the footplate of the stapes to become fixed in the oval window
A patient presents to the ED complaining of a sudden onset of incapacitating vertigo, with nausea and vomiting and tinnitus. The patient mentions to the nurse that she suddenly cannot hear very well. What would the nurse suspect the patient's diagnosis will be? A) Ossiculitis B) Ménière's disease C) Ototoxicity D) Labyrinthitis
D *Labyrinthitis is characterized by a SUNDDEN onset of incapacitating vertigo, usually with nausea and vomiting, various degrees of hearing loss, and possibly tinnitus.
Which of the following nurse's actions carries the greatest potential to prevent hearing loss due to ototoxicity? A) Ensure that patients understand the differences between sensory hearing loss and conductive hearing loss. B) Educate patients about expected age-related changes in hearing perception. C) Educate patients about the risks associated with prolonged exposure to environmental noise. D) Be aware of patients' medication regimens and collaborate with other professionals accordingly.
D *aspirin and quinine, cause irreversible hearing loss.
On otoscopy, a red blemish behind the tympanic membrane is suggestive of what diagnosis? A) Acoustic tumor B) Cholesteatoma C) Facial nerve neuroma D) Glomus tympanicum
D *In the case of glomus tympanicum, a red blemish on or behind the tympanic membrane is seen on otoscopy.
The nurse is reviewing the health history of a newly admitted patient and reads that the patient has been previously diagnosed with exostoses. How should the nurse accommodate this fact into the patient's plan of care? A) The nurse should perform the Rinne and Weber tests. B) The nurse should arrange for audiometry testing as soon as possible. C) The nurse should collaborate with the pharmacist to assess for potential ototoxic medications. D) No specific assessments or interventions are necessary to addressing exostoses.
D *Exostoses are small, hard, bony protrusions found in the lower posterior bony portion of the ear canal; they usually occur bilaterally. They do not normally impact hearing and no treatments or nursing actions are usually necessary.
A patient with a sudden onset of hearing loss tells the nurse that he would like to begin using hearing aids. The nurse understands that the health professional dispensing hearing aids would have what responsibility? A) Test the patient's hearing promptly. B) Perform an otoscopy. C) Measure the width of the patient's ear canal. D) Refer the patient to his primary care physician.
D (Health care professionals who dispense hearing aids are required to refer prospective users to a physician if the patient has sudden or rapidly progressive hearing loss. This would be a health priority over other forms of assessment, due to the possible presence of a pathologic process.)
A nurse is teaching preventative measures for otitis externa to a group of older adults. What action should the nurse encourage? A) Rinsing the ears with normal saline after swimming B) Avoiding loud environmental noises C) Instilling antibiotic ointments on a regular basis D) Avoiding the use of cotton swabs
D (Nurses should instruct patients not to clean the external auditory canal with cotton-tipped applicators and to avoid events that traumatize the external canal such as scratching the canal with the fingernail or other objects. Environmental noise should be avoided, but this does not address the risk for ear infection. Routine use of antibiotics is not encouraged and rinsing the ears after swimming is not recommended.)
After mastoid surgery, an 81-year-old patient has been identified as needing assistance in her home. What would be a primary focus of this patient's home care? A) Preparation of nutritious meals and avoidance of contraindicated foods B) Ensuring the patient receives adequate rest each day C) Helping the patient adapt to temporary hearing loss D) Assisting the patient with ambulation as needed to avoid falling
D (The Epley maneuver is performed by placing the patient in a sitting position, turning the head to a 45-degree angle on the affected side, and then quickly moving the patient to the supine position. Saline is not instilled into the ears and there is no need to assess hearing before the test.)
Following a motorcycle accident, a 17-year-old man is brought to the ED. What physical assessment findings related to the ear should be reported by the nurse immediately? A) The malleus can be visualized during otoscopic examination. B) The tympanic membrane is pearly gray. C) Tenderness is reported by the patient when the mastoid area is palpated. D) Clear, watery fluid is draining from the patient's ear.
D (cerebrospinal fluid associated with skull fracture). *The ability to visualize the malleus (ossicle bone) is a normal physical assessment finding. *The tympanic membrane is normally pearly gray in color. *Tenderness of the mastoid area usually indicates inflammation but NOT emergency
A child has been experiencing recurrent episodes of acute otitis media (AOM). The nurse should anticipate that what intervention is likely to be ordered? A) Ossiculoplasty B) Insertion of a cochlear implant C) Stapedectomy D) Insertion of a ventilation tube
D Eustachian tube = air pressure (If AOM recurs and there is no contraindication, a ventilating, or pressure-equalizing, tube may be inserted. The ventilating tube, which temporarily takes the place of the eustachian tube in equalizing pressure, is retained for 6 to 18 months. ) *cochlear implant => sensorineural hearing loss
The nurse is discharging a patient 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 patient 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
The clinic nurse is assessing a child who has been brought to the clinic with signs and symptoms that are suggestive of otitis externa. What assessment finding is characteristic of otitis externa? A) Tophi on the pinna and ear lobe B) Dark yellow cerumen in the external auditory canal C) Pain on manipulation of the auricle D) Air bubbles visible in the middle ear
Pain on manipulation of the auricle Otitis Externa: infection of outer ear --- PAIN is most sx *Tophi are deposits of generally painless uric acid crystals; they are a common physical assessment finding in patients diagnosed with gout (chai chan^) *Air bubbles in the middle ear may be visualized with the otoscope; however, these do not indicate a problem involving the ear canal.
