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Care of the Clients with Common Ear Problems
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12/21/2017
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ANATOMY AND PHYSIOLOGY *Weber Test – the rounded tip of the handle of the vibrating tuning fork is
placed on the client’s head or teeth. It uses bone conduction to test
The Ear lateralization of sound. A tuning fork is set in motion by tapping it on the
The Ear is divided into 3 parts: External, Middle and Internal Ear. examiner’s knee or hand, and placed on the pt’s head of forehead. This test is
(1) External Ear useful in cases of unilateral loss. It is more accurate in diagnosing sensorineural
a. Auricle or Pinna – it collects sound waves and directs vibrations toward the auditory hearing loss like in Meniere’s Disease.
meatus.
b. External auditory meatus (External auditory canal) Interpretation of results:
– Approximately 2.5cm long, the skin of the canal contains hair, sebaceous glands, and 1. Normal – Negative. Tone is heard in center of head or equally in both ears.
ceruminous glands, which secrete a brown, wax like, substance called Cerumen or Ear Wax. 2. Conductive hearing loss – tone is heard in poorer area, e.g. Otosclerosis. Hears
- It directs sound waves to the tymphanic membrane; hairs and cerumen help cleanse the the sound in the affected area.
canal of foreign matter. 3. Sensorineural hearing loss – hears the sound in the better-hearing hear.
c. Tymphanic Membrane (Eardrum) – protects the middle ear and conducts sound
vibrations from the external ear to the ossicles. (2 )Whisper Voice Test – the examiner covers one ear with palm of the hand, then whispers
- it is about 1cm in diameter and very thin softly 2-syllable words from a distance of 1 or 2 feet from the occluded ear, and out of the
- it is normally pearly gray and translucent pt’s sight (e.g. thirteen, fourteen, fifteen). The person with normal hearing acuity can
correctly repeat what was whispered.
(2) Middle Ear (Tympanic Cavity)
(3) Audiometry – it is the single most important diagnostic instrument in detecting hearing
a. Ossicles – contains the smallest bones of the body: Malleus, Incus, Stapes decrease the loss
magnitude of the sound
- mechanically transmit sound waves from the tympanic membrane through the oval Types:
window to the inner ear.
b. Windows: a. Pure-Tone Audiometry – the louder the tone before the client perceives it, the
b.1. Oval Window – transmits sound vibrations from the stapes to the fluids in the inner greater the hearing loss.
ear b. Speech Audiometry – spoken word is used to determine the ability to hear and
b.2. Round Window – relieves pressure as vibration exit the inner ear discriminate sounds and words. The louder the sound before the client
c. Eustachian Tube (Auditory Tube) – provides air passage from the nasopharynx to the perceives it, the greater the hearing loss.
middle ear. During yawning, sneezing and swallowing, the tensor veli palatine muscle
opens the tube to equalize the pressure on both sides of the tympanic membrane (4) Typanogram and Impedance Audiometry – it measures middle ear muscle reflex to
d. Mastoid – these air-filled spaces that aid the middle ear in adjusting to changes in sound stimulation and compliance of the tympanic membrane, by changing the air pressure
pressure in a sealed ear canal. Compliance is impaired with middle ear diseases.
(3) Inner Ear – is housed deep within the temporal bone. The organs for hearing (Cochlea) (5) OculovestibularTest or Ice Water Caloric Test – irrigate the ear with cold water.
and balance (Semicircular Canal), as well as cranial nerves VII (Facial Nerves) and VIII
(Vestibulocochlear nerve), are all part of this complex anatomy. Normal result : lateral conjugate nystagmus of the eyes towards area of stimulation.
a. Bony Labyrinth – surrounds and protects the membranous labyrinth Abnormal result: dysconjugate nystagmus of the eyes.
a.1. Vestibule – contains the utricle and saccule, which function in the sense of balance. Then, irrigate the ear with warm water.
a.2. Cochlea – contains auditory receptors which functions in hearing Normal result: lateral conjugate nystagmus of the eyes away from the area of stimulation.
a.3. Semi-circular canals – function in the sense of balance. Abnormal result: dysconjugate nystagmus of the eyes.
b. Membranous labyrinth – contains receptor cells for hearing
b.1. Utricle and saccule – organ of static equilibrium (6) Otoscope – is used visually to examine the ears. Examines the external auditorycanal
b.2. Cochlear duct – contains Organ of Corti or The End Organ for Hearing, which is the and tympanic membrane. Otoscope should be held in the examiner’s right hand, in a pencil-
center for acute hearing and a snail-shaped, bony tube about 3.5cm long with 2 and a hald hold position, with the examiner’s hand braced against the patient’s face.
spiral turns. It contains the receptors for hearing.
b.3. Semi-circular canals – function in dynamic equilibrium (7) Schwabach Test – compares client hearing with that of the examiner (assuming that
examiner has normal hearing)
PHYSIOLOGIC CHANGES OF THE EAR WITH AGING
SYMPTOMS OF EAR DISEASES
1. Cerumen that accumulates in the external eat contribute to hearing loss
especially in low frequency range. DEAFNESS
2. Degeneration of the receptor cells in the Organ of Corti(Presbycussis) - means that the pt has a hearing loss which may be mild or severe
3. Ossicles may become less movable and interfere with transmission of sound - hearing loss may be conductive, sensorineural or mixed types
waves. - the most common causes of deafness in childhood is serious otitis media whereas in
4. Decrease in cochlear branch of thecranial nerve VII contributes to hearing loss; adults, presbycussis is the most common cause.
reduction in the vestibular branch interferes with balance and equilibrium. - Presbycussis means deafness of the elderly and it is a sensorineural hearing loss
5. Bacterial and viral infections in the temporal bone may cause sensorineural caused by the degeneration of the nervous tissue. It is more common among men,
hearing loss. over 50 years of age.
