CH 21 EAQ Auditory Problems

What is a possible effect of cold otic drops administered in the ear canal? a. Vertigo b. Infection c. Barotrauma d. Tympanum burn

ANS: A Administration of cold ear drops can cause vertigo due to the stimulation of the semicircular canals of the ear. Hot drops, not cold drops, can burn the tympanic membrane of the ear. For this reason, ear drops are instilled at room temperature. Barotrauma of the ear is ear discomfort caused by pressure changes. Increased air or water pressure can cause this. Microorganisms such as bacteria or fungi cause infection to the ear. Eardrops are not responsible for this.

The patient has been diagnosed with benign paroxysmal positional vertigo. The nurse knows that which anatomic area of the ear contributes to this disturbance? a. semicircular canals b. oval window c. facial nerve d. cochlea

ANS: A Benign paroxysmal positional vertigo occurs when the organs of balance (the three semicircular canals (1)) have debris or excessive pressure within the lymphatic fluid. The oval window (2) is in the middle ear and receives the vibrations of the ossicles. The facial nerve (CN VII) (3) traverses above the oval window in the middle ear and may be damaged by chronic ear infection or trauma that causes problems related to voluntary facial movements. The cochlea (4) is the coiled structure in the inner ear that is the receptor organ for hearing.

A 25-year-old patient reports tinnitus, diminished hearing, and changes in equilibrium. The nurse assesses that the patient, a worker in a rayon fiber-manufacturing unit, has been exposed to carbon disulfide. What would the nurse conclude from this assessment? a. The patient has ototoxicity. b. The patient has Ménière's disease. c. The patient has central hearing loss. d. The patient has an acoustic neuroma.

ANS: A Chemicals used in industry such as carbon disulfide may damage the inner ear. The patient exposed to ototoxic chemicals may exhibit signs and symptoms of ototoxicity such as tinnitus, diminished hearing, and changes in equilibrium. Ménière's disease is characterized by symptoms caused by inner ear disease that include episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness. However, symptoms usually begin between 30 and 60 years of age. Acoustic neuroma is seen in patients between 40 and 60 years of age. This patient is too young for acoustic neuroma. It is a unilateral benign tumor that occurs where the cranial nerve VIII enters the internal auditory canal. Central hearing loss involves an inability to interpret sound, including speech. It occurs due to a problem in the central nervous system (CNS) but is not manifested as any changes in equilibrium.

The nursing student prepares a chart on the diagnostic tests and treatments associated with different auditory problems. Which disease has the nursing student correctly associated with its diagnostic test and treatment? (disease -> diagnostic test -> treatment) a. External otitis -> pseudomonas aeruginosa identified through culture of drainage -> topical anesthetic drop b. Chronic otitis media -> mastoid x ray -> labyrinthectomy c. Endolymphatic hydrops -> difference of 25 dB between air and bone conduction levels of hearing -> stapes prosthesis surgery d. Otitis media with effusion -> tests to rule out cns disease -> antihistamines and benzodiazepines during the acute attack

ANS: A External otitis involves inflammation or infection of the epithelium of the auricle and ear canal. Pseudomonas aeruginosa is the most common bacterial cause of this disease. Culture and sensitivity studies of the drainage can be used to diagnose external otitis. Topical treatments may include antibiotic drops for infection and corticosteroids for inflammation. Chronic otitis media can involve the mastoid bone, so mastoid x-ray is one of the diagnostic tests for this disease. However, a labyrinthectomy is not used for treating chronic otitis media; instead, it can be used as surgical therapy for Ménière's disease. In otosclerosis, tuning fork tests and an audiogram demonstrate a difference of at least 20 to 25 dB between air and bone conduction levels of hearing. Otosclerosis can be treated surgically by replacing the stapes with a metal or Teflon prosthesis. Endolymphatic hydrops, or Ménière's disease, is not diagnosed by the air-bone gap, nor treated with a prosthetic stapes. For the diagnosis of Ménière's disease, tests are done to rule out CNS disease; it is treated with antihistamines and benzodiazepines during an acute attack. This is not how otitis media with effusion is diagnosed or treated.

A patient receiving injectable gentamicin for acute diarrhea complains of tinnitus, diminished hearing, and dizziness. What is the most appropriate nursing action? a. Stop the drug immediately. b. Decrease the drug dosage. c. Plug the ear canals with cotton. d. Reassure the patient that the effects are temporary.

ANS: A Gentamicin is an aminoglycoside drug and is an ototoxic drug, and the nurse should monitor the patient for ototoxic effects, such as tinnitus, diminished hearing, and changes in equilibrium. If the patient experiences these symptoms, the drug should be immediately stopped. The symptoms may reverse after discontinuing the drug. Decreasing the dosage may still be ototoxic. Reassuring the patient that symptoms may be temporary and plugging the ears may not contribute to management of symptoms.

Which treatment is administered to fight infection in a patient with external otitis? a. Antibiotics b. Corticosteroids c. Mild analgesics d. Irrigation of the canal

ANS: A Inflammation or infection of the epithelium of the auricle and ear canal are the main symptoms of external otitis. Topical or systemic antibiotics are prescribed to treat infection associated with external otitis, depending on whether surrounding tissue is involved. To control the inflammation, the health care provider generally prescribes corticosteroids. Mild analgesic drops usually control the pain. Irrigation of the canal with body temperature solutions softens the cerumen.

Which statement regarding auditory problems among different populations is correct? a. Native Americans have an increased incidence of otitis media. b. Asian Americans have a higher incidence of hearing impairment. c. African Americans have a higher incidence of macular degeneration. d. Individuals between 30 and 60 years of age show the symptom of otosclerosis.

