Ears

Which instructions would the nurse give to the parents to prevent otitis externa in their child after every swim lesson? Select all that apply. "Put rubbing alcohol into your child's ears." "Rub your child's ears vigorously with a towel." "Instill 2% acetic acid into your child's ears." "Clean your child's ears with a cotton bud." "Place warm mineral oil in your child's ears.

"Put rubbing alcohol into your child's ears." "Instill 2% acetic acid into your child's ears."

Which response by the nurse would help a patient who is asking about tympanostomy tubes? "They remain in place forever." "They usually fall out in about 12 to 18 months." "They dissolve on their own within a year." "They will be surgically removed after 24 months."

"They usually fall out in about 12 to 18 months."

what is osteoclerosis?

-Gradual hardening of foot plate of stapes & become fixed in the oval window -Causes progressive deafness -a cause of conductive hearing loss in young adults between the ages of 20 and 40 years

Chondrodermatitis Nodularis Helicus

-Painful nodules develop on the rim of the helix as a result of repetitive mechanical pressure or environmental trauma -small red and defined

carcinoma

-Ulcerated, crusted nodule with indurated base that fails to heal. Bleeds intermittently -cancerous

what is mechanical dysfunction? what is it caused by?

-a conductive hearing loss involves a mechanical dysfunction of the external or middle ear -conductive hearing loss is may be caused by lots of earwax, tympanic membrane is burst, buildup of pus

what are some risks of developing Otis media (OM)?

-absence of breastfeeding in the first 3 months of age -preterm birth -exposure to secondhand smoke-smoking in the home -daycare attendance -male sex -pacifier use -seasonally -bottle feeding

what is the audiometric testing?

-battery powered hand held instrument -while patient is sitting prop his/her elbow up on the armrest and make a fist -raise your finger as soon as you hear the tone, lower your finger as soon as you dont hear the tone -each tone should be on for 1.5 seconds

sebaceous cyst

-behind lobule -black punctum indicates blocked sebaceous gland -filled with waxy sebaceous material -often in multiples

what happens to children when the lumen is occluded ? how do you fix this?

-child is a greater risk for middle ear infection -get a eustachian tube --> only do this until the age of 3

what happens to the ears of an aging adult?

-cilia lining of ears becomes coarse and stiff -presbycusis: hearing loss of aging caused by nerve degeneration

what subjective data would you find for the ear?

-earache -infections -discharge -hearing loss -environmental noise -tinnitus (ringing, roaring in ears) -vertigo -patient-centered care (how do you clean your ears?)

otis externa (swimmers ear)

-infection of the outer ear -severe painful movement of the pinna and tragus -hearing normal or slightly diminished -more common in hot humid weather

what is the bony labyrinth?

-inner ear -cavity in the temporal lobe -divided into 3 sections: vestibule, semicircular canals, cochlea -holds sensory organs for equillibrium and hearing -gives info to the brain about body's position in shape

What happens to elderly hearing?

-lose high frequency (whispering is high pitched) -difficulty to hear consonants -slowly progresses after the age of 50 -garbled -localization

What is sensorineural hearing loss? what are the causes?

-loss signifies pathology of the inner ear, cranial nerve VII, or the auditory areas of the cerebral cortex -presbycusis- hearing becomes less and less the older they get

what does the eustachian tube do and where does it go?

-normally is closed, but opens when you yawn, swallow/chew to maintain pressure -goes to the nasopharynx

what is the job of the middle ear?

-outer ear to the inner ear -Protects inner ear; reduces the amplitude of loud sounds -Eustachian tube equalizes air pressure on each side of the tympanic membrane so it does not rupture

keloid

-overgrowth of scar tissue -more common in dark pigmented people -common at lobule

when testing hearing acuity, what response should a newborn have? a 3-4 month old? 6-8 months? preschool and school aged?

-silent room, made a loud sudden noise like clapping or squeezing a toy newborn: startle (moro) reflex. acoustic blink reflex 3-4 months: acoustic blink reflex, infant stops moving and appears to listen, stops sucking, quiets if crying, cries if quiet 6-8 months: turns head to sound, responds to own name preschool/school-aged: screened with audiometry

tophi

-small, whitish nodules of uric acid -sign of gout

what are the 2 distinct types of cerumen? what races are they associated with?

-wet, honey-brown wax in Caucasians and African Americans -dry, flaky white wax in East Asians and American Indians

in children: Ears should be positioned within how many degrees vertically

10 degrees

a whisper is about how many decibels?

20 dB

How do we hear?

3 levels: 1. Peripheral: the ear transmits sound and converts its vibrations into electrical impulses, which can be analyzed by the brain 2. Brainstem: locates the source of sound and identifies the sound 3. Cerebral Cortex -interprets meaning of sound and do what is necessary

The auditory reaction time increases after age ___.