- Hearing loss in presbycussis is predominantly in the higher frequencies (high-pitched
sounds like women’s voice)
Ear Protection
-the most common and important type of occupational hearing loss is caused by loud MIDDLE EAR PROBLEM
noise.
- a sound intensity is measured in decibel. Ordinary speechis about 50 db. Noise over 70 o ACUTE OTITIS MEDIA
db is potentially damanging to the ear. -an inflammation and infection of the middle ear caused by the entrance of
pathogenic organisms, with rapid onset of signs and symptoms. It is a major
General Ear Care problem in children but it may occur at any age.
- Pathogenic organisms gain entry into the normally sterile middle ear, usually
- Ear is generally self-cleaning. Cerumen (earwax) lubricates the skin in the through a dysfunctional Eustachian tube.
auditory canal and entraps foreign material entering the canal - Most common organisms include Streptococcus pneumoniae, Haemophilus
- Clean the auditory canal only with a wet soft cloth over the tip of the finger. influenza and Staphylococcus aureus.
Do not insert anything to the auditory canal beyond the extent of vision.
- It is best to keep the eyes and mouth both open while blowing the nose to Clinical Manifestations:
reduce pressure that may force contaminated material up the Eustachian Pain and fever
tube and into the middle ear. Purulent drainage (Otorrhea) is present if tympanic membrane is
perforated
COMMON NURSING INTERVENTIONS RELATED TO THE EARS Irritability may be noted in the young person
Headache, hearing loss, anorexia, nausea and vomiting may be
- Administration of ear drops present
- Medications ofr the ear should be warmed to prevent discomfort. Do not Purulent effusion may be visible behind tympanic membrane may
overheat. be reddened on otoscopic examination.
- Instruct pt to turn head so that it is tilted away from the affected side. After Hx may reveal previous upper respiratory infection, allergic rhinitis
drops are instilled, the head is kept tilted for a few minutesto prevent leakage or smoking in household and sibling otitis media in children
of drop from the ear.
- Softening and removing cerumen deposits: Management:
*Daily instilling a few drops of Hydrogen peroxide or warmed gkycerin
Carbamine (urea). Peroxide in glycerol (Oebrox) may be used. Antibiotic tx – Amoxicillin is the 1st line of tx
If drainage occurs, an antibiotic otic preparation is usually prescribed.
Surgery: MYRINGOTOMY – an incision is made into the posterior inferior
aspect of the tympanic membrane for relief of persistent effusion. Surgery
Management: Management
Pt can be asked to keep a diary noting presence of aural symptoms (e.g.tinnitus, 1. Cerumen can be removed by irrigation, suction or instrumentation unless the
distorted hearing) when episodes of vertigo occur. This may help diagnose pt has a perforated eardrum or an inflamed external ear
which ear is involved and whether surgery will be needed. 2. For successful removal, the water stream must flow behind the obstructing
Administration of osmotic diuretics (Diamox) cerumen to move it first laterally and then out of the canal.
Administration of the vestibular suppressant to control symptoms: 3. If irrigation is unsuccessful, direct visual, mechanical removal can be performed
Meclizine (Antivert, Bonine) up to 25 mg qid 4. Instilling a few drops of warmed glycerine, mineral oil, or half-
Diphenhydramine (Benadryl 25 to 50 mg tid to qid strengthhydrogen peroxide into theear canal for 30 minutes can soften
Diazepam (Valium) 2 mg tid or 5 to 10 mg IM or IV (addictive cerumen before the its removal.
potential) 5. Use of cerumen curette, aural suction and a binocular microscope for
Streptomycin (I.M.) or gentamicin may be given to selectively destroy magnifications.
vestibular apparatus if vertigo is uncontrollable
Additional antiemetic, such as Promethazine (Phenergan), may be needed to
reduce nausea, vomiting and resistant vertigo.
For foreign objects
1. Irrigation for vegetable bodies and insects are contraindicated
2. Insect can be dislodged by instilling mineral oil
3. Mechanical removal and aural suction can be performed
4. Foreign bidy may have ti be extracted in the operating room with the pt under general
anesthesia.
o ACOUSTIC NEUROMA
- Is a benign tumor of the vestibular or acoustic nerve
- The tumor may cause damage to hearing and to facial movements and
sensations, Symptoms begin with tinnitus= and progress to gradual
sensorineural hearing loss.
- Tx includes surgical removal of the tumor via craniotomy
- Care is taken to preserve the function of the facial nerve
- Postop nursing care is similar to postoperative craniotomy care
- An acoustic neuroma expands out of the internal auditory canal, displacing the
cochlear, facial and trigeminal nerves located in the cerebellopontine angle.
- NOTE: After the surgery, the pt may experience asymmetry of the face d/t
affectation of the facial nerve. This will spontaneously be resolved in few
months.
- There will be dryness of the eye on the affected side and this eye will not be
able to produce tears for sometime. Artificial tears may be instilled into the eye
at regular basis to prevent corneal ulceration.
- There will be absent or diminished taste sensation d/t affectation of the facial
nerve.
PREOPERATIVE CARE
POSTOPERATIVE CARE
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