ANS: A Native Americans have an increased incidence of otitis media compared to whites. Whites have a higher incidence of hearing impairment when compared with Asian Americans. Whites have a higher incidence of macular degeneration than African Americans. Symptoms of endolymphatic hydrops usually begin between 30 and 60 years of age. Otosclerosis is the most common cause of hearing loss in young adults.

The patient with Ménière's disease had decompression of the endolymphatic sac to reduce the frequent and incapacitating attacks the patient was experiencing. What should the nurse include in the discharge teaching for this patient? a. Airplane travel will be more comfortable now b. Avoid sudden head movements or position changes c. Cough or blow the nose to keep the eustachian tube clear d. Take antihistamines, antiemetics, and sedatives for recovery

ANS: B After ear surgery the patient should avoid sudden head movements or position changes. Airplane travel should be avoided at first, because increased pressure and ear popping normally are experienced, which will disrupt healing. The patient should not cough or blow the nose, because this increases pressure in the eustachian tube and middle ear cavity and may disrupt healing. Antihistamines, antiemetics, and sedatives are used to decrease the symptoms of acute attacks of Ménière's disease.

Which type of hearing loss involves an inability to interpret sound, including speech, because of a problem in the central nervous system (CNS)? a. Mixed hearing loss b. Central hearing loss c. Conductive hearing loss d. Sensorineural hearing loss

ANS: B Central hearing loss involves an inability to interpret sound, including speech, because of a problem in the CNS. Mixed hearing loss occurs due to a combination of conductive and sensorineural causes. In conductive hearing loss, the patient often speaks softly because hearing his or her own voice seems loud. Sensorineural hearing involves a diminished ability to hear high-pitched sounds, including consonants, because of the impairment of function of the inner ear or the vestibulocochlear nerve (CN VIII).

A nursing student is preparing a chart on the various problems associated with different parts of the ear. Which chart entry indicates that the nursing student has correctly mapped the disease with the part of the ear involved and the cause of the disease? (Disease: Part of the ear affected: Cause) a. Benign paroxysmal positional vertigo (BPPV): Middle ear: infection, leading to formation of "ear rocks" b. Otosclerosis: Internal: Genetic c. Meniere's Disease: Inner Ear: Excessive accumulation of endolymph in the membranous labyrinth d. Chronic Otitis Media: Inner Ear: Unknown

ANS: B Otosclerosis affects the internal ear. It is a hereditary autosomal dominant disease and therefore caused by genetic factors. BPPV is an infection of the inner ear, not the middle ear. Head trauma, infection, or degeneration from the aging process injures the utricle, which leads to the formation of debris known as "ear rocks." This debris leads to BPPV by causing vertigo with specific head movements. Ménière's disease does affect the inner ear. However, its cause is unknown; excessive accumulation of endolymph in the membranous labyrinth is an effect of this disease, not its cause. Chronic otitis media affects the middle ear, not the inner ear. Also, it is caused by repeated attacks of otitis media, especially in adults who have a history of recurrent otitis in childhood.

The nurse is providing care for a 73-year-old male patient who has sought care because of a loss in hearing acuity over the past several years. Which statement by the nurse is most accurate? a. "This is often caused by an infection that will resolve on its own." b. "Many people experience an age-related decline in their hearing." c. "This is likely an effect of your medications. Try stopping them for a few days." d. "You can likely accommodate for your hearing loss with a few small changes in your routine."

ANS: B Presbycusis is a loss of hearing that is both common and age related. Infections most often are accompanied by different symptoms. It would be inappropriate to counsel the patient to stop medications. It would be simplistic to advise the patient to accommodate the hearing loss rather than seek intervention.

Which type of presbycusis is associated with the loss of sensory hair cells? a. Neural b. Sensory c. Cochlear d. Metabolic

ANS: B Sensory presbycusis is associated with atrophy of the auditory nerve and loss of sensory hair cells. Neural presbycusis is associated with degenerative changes in the cochlea and spinal ganglion. Cochlear presbycusis is associated with stiffening of basilar membrane. Metabolic presbycusis is associated with atrophy of the blood vessels in the wall of cochlea.

A patient experiences an attack of Ménière's disease. Which intervention is most important for the nurse to include in the patient's plan of care? a. Increased fluid intake b. Decreased environmental stimuli c. Provision of the patient's regular diet d. Assessment for orthostatic hypotension

ANS: B The etiology of Ménière's disease is not well understood, but stress and excessive sensory stimulation are possible causes. Decreasing environmental stimuli is one approach to treatment and controlling the severity of the symptoms. Fluid intake should be decreased; this may ease the symptoms because in Ménière's disease there is an increase in the endolymphatic fluid of the inner ear. It is believed this causes disease symptoms. If there is no nausea and vomiting, the patient may eat a regular diet as tolerated, but this is not as high a priority as decreasing environmental stimuli is. Patients may experience tinnitus and vertigo, but the blood pressure is not affected, so orthostatic hypotension does not occur.

When using the otoscope, the nurse is unable to see the landmarks or light reflex of the tympanic membrane. The tympanic membrane is bulging and red. What does the nurse think is most likely occurring in the patient's ear? a. Swimmer's ear b. Acute otitis media c. Impacted cerumen d. Chronic otitis media

ANS: B The manifestations of the inability to see the landmarks or light reflex of the tympanic membrane and the bulging and redness of the tympanic membrane are those of acute otitis media. With swimmer's ear and chronic otitis media, there is frequently drainage in the external auditory canal. Impacted cerumen would block the visualization of the tympanic membrane.