Epley maneuver
Series of head movements to relieve symptoms of benign positional vertigo
ankylosis
abnormal condition of stiffness
presbycusis
age related hearing loss
Acoustic neuroma
benign tumor on the auditory nerve (8th cranial nerve) that causes vertigo, tinnitus, and hearing loss
Which precaution should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance? a. Encourage the client to move the head slowly b. Restrict the client from focusing on one spot c. Have the client wait for help before moving d. Recommend that the client keep his or her eyes closed
c. * 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.
Labyrinthitis
inflammation of the labyrinth
Otoscope
instrument for examining the ear
nystagmus
involuntary, jerking movements
Ataxia
lack of muscle coordination
The Eustachian tube connects the _________ to the middle ear and opens with yawning, swallowing or the Valsalva maneuver
nasopharynx
The Eustachian tube connects the ____________ to the middle ear and opens with yawning, swallowing or the Valsalva maneuver
nasopharynx
organ of Corti ear
organ located in the cochlea; contains receptors (hair cells) that receive vibrations and generate nerve impulses for hearing
Barotrauma
pressure-related ear condition
Tympanogram
record of middle ear function (presented in graph form)
Air conduction is the more efficient pathway. true or false?
true
Reports of crackling and popping sounds in the ear and a temporary loss of hearing following middle ear surgery are normal
true
What separates the external from the middle ear?
tympanic membrane
Rinne test
useful for distinguishing between conductive hearing loss or sensorineural hearing loss. •AC is greater than BC in normal hearing
Following mastoid surgery the patient asks about showering. How should the nurse respond?
•No water should be allowed to enter the ear for 2 wks. •OK to shampoo or shower 2 - 3 days after surgery as long as the affected ear is protected from water. •Saturate cotton ball with petrolatum jelly and place loosely into the ear.
What are the primary, secondary, and tertiary roles of nursing in regards to hearing?
•Primary promote and educate the public on activities that preserve hearing and balance •Secondary - screen individuals for hearing loss, balance disorders - assist with accurate diagnosis •Tertiary - assist individuals with managing hearing or balance disorders oimprove outcomes. o •Aural rehab ohelps to maximize communication skills in individuals with hearing impairment
A client is scheduled for surgery to remove an acoustic neuroma. The nurse observes the client crying and stating "I don't want to die". How should the nurse respond?
•Respond to the client in a way that shows empathy (understanding). •Ask the patient what they were informed and know about the surgery. •Allow the patient to discuss how they feel. •The nurse should know that death from acoustic neuroma surgery is rare.
Which clinical manifestations are associated with hearing loss?
•Tinnitus •Increased inability to hear in a group •Turning up the volume on the TV •Fatigue:
momost troublesome complaint related to Ménière's disease
•Vertigo
What are some of the causes of conductive hearing loss?
•perforated TM •hardening of the ossicles •cerumen blocking ear canal
What surgical procedures are used to correct disorders of the middle ear?
•tympanoplasty •ossiculoplasty •mastoidectomy
Weber test hearing
•uses BONE conduction to test lateralization of sound •useful for detecting unilateral hearing loss •The sound should be heard equally in both ears * conductive hearing loss hear the sound better in the affected ear * sensorineural hearing loss hear the sound better in the unaffected hear
The nurse is assessing a patient with multiple sclerosis who is demonstrating involuntary, rhythmic eye movements. What term will the nurse use when documenting these eye movements? A) Vertigo B) Tinnitus C) Nystagmus D) Astigmatism
C
The nurse is planning the care of a patient with a diagnosis of vertigo. What nursing diagnosis risk should the nurse prioritize in this patient's care? A) Risk for disturbed sensory perception B) Risk for unilateral neglect C) Risk for falls D) Risk for ineffective health maintenance
C
When assessing unilateral hearing loss with the Weber test, sound is heard better in the affected ear with ______ deafness and in the unaffected ear with __________deafness
conductive sensorineural
Labyrinthitis treatment
- IV antibiotic therapy - fluid replacement - administration of an antihistamine ( meclizine and antiemetic medications )
What is the function of the eustachian tube?