70

Battle sign

Bruising behind an ear over the mastoid process that may indicate a skull fracture.

How would the normal tympanic membrane appear during an otoscopic examination? Straight and pink Convex and slightly white Opaque and red Concave and pearly gray

Concave and pearly gray The tympanic membrane is concave with a pearly gray color. The tympanic membrane is oval, pulled in at its center and is not straight. The tympanic membrane is not convex or opaque; it is concave and translucent. The normal tympanic membrane is pearly gray, and is not pink, slightly white, or red in color.

Which finding would be common in a patient with sensorineural hearing loss? Cranial nerve VIII damage Foreign bodies in the ear Pus or serum in the middle ear Perforated tympanic membrane

Cranial nerve VIII damage

low set ears indicate?

Down syndrome

Which is the function of the eustachian tube in the middle ear? Promotes lubrication of the ear Helps in maintaining balance Prevents the entry of foreign bodies Equalization of air pressure on both sides of the eardrum

Equalization of air pressure on both sides of the eardrum

Which examples are functions of the middle ear? Select all that apply. Equalizes air pressure Protects the inner ear Conducts the sound vibrations Maintains a sense of equilibrium Transmits sound waves to the brain

Equalizes air pressure Protects the inner ear Conducts the sound vibrations

Which part of the ear connects the middle ear to the nasopharynx? Eustachian tube Semicircular canals Tympanic membrane External auditory canal

Eustachian tube

Which finding would the nurse observe in a patient with a basal skull fracture? Redness in the ear with purulent discharge Dirty yellow-colored, foul odor discharge from the ear Frank blood and watery discharge from the ear Reddish-blue discoloration from the ear with necrosis

Frank blood and watery discharge from the ear

Which findings would the nurse observe in a patient who has unreported hearing loss? Select all that apply. Answers questions slowly but appropriately Has a flat, monotonous tone of voice Speaks with an unusually loud voice Watches the nurse's face closely Strains forward to hear

Has a flat, monotonous tone of voice Speaks with an unusually loud voice Watches the nurse's face closely Strains forward to hear

cellulitis

Inflammation of cellular or connective tissue

Which part of the ear would be affected in a patient with impaired hearing and impaired balance? External Middle Inner Auricle

Inner

Which structure of the ear would be dysfunctional in a patient who reports spinning and whirling sensations? Labyrinth Ear ossicles Eustachian tube External auditory canal

Labyrinth

When examining an ear, which ear should you look at first, the painful ear or the "normal" ear?

Normal ear because you could create cross contamination

a sticky yellow discharge may indicate?

Otis media or otis externa

Which condition may cause conductive hearing loss in a patient? Presbycusis Otosclerosis Infection of the labyrinth Eighth cranial nerve damage

Otosclerosis

Which piece of equipment would the nurse obtain to determine middle ear infection in a 4-week-old newborn? Yellow light otoscope Squeeze toy Tuning fork Pneumatic bulb

Pneumatic bulb For the newborn's first 6 weeks, drum immobility is the best indicator of middle ear infection and requires a pneumatic bulb. Give a small pump to the bulb and release the bulb; normally the tympanic membranes moves inward with a slight puff and outward with a slight release. A yellow light otoscope indicates low batteries; the otoscope should be a bright white light. A squeeze toy is used to determine the presence of the startle (Moro) reflex, not for a middle ear infection. A tuning fork is used to determine types of hearing loss, not for a middle ear infection.

Assesses ability vestibular apparatus in inner ear help maintain standing balance.

Romberg test

Which otoscopic finding would the nurse observe for a patient with mycoplasma pneumonia infection who has bullous myringitis? Many white dots One large polyp Small blood-filled vesicles Cheesy, pearly white drum

Small blood-filled vesicles

Which part of the ear does the tympanic membrane separate? The external and the middle ear The middle and the inner ear The auricle and the cochlea The middle ear and the eustachian tube

The external and the middle ear

Which signs and symptoms would the nurse find in the patient with cholesteatoma? Select all that apply. Tinnitus Otorrhea Inflammation of the pinna Blue discoloration of the eardrum Pearly white-colored tympanic membrane

Tinnitus Otorrhea Pearly white-colored tympanic membrane

Which assessment finding would be typical in a patient with otitis externa? Reddish-blue swollen auricle Dirty gray discharge with foul odor Tragus pain upon palpation Branchial remnant

Tragus pain upon palpation

Which landmarks would the nurse observe when examining the tympanic membrane of a patient? Select all that apply. Umbo Manubrium Vestibule Stapes Short process of the malleus

Umbo Manubrium Short process of the malleus

Which at-risk children would the nurse assess closely for hearing deficits? Select all that apply. Had meningitis Was a low-birth-weight newborn Is being breastfed Will be attending public school Has kidney disease