The nurse is reviewing the types of hearing loss. The patient who has a sensorineural hearing loss should display which of these problems? a. Hears better in a noisy environment b. Hears sound but does not understand speech c. Often speaks softly because his or her own voice seems loud d. Experiences clearer sound with a hearing aid if the loss is over 40 to 50 dB

ANS: B The patient with sensorineural hearing loss has the ability to hear sound but not to understand speech. The ability to hear high-pitched sounds, including consonants, diminishes. Sounds become muffled and difficult to understand. A hearing aid may help some patients, but it only makes sounds and speech louder, not clearer. Hearing better in a noisy atmosphere, speaking softly because one's own voice seems loud, and hearing clearer with a hearing aid if the loss is 40 to 50 dB are characteristics of conductive hearing loss.

Which criteria should the nurse consider for the placement of an implanted hearing system in a patient to treat moderate to severe sensorineural hearing loss? Select all that apply. a. Loss of sensory hair cells b. Normal middle ear anatomy c. Bilateral hearing impairment d. Normally functioning Eustachian tube e. Stable bilateral sensorineural hearing loss

ANS: B D E An implanted hearing system treats moderate to severe sensorineural hearing loss. Criteria for placement of this device include normal middle ear anatomy, a normally functioning Eustachian tube, and stable bilateral sensorineural hearing loss. Loss of sensory hair cells leads to sensory presbycusis that responds well to sound amplification. Patients with bilateral hearing impairment require binaural hearing.

What instructions would the nurse teach a patient and caregiver regarding the prevention of external otitis? Select all that apply. a. Report any decrease in cerumen production. b. Do not dry the ears with a cotton-tipped applicator. c. Report itching of the cochlea if it becomes a problem. d. Use earplugs if the patient is prone to swimmer's ear. e. Do not put anything in the ear canal unless instructed by the healthcare provider.

ANS: B D E Wearing earplugs can prevent contaminated water from contacting the external canal, thereby preventing the alteration of normal flora leading to bacterial growth. Ears should be cleaned and dried with a washcloth, as cotton-tipped applicators can cause serious injury to the tympanic membrane. Putting objects into the ear canal can cause impaction of cerumen, impairing hearing, or penetration of the middle ear. An increase, not decrease, in cerumen production has been shown to have an effect on development of external otitis. Itching ears are a common symptom with external otitis; however, the cochlea is in the inner ear and does not itch.

What is the nurse's highest priority when caring for a patient experiencing an acute attack of vertigo? a. Educate the patient about diet restriction to prevent future episodes. b. Consult with an audiologist to arrange for an audiogram to be completed. c. Manage the patient's symptoms with antihistamines, anticholinergics, and benzodiazepines. d. Explain to the patient's spouse that a labyrinthectomy is the only successful treatment for vertigo.

ANS: C Managing the patient's symptoms in acute attack of vertigo is the nursing Intervention that will bring the patient the most immediate relief, which makes it a top priority. Educating a patient about how to further prevent episodes of vertigo is not a priority in the acute management of vertigo; this can take place once the symptoms are under control. While an audiogram may help to confirm a diagnosis of Ménière disease, it is not necessary to provide an audiogram for the patient during an attack of vertigo. A labyrinthectomy is not the only recognized treatment for vertigo, nor is it a priority during the initial phase of the patient's illness.

Which auditory disorder is caused by an excessive accumulation of endolymph in the membranous labyrinth? a. Otitis Media b. Otosclerosis c. Ménière's disease d. Acoustic neuroma

ANS: C Ménière's disease, also called endolymphatic hydrops, results in an excessive accumulation of endolymph in the membranous labyrinth. The volume of endolymph increases until the membranous labyrinth ruptures. Otitis media is caused by an infection of the tympanum, ossicles, and space of the middle ear. Otosclerosis is a hereditary autosomal dominant disease caused by the vascular and bony changes in the middle ear. Otoscopic examination may reveal Schwartz's sign. Acoustic neuroma is a disorder of cranial nerve VIII, on which a unilateral benign tumor grows.

A patient tells the nurse that the right ear feels like it is plugged but does not hurt. This symptom is associated with which condition? a. Mastoiditis b. External otitis c. Otitis media with effusion d. Perforation of the tympanic membrane

ANS: C Otitis media with effusion is inflammation of the middle ear with fluid in the middle ear space. The eustachian tube, which normally allows air into the ear to equalize pressure, is blocked. Negative pressure develops, and fluid is pulled into the middle ear space. This effusion causes the patient to experience the feeling of fullness in the ear and diminished hearing. Mastoiditis is a complication of chronic otitis media in which recurrent ear infection spreads to the mastoid bone of the skull, resulting in hearing loss. External otitis involves inflammation or infection of the epithelium of the auricle and ear canal. Perforation of the tympanic membrane occurs with otitis media when pressure from the infection ruptures the eardrum and purulent fluid drains out of the ear canal.

Which nursing intervention is most appropriate for facilitating communication with a patient who has a hearing impairment? a. Speaking loudly and shouting if necessary b. Asking the patient questions that can be answered with a yes or no response c. Standing close to the patient and speaking slowly and clearly in a normal tone d. Standing to one side of the patient when speaking and directing the voice directly into the patient's ear

ANS: C Standing close to and directly in front of the patient will greatly facilitate communication. The nurse also should ensure that the patient can see the nurse's mouth to help facilitate lip-reading. Shouting at the patient with a hearing impairment distorts the voice and further hinders understanding. Asking yes-or-no questions and standing to one side and speaking directly into the patient's ear are not appropriate or effective means of communicating with the patient who has a hearing impairment.