1) ventilation of the middle ear so that ambient pressure and middle ear pressure are similar 2) protection of the middle ear from reflux of nasopharyngeal secretions and bacterial flora 3) drainage of secretions from the middle ear into the nasopharynx
A patient with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the patient? A) Sit or stand in front of the patient 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 patient's name loudly before starting to talk
A
bulging eardrum is caused by
A bulging eardrum would suggest otitis media.
The nurse and a colleague are performing the Epley maneuver with a patient who has a diagnosis of benign paroxysmal positional vertigo. The nurses should begin this maneuver by performing what action? A) Placing the patient in a prone position B) Assisting the patient into a sitting position C) Instilling 15 mL of warm normal saline into one of the patient's ears D) Assessing the patient's baseline hearing by performing the whisper test
B
While reviewing the health history of an older adult experiencing hearing loss the nurse notes the patient has had no trauma or loss of balance. What aspect of this patient's health history is most likely to be linked to the patient's hearing deficit? A) Recent completion of radiation therapy for treatment of thyroid cancer B) Routine use of quinine for management of leg cramps C) Allergy to hair coloring and hair spray D) Previous perforation of the eardrum
B (quinne: herbs) *Radiation therapy for cancer should not affect hearing * Allergy to hair products may be associated with otitis externa; *Recurrent otitis media with perforation can affect hearing as a result of chronic inflammation of the ossicles in the middle ear.
Audiometry confirms a client's chronic progressive hearing loss. Further investigation reveals ankylosis of the stapes in the oval window, a condition that prevents sound transmission. This type of hearing loss is called:
Conductive hearing loss results from interference with the conduction of sound waves (sound transmission) from the tympanic membrane to the inner ear. * The stapes must move freely for sound to be transmitted. Bone tissue overgrowth causes the stapes to become fixed or immobile (ankylosed) in the oval window, preventing sound transmission.
How do organisms in the oropharynx (back of throat) infect the middle ear?
Organisms can travel through the Eustachian tube.
Otalgia
Otalgia is a sensation of fullness or pain in the ear.
How should the nurse respond to a patient who complains of a disturbance in the way food tastes after middle ear surgery?
Patients experience a taste disturbance and dry mouth on the side of surgery for several months until the nerve regenerates
How should the nurse irrigate the ear?
Remove cerumen using warm water (cold stimulates vomiting) and a gentle irrigation in order to avoid perforating the tympanic membrane
The _____________ test assesses both air and bone conduction of sound.
Rinne test
A patient is receiving long term vancomycin for a bone infection. What toxic effect is the patient at risk for in regarding to hearing?
Risk for ototoxicity
During his annual physical examination, a retired airplane mechanic reports noticeable hearing loss. The nurse practitioner prescribes a series of hearing tests to confirm or rule out noise-induced hearing loss, which is classified as a:
Sensorineural loss. - noise-induced hearing loss refers to hearing loss that follows a long period of exposure to loud noise. It is inherent in jobs that involve heavy machinery, noisy engines, and artillery.
otolaryngologists.
Specialize in the ear, nose, and throat.
Conductive hearing loss, such as from otosclerosis or otitis media, When performing the Weber test the sound lateralizes toward the affected ear
TRUE
Canalith Repositioning Maneuver
The canalith repositioning procedure can treat benign paroxysmal positional vertigo (BPPV), which causes dizziness when you move your head. The procedure consists of head maneuvers that move particles in your inner ear (otoconia) — which cause dizziness — to a part of your ear where they won't.
following a ear surgery the nurse tells the family
The caregiver and patient are cautioned that the patient may experience some vertigo and will therefore require help with ambulation to avoid falling
What cranial nerve complication should the nurse assess for following surgery?
VII - facial nerve damage VII- hearing loss
vertigo
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.
Serous otitis media
a fluid buildup in the middle ear that can follow acute otitis media or can be caused by obstruction of the Eustachian tube
What is the function and the structure of the membranous labyrinth?
a system of ducts and dilatations located within the bony labyrinth of the internal ear and it contains the receptors for hearing and balance.
What would happen if the tympanic membrane was injured?
could impair hearing
A client is receiving long-term intravenous therapy with gentamicin for a chronic wound infection. Which of the following would be most important for the nurse to ensure? a. Monitor complete blood counts every other day. b. Assess intravenous access site daily. c. d. Obtain specimens for wound cultures daily. Arrange for audiograms twice a week.
rrange for audiograms twice a week.
healthy tympanic membrane
translucent, pearly gray
A cochlear implant is an auditory prosthesis used for people with profound sensorineural hearing loss bilaterally who do not benefit from conventional hearing aids
true