Was a low-birth-weight newborn Has kidney disease

Which otoscopic finding would the nurse observe in a patient who has an ear infection with effusion? Pearly gray-colored eardrum Whiter and denser annulus at the periphery Yellow/amber-colored tympanic membrane Visible malleus behind the tympanic membrane

Yellow/amber-colored tympanic membrane

Brachial remnant and ear deformity

a facial remnant or leftover of the embryologic branchial arch usually appears as skin tags

what is a mixed loss of hearing?

a mixed loss is a combination of conductive and sensorineural types in the same ear

what is a darwin tubercle?

a small, painless nodule at the helix

how should you examine an adult ear? how should you examine an infant or a child under 3 years old?

adult: tilt persons head toward the opposite shoulder and pull the pinna up and back infant/child under 3: pull pinna down -Hold upside down along your fingers & have dorsa (back) of your hands along the person's cheek braced to steady the otoscope -Can also hold as a pencil -Prevents forceful insertion and steadies your hand in case person moves their head -Make sure canals are free of cerumen before testing for hearing

What is presbycusis? what groups is it more common with?

age related hearing loss -lower prevalence with af. am. compared with whites or hispanics

what does the tuning fork test measure?

air conduction (AC) or bone conduction (BC)

what are the pathways of hearing? which is the most efficient?

air conduction: most efficient bone conduction

how loud a noise is

amplitude

complete absence of the external ear ?

anotia

Blood or clear watery drainage suggests

basal skull fracture

what color is the incus?

bone under pinky tissue

the ear is made up of ?

cartilage

the TONE of sound is measured in..?

cycles per second or Hertz

Cerumen production (does/doesn't) increase with age

does

pinna/auricle

ear

cerumen = ?

ear wax

what is the tympanic membrane?

eardrum -pearly gray color and a prominent cone of light -oval and slightly concave -parts of the malleus show through

when should you perform an otoscope assessment on an infant/child?

end of the complete examination

what are the 3 portions of the external ear and what does it do?

external, middle, inner -gets sound into the ear

pitch (cycles per sound) high or low

frequency

Reddish-blue discoloration and swelling of auricle after exposure to extreme cold. Vesicles or bullae may develop, the person feels pain and tenderness, and ear necrosis may ensue.

frostbite

red-blue discoloration of ear occurs with?

frostbite

what is the function of the labyrinth?

gives information to the brain about body's position in space

Cerebral spinal fluid (CSF) feels oily and is positive for

glucose

what is the ear's responsibility?

hearing and maintaining equilibrium

anything that obstructs the transmission of sound

hearing loss

impacted cerumen is a common cause of ..?

hearing loss

area that is around external auditory meatus

helix

what happens if the bony labyrinth in the inner ear becomes inflamed?

it gives wrong info to the brain which causes dizziness, vertigo, staggering which can lead to a bad inner ear infection

when is eardrum assessment needed for children?

mandatory for any infant or child requiring care for illness or fever

where is the helix, lobule, tragus, and mastoid process on the ear?

mastoid process under ear

what is the difference between microtia and macrotia?

microtia: ears smaller than 4 cm vertically macrotia: ears larger than 20 cm

what is an abnormal response when assessing vibratility ?

no movement

when choosing the correct speculum what should do you?

note the size of auditory meatus

occurs directly from ear disease or is referred pain from a problem in teeth or oropharynx

otalgia

___ occurs due to obstruction of the eustachian tube or passage of nasopharyngeal secretions into the middle ear (middle ear infection)

otitis media (OM)

in children: Top of ears should be at same level as

outer canthus and occiput

a hearing loss with low-intensity speech, but sound actually becomes painful when speaker repeats in a loud voice

recruitment

where can the cone of light be seen?

right ear at 5:00 and left ear at 7:00

what is tinnitus?

ringing or buzzing in the ears

what gives a better seal on an otoscope?

rubber tip on the end

what is the difference between subjective and objective vertigo?

subjective vertigo: feeling of spinning person objective vertigo: feeling of spinning objects around person

which test is more accurate when detecting conductive hearing loss?

the Rinne test

if mother gets rubella during the first trimester it can damage ?

the organ of Corti and impair hearing

why is the ear cone shaped?

to funnel sound into opening

opening to the outer ear is covered by the ..?

tympanic membrane (TM)

DO NOT IRRIGATE EAR IF

tympanic membrane is perforated or infected

when examining an infant or young child, a pneumatic bulb attachment enables you to direct a light puff of air toward the drum to assess?

vibratility

what temperature water should you use to irrigate?

warm water

When you ask the question "Do you have difficulty hearing now?" and the answer is yes what should you do? if the answer is no?

yes: perform audiometric testing no: screen using whispered voice test