Which instruction given by the nursing student during ear care training needs correction by the registered nurse? a. "Do not put anything in your ear canal." b. "Report itching if it becomes a problem." c. "Dry the ear with cotton-tipped applicators." d. "Report chronic excessive cerumen if it impairs your hearing."

ANS: C The ears should be kept as dry as possible. However, cotton-tipped applicators should not be used for drying the ears. Rather, a hair dryer set to low and held at least 6 inches from the ear can be used to evaporate the water from the ear. Unless requested by the health care provider, nothing should be put in the ear canal. The health care provider should be consulted if consistent itching occurs or if excessive cerumen impairs hearing.

An otoscopic examination of a patient reveals a positive Schwartz's sign. A tuning fork test and an audiogram demonstrate air-bone gaps. Which statement describes the disorder these tests are used to diagnose? a. Free-floating debris in the semicircular canal causes vertigo with specific head movements. b. A unilateral benign tumor grows where the vestibulocochlear nerve enters the internal auditory canal. c. The spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window. d. The patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.

ANS: C The patient has otosclerosis, which can be diagnosed with otoscopic examination revealing a positive Schwartz's sign along with tuning fork tests and an audiogram identifying air-bone gaps. In otosclerosis, spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window, thereby reducing the transmission of vibrations to the inner ear fluids. This results in conductive hearing loss. In benign paroxysmal positional vertigo (BPPV), free-floating debris in the semicircular canal causes vertigo with specific head movements, such as getting out of bed, rolling over in bed, and sitting up from lying down. An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve enters the internal auditory canal. The tumor can compress the trigeminal and facial nerves and arteries within the internal auditory canal. In Ménière's disease, the patient experiences significant disability because of sudden, severe attacks of vertigo with nausea, vomiting, sweating, and pallor.

A patient reports an inability to understand speech in spite of being able to hear sounds properly. The patient has a history of Paget's disease of the bone and is being treated with antibiotics. The nurse recognizes that the patient is most likely experiencing which type of hearing loss? a. Mixed hearing loss b. Conductive hearing loss c. Sensorineural hearing loss d. Central and functional hearing loss

ANS: C The patient is able to hear sound but is unable to understand speech. The patient also has a history of Paget's disease of the bone and is receiving antibiotic therapy. These factors lead to sensorineural hearing loss. Sensorineural hearing loss is caused by impairment of function of the inner ear or the vestibulocochlear nerve. Mixed hearing loss occurs due to a combination of conductive and sensorineural causes. In conductive hearing loss, the patient often speaks softly because he can hear his own voice quite loud. The patient hears better in a noisy environment. In central and functional hearing loss, the patient is unable to interpret sound, including speech. This is caused mainly due to a problem in the brain area controlling speech.

Which hearing-impaired patient is the most ideal candidate for a cochlear implant? a. The middle-aged patient being treated for benign paroxysmal positional vertigo (BPPV) b. The older adult with slight hearing loss which does not significantly impact activities c. The teen with profound sensorineural hearing loss after tympanic membrane (TM) rupture d. The construction worker with tinnitus after prolonged exposure to excessively loud equipment

ANS: C The teenager with profound sensorineural hearing loss after TM rupture is the ideal candidate for a cochlear implant, as hearing loss occurred after speech development, and this patient will adapt to the implant well. Patients who suffer from BPPV typically do not demonstrate hearing loss. A cochlear implant is not indicated for slight hearing loss at any age. Tinnitus is the perception of sound when no source is present. A cochlear implant would be inappropriate treatment for tinnitus.

The registered nurse is preparing to teach a group of nursing students about the use of verbal aids when communicating with hearing-impaired patients. Which information does the nurse include in the teaching plan? a. Refrain from having light behind the patient. b. Speak in a clear voice and shout at the patient. c. Use simple sentences and rephrase sentences if required. d. Maintain eye contact and draw the attention of the patient with hand movements.

ANS: C The use of simple sentences is an example of a verbal aid that the nurse can use while communicating with a hearing-impaired patient. If required, the nurse should rephrase the sentence and use different words to help the patient understand. As a nonverbal aid, the nurse should avoid light behind the speaker, not the patient. As a verbal aid, the nurse should speak in a normal voice directly into the better ear. The nurse should not shout to make the patient understand. As a nonverbal aid, the nurse should maintain eye contact and draw attention of the patient with hand movements.

A patient has just been fitted with a new hearing aid. Which statement by the patient reflects a correct understanding of care and use of hearing aids? Select all that apply. a. "I will replace the batteries monthly." b. "I need to clean the ear molds daily." c. "I will disconnect or remove the batteries when not in use." d. "I will always keep them in their storage box when I am not wearing them." e. "I will wear this at home at first to get used to how it works while it is quiet."

ANS: C D E Initially, use of the hearing aid should be restricted to quiet situations in the home. As adjustment to the increase in sounds and background noise occurs, the patient can progress to situations in which several people will be talking simultaneously. Next, the environment can be expanded to the outdoors and then the shopping mall or grocery store. When the hearing aid is not being worn, it should be disconnected or removed and kept in its storage box. Battery life averages one week. Ear molds should be cleaned weekly or as needed.

The nursing instructor is teaching a group of nursing students about the treatment of cerumen and foreign bodies in the external ear canal. Which statements made by the nursing student indicate an understanding regarding the instruction? Select all that apply. a. "The canal should be irrigated with cold solutions." b. "The ear canal should be completely occluded with the syringe tip." c. "Use of cotton-tipped applicators to clean the ears should be avoided." d. "Mild lubricant drops should be used as initial treatment for cerumen removal." e. "Mineral oil can be used with microscopic guidance to kill an insect before removal."

ANS: C E Mineral oil or lidocaine drops can be used to kill an insect before removal with microscope guidance. Ears should be cleaned with a washcloth and finger, and never with cotton-tipped applicators. This is because penetration of the middle ear by a cotton-tipped applicator can cause serious injury to the tympanic membrane (TM) and ossicles, and can also cause cerumen to become impacted against the TM and impair hearing. Management of cerumen involves irrigation of the canal with body temperature solutions to soften the cerumen. When irrigating the ear canal to soften the cerumen, it is important to make sure that the ear canal is not completely occluded with the syringe tip. Mild lubricant drops may be used to soften the earwax only if irrigation does not remove the wax, and not as the initial step for cerumen removal.

Identify a causative factor associated with a sensorineural hearing loss. a. Otosclerosis b. Impacted cerumen c. Perforation of the tympanic membrane d. Ototoxicity from chemotherapeutic medications

ANS: D A sensorineural hearing loss involves damage to the neural component of hearing. Within the inner ear there are sensory hair cells in the cochlea that pick up impulses and initiate nerve impulse to the brain via the acoustic branch of the eighth cranial nerve. Medications, including some chemotherapy, can damage this nerve pathway of hearing. Otosclerosis is a hereditary condition causing a conductive hearing loss because of bony growth that limits the stapes from vibrating in response to sound. Impacted cerumen (earwax) causes a conductive hearing loss because the sound vibrations are blocked by excessive earwax in the ear canal. A perforated tympanic membrane (ruptured eardrum) causes a conductive hearing loss because the tympanic membrane is no longer intact to adequately conduct sound vibrations.

Which type of presbycusis is correctly documented with its cause, associated hearing change, and prognosis? (type: cause: hearing change: prognosis) a. Neural: atrophy of auditory nerve: loss of high pitched sounds: helped by appropriate forms of amplification b. Sensory: Stiffening of basilar membrane: Hearing loss increases from low to high frequencies: Good response to sound amplificiation c. Cochlear: Degenerative changes in cochlea and spinal ganglion: Loss of speech discrimination: Amplification alone not sufficient. d. Metabolic: Atrophy of blood vessels in wall of cochlea; Uniform loss for all frequencies accompanied by exaggerated perception of sound: good response to hearing aid

ANS: D Metabolic presbycusis is caused by the atrophy of blood vessels in the wall of the cochlea with an interruption of essential nutrient supply. It is associated with uniform loss for all frequencies accompanied by recruitment. The patient responds well to hearing aids. Neural presbycusis is caused by degenerative changes in the cochlea and spinal ganglion. It is associated with loss of speech discrimination, and amplification alone is not sufficient to treat this type of hearing loss. Sensory presbycusis responds well to sound amplification; however, it is caused by atrophy of the auditory nerve and loss of sensory hair cells. Associated hearing change is a loss of high-pitched sounds. Cochlear presbycusis is caused by a stiffening of the basilar membrane, which interferes with sound transmission in the cochlea. The associated hearing loss increases from low to high frequencies, and speech discrimination is affected with higher-frequency losses. This type of hearing loss is helped by appropriate forms of amplification.

A patient is diagnosed with otitis media with effusion. The nurse expects that the patient will most likely exhibit what symptoms? a. Pain, fever, malaise, and reduced hearing b. Limited movement of the footplate of the stapes in the oval window. c. Episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness d. Feeling of fullness of the ear, a plugged feeling or popping, and decreased hearing

ANS: D Otitis media with effusion is an inflammation of the middle ear with an accumulation of fluid in the middle ear space. The patient may complain of a feeling of fullness of the ear, a plugged feeling or popping, and decreased hearing. The fluid may be thin, mucoid, or purulent. Pain, fever, malaise, and reduced hearing are symptoms of acute otitis media. Episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness are signs of Ménière's disease. Spongy bone developments from the bony labyrinth, preventing movement of the footplate of the stapes in the oval window, are signs of otosclerosis.

After providing education to a patient with otosclerosis, the nurse determines that the teaching was effective when the patient states that the hearing loss is due to what? a. A tumor in the middle ear b. Too much ear wax buildup c. Taking too much aspirin over the years d. A problem with the bones in the middle ear

ANS: D Otosclerosis, the deterioration of the bones of the middle ear, is the most common cause of conductive hearing loss. Tumors, too much ear wax, and too much aspirin are problems that may affect hearing but are not related to otosclerosis.

The nurse recalls that presbycusis is hearing loss primarily caused by what? a. Traumatic injury b. Congenital defect c. Conductive defect d. Sensorineural loss

ANS: D Presbycusis is due primarily to sensorineural hearing loss. It is a common type of hearing loss in adults older than 50 years. Traumatic injury and congenital and conductive defects are not associated with presbycusis. Also, conductive hearing loss is the result of repeated trauma such as exposure to loud noises or drug toxicity.

Which instruction should the nurse provide while teaching the patient and caregiver how to reduce the risk of external otitis? a. "Report if you notice earwax in the ear canal." b. "Dry your ears with cotton-tipped applicators." c. "Never use a hair dryer to speed up water evaporation from the ear." d. "Turn your head to each side for 30 seconds to drain water from the ear."

ANS: D Swimming and showering may alter the flora of the external canal because of chemicals and contaminated water, and thus cause external otitis. The nurse should instruct the patient to turn his or her head to each side for 30 seconds at a time to help water run out of the ears. This would help keep the ear dry. Earwax is normal, and it protects the ear canal. Chronic excessive cerumen should be reported if it impairs the patient's hearing. If water gets inside the ears, they should not be dried with cotton-tipped applicators. Instead, a hair dryer set to low and held at least six inches from the ear can speed water evaporation.

A nurse is comparing otosclerosis and otitis media with effusion. Which statement is correct regarding these two diseases? a. Otosclerosis can be caused by changes in air pressure, whereas otitis media with effusion follows chronic sinus infections. b. Otosclerosis is an inflammation of the middle ear, whereas otitis media with effusion is a hereditary recessive disease. c. Otosclerosis may be accompanied by a reddish blush of the tympanum, whereas otitis media with effusion is accompanied by purulent discharge from the ear. d. Otosclerosis is treated by oral administration of sodium fluoride, with vitamin D and calcium carbonate, whereas otitis media with effusion does not require antibiotic therapy.

ANS: D The hearing loss associated with otosclerosis may be stabilized by the oral administration of sodium fluoride, with vitamin D and calcium carbonate. These medications slow bone resorption and encourage the calcification of bony lesions. Otitis media with effusion usually resolves without treatment but may recur. Chronic sinus infections can lead to otitis media with effusion; so can barotrauma caused by pressure change. Otosclerosis is not associated with a change in air pressure. Otosclerosis is a hereditary autosomal dominant disease, whereas otitis media with effusion is an inflammation of the middle ear with a collection of fluid in the middle ear space. In a patient with otosclerosis, an otoscopic examination may reveal a reddish blush of the tympanum known as Schwartz's sign; this is caused by the vascular and bony changes within the middle ear. In otitis media with effusion, the patient does not experience pain, fever, or discharge from the ear.

Which nonverbal aids can the nurse adopt to effectively communicate with a patient with hearing loss? a. Refraining from touching the client b. Having a light source behind the speaker c. Maintaining equal distance from both ears d. Refraining from covering the mouth or face with hands

ANS: D The nurse should not cover his or her mouth or face with the hands to communicate effectively with a patient with hearing loss. Using touch can be an effective strategy in this situation. The nurse should refrain from having light behind the speaker. The nurse should move close to the better ear while communicating with the patient with hearing loss.

What behavior does the nurse assessing a patient with hearing loss expect to encounter? a. Aggressiveness b. Constant repetition c. Answering questions appropriately d. Irritability with others not speaking up

ANS: D The patient with hearing loss will become irritable at others who do not speak loudly enough for the patient to hear. Answering questions appropriately, aggressiveness, and constant repetition are not associated with hearing loss.

What is important for the nurse to include in the postoperative care of the patient following a stapedectomy to correct otosclerosis? Select all that apply. a. Check the gag reflex. b. Encourage independence. c. Avoid changing the cotton padding. d. Instruct patient to refrain from lifting or bending. e. Inform patient that nausea and dizziness may occur.

ANS: D E The patient may experience dizziness, nausea, and vomiting as a result of stimulation of the labyrinth during surgery. The patient should take care to avoid sudden movements that may bring on or exacerbate vertigo. Actions that increase inner ear pressure, such as coughing, sneezing, lifting, bending, and straining during bowel movements, should be avoided. Place a cotton ball in the ear canal, and cover the ear with a small dressing. It is not necessary to check a gag reflex. The patient will need assistance early postoperatively for safety reasons, so the nurse should not promote independence. The cotton padding may need to be changed if there is excess drainage.

What instruction should the nurse include when teaching a caregiver ways to communicate better with a patient who has hearing loss? Select all that apply. a. Maintain eye contact. b. Speak normally and slowly. c. Move closer to the better ear. d. Overenunciate whatever you say. e. Write out names or difficult words. f. Do not draw attention with hand movements.

ANs: A B C E The family and caregivers can help the patient with hearing loss by using strategies for improving verbal and nonverbal communication. These strategies include maintaining eye contact when talking, speaking normally and slowly, moving closer to the better ear, and writing out names and words that are difficult to understand. Hand movements can be used to draw attention. Overenunciating should be avoided.

The nurse assesses a patient with an inner ear problem. What is the most significant symptom for which the nurse should be alert in this patient? a. Vertigo b. Tinnitus c. Headaches d. Hearing loss

ANS: A

Which surgical procedure involves an incision in the tympanum to release the increased pressure and exudate from the middle ear? a. Myringotomy b. Stapedotomy c. Tympanoplasty d. Mastoidectomy

ANS: A A myringotomy is a surgical procedure being performed on a patient with acute otitis media. It involves an incision in the tympanum to release the increased pressure and exudate from the middle ear. A stapedotomy is a microdrill or laser surgical treatment that involves opening the footplate as a part of collaborative care of otosclerosis. A tympanoplasty, also called a myringoplasty, involves reconstruction of the tympanic membrane and/or the ossicles of a patient with otitis media. A mastoidectomy is a surgery performed along with a tympanoplasty to remove the infected portions of the mastoid bone in a patient with chronic otitis media.

Which statement is true regarding a patient with conductive hearing loss? a. This patient hears better in a noisy environment. b. This patient can hear sound, but not understand speech. c. This patient speaks very loudly because of an inability to hear his or her own voice. d. This patient does not benefit from using a hearing aid because it makes speech clearer, not louder.

ANS: A A patient with a conductive hearing loss hears better in a noisy environment. A patient with sensorineural hearing loss hears sound but does not understand speech. A patient with conductive hearing loss often speaks softly because his or her own voice seems loud. If correcting the cause of conductive hearing loss is not possible, a hearing aid may help if the loss is greater than 40 to 50 dB. For a patient with sensorineural hearing loss, the hearing aid may not always help because it only makes sounds and speech louder, not clearer.

The patient experiences loss of high-pitched sounds but understands speech with good response to sound amplification. Which statement accurately describes the patient's condition? a. There is loss of sensory hair cells. b. There is stiffening of the basilar membrane. c. There are degenerative changes in the cochlea. d. There is atrophy of the blood vessels in the wall of the cochlea.

ANS: A Presbycusis is hearing loss associated with aging. Loss of sensory hair cells occurs in the case of neural presbycusis; as a result, the patient experiences loss of high-pitched sounds. The patient, however, correctly understands speech and responds well to sound amplification. Stiffening of the basilar membrane occurs with cochlear presbycusis, and this condition interferes with sound transmission in the cochlea. With this disorder, speech discrimination is affected with higher-frequency losses. Degenerative changes in the cochlea, termed as neural presbycusis, results in loss of speech discrimination. In the case of metabolic presbycusis, there is atrophy of the blood vessels in wall of the cochlea. Such patients experience uniform loss for all frequencies accompanied by recruitment.

Which auditory disorders are related to the inner ear? a. Presbycusis b. Cholesteatoma c. Serous otitis d. Otosclerosis

ANS: A Presbycusis is hearing loss associated with aging; it is related to the inner ear. Cholesteatoma, serous otitis, and otosclerosis are disorders of the middle ear.

The nurse is caring for a 25-year-old sexually active woman who was just vaccinated against the rubella virus. Which instruction should the nurse give this patient? a. "Refrain from becoming pregnant for at least three months after being immunized." b. "Refrain from exposure to chemicals such as toluene, carbon disulfide, and mercury." c. "Undertake serological testing for the presence of antibodies against the rubella virus." d. "Be aware that rubella infection during the first eight weeks of pregnancy is associated with an 85 percent incidence of congenital rubella syndrome."

ANS: A The nurse should instruct the patient to avoid pregnancy for at least three months after being immunized against the rubella virus, which can cause deafness in the fetus and malformations affecting the ear. A patient should be vaccinated against rubella virus only when serological tests for the presence of antibodies for this virus are found positive. Chemicals such as carbon disulfide are ototoxic and may damage the inner ear. Such patients may exhibit signs and symptoms of ototoxicity. However, ototoxicity is not related to rubella infection. Rubella infection during the first eight weeks of pregnancy is associated with an 85 percent incidence of congenital rubella syndrome. This syndrome may cause sensorineural deafness in the child. This information is, however, not significant for a woman who is already vaccinated against rubella virus.

A nurse is explaining measures to prevent external otitis to a group of patients. Which interventions should the nurse include in the teaching? Select all that apply. a. Report any itching in the ear. b. Use earplugs when swimming. c. Keep the ears as dry as possible. d. Avoid putting anything in the ear canal. e. Avoid using hairdryers to dry the external ear.

ANS: A B C D External otitis is associated with the inflammation or infection of the epithelium of the auricle and ear canal. External otitis can be prevented by keeping the ears as dry as possible because moisture promotes bacterial growth. However, if itching becomes a problem, it should be immediately reported. The patient should be advised to avoid inserting anything into the ear, because this may cause infection. Water in the swimming pool may be contaminated or contain chemicals that alter the flora of the external canal. Therefore earplugs should be used at the time of swimming. A hair dryer set to low and held at least six inches from the ear can speed water evaporation.

An acoustic neuroma is removed from a patient, and the nurse instructs the patient about tumor recurrence. What should the nurse instruct the patient to monitor? Select all that apply. a. Episodes of dizziness b. Lack of coordination c. Worsening of hearing d. Inability to close the eye e. Clear drainage from the nose

ANS: A C D E An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve (CN VIII) enters the internal auditory canal. Clinical manifestations of tumor recurrence, including facial nerve (CN VII) paralysis, can be manifested by intermittent vertigo, hearing loss, and inability to close the eye. The patient should report any clear, colorless discharge from the nose because it may be cerebrospinal fluid (CSF), which increases the risk of infection. Lack of coordination is not a manifestation of acoustic neuroma.

The nurse is interviewing an elderly patient who has hearing loss. Which strategies would best assist the nurse in communicating with this patient? Select all that apply. a. Use simple sentences. b. Overenunciate speech. c. Speak normally and slowly. d. Exaggerate facial expressions. e. Avoid distracting environments. f. Raise the voice to a higher pitch.

ANS: A C E Speak normally and slowly directly into the patient's better ear. Use simple sentences, rephrase sentences, or use different words. Write out names or difficult words. Avoid shouting and distracting environments. Overenunciating the speech, exaggerating facial expressions, and raising the voice to a higher pitch are not effective strategies for communicating with the patient with hearing loss.

Which decibel loss indicates moderately severe hearing impairment? a. 52 dB b. 60 dB c. 85 dB d. 110 db

ANS: B A decibel loss in the range of 56 to 70 dB indicates moderately severe hearing impairment. Hearing loss in the range of 41 to 55 dB indicates moderate impairment. Hearing loss in the range of 71 to 90 dB indicates severe impairment. Hearing loss over 90 dB indicates profound impairment, associated with congenital deafness.

The patient is given an oral dose of glycerol followed by serial audiograms over three hours. Which symptom did the nurse assess in the patient? a. Presence of positive Schwartz's sign b. Aural fullness and fluctuating sensorineural hearing loss c. Reduction in touch sensation in the posterior ear canal d. A painless condition with hearing loss, nausea, and episodes of dizziness

ANS: B A glycerol test is a diagnostic test aimed to confirm Ménière's disease. The symptoms of this disorder include aural fullness and fluctuating sensorineural hearing loss. A series of audiograms over three hours is done after the patient is given an oral dose of glycerol. Improvement in hearing or speech discrimination occurs due to the osmotic effect of glycerol that pulls fluid from the inner ear. An otoscopic examination, the Rinne test, the Weber test, audiometry, and tympanometry are the diagnostic tests used to confirm otosclerosis. Such patients show positive Schwartz's sign. Patients with acoustic neuroma have reduced touch sensation in the posterior ear canal. Diagnostic tests to confirm acoustic neuroma include neurologic, audiometric, and vestibular tests; CT scans; and MRI. A mastoid x-ray is one of the tests used to diagnose chronic otitis media. This is a painless auditory disorder with hearing loss, nausea, and episodes of dizziness.

What instructions should the nurse include when teaching a patient how to administer ear drops? Select all that apply. a. Administer cold, not warm, drops. b. The tip of the dropper should not touch the ear. c. The ear should be positioned so that the drops can run into the canal. d. The drops should not be put in using a cotton wick placed in the ear canal. e. The position of the ear should be maintained for two minutes to let the drops spread.

ANS: B C E When administering ear drops, the patient should position the ear so that the drops run into the canal, and this position should be maintained for two minutes to let the drops spread. The dropper should not touch the ear; avoiding contact reduces the spread of infection. The ear drops should be at room temperature when administered. Cold drops can cause vertigo; very warm drops can burn the tympanic membrane. Sometimes the drops are placed onto a wick of cotton that is placed in a canal.

Which is the most powerful hearing aid available for use by patients with hearing loss? a. In the ear b. In the canal c. Behind the ear d. Completely in the canal

ANS: C A behind-the-ear hearing aid is the most powerful hearing aid and is used for all types of hearing loss. An in-the-ear hearing aid is used for mild to severe hearing loss, which provides powerful amplification. An in-the-canal hearing aid is also used for mild to severe hearing loss. A hearing aid set completely in the canal is used for mild to moderate hearing loss.

During assessment, the nurse finds rough sandpaper-like changes to the upper border of the auricle of the patient. What does this observation indicate? a. Otosclerosis b. Cholesteatoma c. Actinic keratoses d. Chronic otitis media

ANS: C Actinic keratoses are premalignant lesions associated with chronic sun exposure. The upper border of the auricle with premalignant lesions looks like rough sandpaper. Otosclerosis is a hereditary autosomal dominant disease that results in hearing loss and mostly affects young adults. Cholesteatoma is the mass of epithelial cells and cholesterol that develops in the middle ear, which may enlarge and destroy the adjacent bones. Chronic otitis media is a painless condition of the ear characterized by a purulent exudate and inflammation that can involve the ossicles, the auditory tube, and the mastoid bone.

Which type of hearing loss occurs only when conditions in the outer or middle ear impair the transmission of sound through air to the inner ear? a. Mixed hearing loss b. Functional hearing loss c. Conductive hearing loss d. Sensorineural hearing loss

ANS: C Conductive hearing loss occurs when conditions in the outer or middle ear impair the transmission of sound through air to the inner ear. Mixed hearing loss occurs due to a combination of conductive and sensorineural causes. Functional hearing loss may be caused by an emotional or a psychologic factor. Sensorineural hearing loss is caused by impairment in function of the inner ear or the vestibulocochlear nerve (CN VIII).

Which disorder can malignant external otitis cause in an older patient with diabetes mellitus? a. Otalgia b. Otosclerosis c. Osteomyelitis d. Acoustic neuroma

ANS: C Malignant external otitis, a serious infection caused by the bacteria Pseudomonas aeruginosa, occurs mainly in older patients with diabetes mellitus. This infection can spread from the external ear to the parotid gland and temporal bone, causing osteomyelitis. Otalgia, or ear pain, is one of the first signs of external otitis. Otosclerosis is a hereditary autosomal dominant disease in which a spongy bone develops from the bony labyrinth, which prevents the movement of the footplate of the stapes in the oval window. An acoustic neuroma is the result of a unilateral benign tumor at the spot where the eighth cranial nerve enters the internal auditory canal.

What substance is most appropriate for the nurse to use to remove an insect from a patient's ear? a. Water b. Alcohol c. Mineral oil d. Hydrogen peroxide

ANS: C Mineral oil causes the least amount of trauma and irritation to the ear canal. Water and hydrogen peroxide should not be used because the insect could swell, which would make it more difficult to remove. Alcohol may cause both irritation of the ear canal and swelling of the insect.

A patient with septic shock is receiving multiple medications. Which intravenous (IV) medication is most likely to cause a hearing loss? a. Aspirin b. Ampicillin c. Dopamine d. Vancomycin

ANS: D The IV medication in use that is most likely to cause a hearing loss is vancomycin, because it is an ototoxic medication. For that reason, serum drug levels are monitored to maintain therapeutic levels and reduce the risk of ototoxicity. Neither dopamine nor ampicillin is likely to cause hearing loss. Aspirin also can cause hearing loss, but it is not administered IV.

The nurse provides education to a patient with Ménière's disease. What long-term effect of the disease should the nurse include in the teaching? a. Hearing loss b. Double vision c. Chronic vertigo d. Chronic headaches

ANS: A Ménière's disease, which involves the inner ear, is characterized by episodes of acute vertigo and tinnitus. It can result in progressive and irreversible sensorineural hearing loss. Double vision is not an associated symptom of Ménière's disease. Chronic vertigo and chronic headaches may or may not be associated with Ménière's disease.