EAR

Physical assessment

- external ear - otoscopic examination - gross auditory aquity (whisper test)

if conductive hearing loss (otosclerosis, OM) Webers

bad ears hear better

if sensorineural hearing loss (nerve damage) Webers

better ears hear better

Rinne normal

AC > BC

If conductive hearing loss (otosclerosis, OM): Rinne

AC (less than greater to) BC

if sensorineural hearing loss (nerve damage)

AC (greater than) BC

tinnitus

unwanted noise (buzzing, hissing, roaring) in the head or ear (one or both)

what can cause tinnitus

- otologic- CV- Thyroid - psychosocial diseases- HDL- Low B12 - head injury

meds that causes tinnitus

- ASA- Loop diuretics - many abx including aminoglycoside abx (gentamicin), alcohol, chemotherapy

dizziness

lightheadedness, altered sensation of orientation in space

vertigo

- illusion of motion of the person or surrounding - spinning - objects moving around

ataxia

failure of muscle coordination

ototoxicity

hearing loss, tinnitus, balance deficit common side effect of many meds (ASA, quinine, many IV abx, chemo)

syncope, fainting, LOC (passing out)

cardiovascular disease symptoms

causes of hearing loss

- genetic factors - acquired (TORCH) infections- trauma - chronic exposure to loud noise - age-related

conductive hearing loss

external or middle ear disorders - impacted cerumen, otitis media, otosclerosis

sensorineural hearing loss

damage to the cochlea or vestibulocochlear nerve

functional (psychogenic) hearing loss

no detectable structural change

s/s of hearing loss

- progressive difficulty hearing high pitched sounds, worse hearing in groups, failure to response - tinnitus - communication deficits (inattention, speaking loudly, cupping the ear) - social isolation

recognizing and managing risk factors (hearing loss)

- low birth weight (children at risk need routine audiometry for speech implications) - family history- ototoxic meds - recurrent ear infections- bacterial meningitis - chronic exposure to loud noise (occupational & ear protection) - traumatic perforation of TM

Speech reading

lip reading - stand in front of the pt facing them and ensure that they have their glasses on - if you have to masked use a picture board or write it out

hearing aids

- become familiar with pts device, proper use, check for malfunction - know what part may be washed/wiped; skin care - DO NOT lose them - manual dexterity

screaming

does not help; high pitch is harder to hear- speak slowly and distinctly

which side is better

- get to know your patient and stand closer to the better ear- ensure ears are clear of cerumen

what does impacted cerumen look like?

black, looks like tar

external otitis is common in who?

swimmers

s/s of cerumen impaction

- otalgia (pain/fullness) - hearing loss

mgmt of serum impaction

- cerumenolytic meds: carbide peroxide (debrox) OTC with/without irrigation TID - warm water irrigation - instrumentation

irrigation education

how to clean the ear, avoid inserting any forge in object into the ear canal

use warm water to irrigate to prevent

n/v, vertigo, and discomfort

before irrigation, you should visualize?

TM (to ensure intactness) prior and after treatment

irrigate gently to avoid damage to

TM

s/s of external otitis

otalgia, discharge, tenderness, pruritus, hearing loss (severe: fever, cellulitis, lymphadenopathy) - otoscope: erythema, edema

mgmt of external otitis

- analgesic - antimicrobial/antifungal ear drops - corticosteroids (Online with bacterial infection)

education for external otitis

how to clean the ear, keeping the ear dry

complicaitons of external otitis

otitis media deeper (malignant external otitis) temporal bone osteomyelitis which can be fatal

prevention of external otitis

- wear ear plugs when swimming - no hairspray - no makeup around the ear - don't let pets lick you around the ear

acute otitis media

acute infection of middle ear common in children

s/s of acute otitis media

- purulent drainage in the middle ear --> hearing loss- otalgia (sudden relief = TM perforation and drainage) - fever

pain mgmt for acute otitis media

PO NSAIDs, warm compress PO abx

surgical mgmt for acute otitis media

myringotomy (ear tube) to relieve middle ear pressure, fluid, pain

nursing for acute otitis media

assess/monitor for deeper infection (meningitis), osteromyeltisis of mastoid

risk factors for acute otitis media

- children age 6 months to 2 years- daycare settings - bottle fed babies - especially while lying down - seasonal factors (fall & winter) - poor air quality - exposure to smoke or high levels of pollution - family history

complications of otitis media

- impaired hearing - speech or developmental delays - spread on infection

serous otitis media

- caused by Eustachian tube obstruction --> negative pressure in the middle ear - may be secondary to CA/radiation affecting Eustachian tube, barotrauma (pressure change in scuba diving, airplane descent)

s/s of serous otitis media

hearing loss, fullness in ear TM pulled inward (early) bulging out with effusion (late)

mgmt for serous otitis media

- manage infection - surgical: ringotomy to relieve middle ear pressure, fluid, pain - PO corticosteroid for inflammation - decongestants: not effective

otosclerosis

abnormal spony bone formation around the oval window --> fixation of stapes (stirrup) - progressive hearing loss, better bone conduction than air conduction (Rinne)

mgmt of otosclerosis

- hearing aid - surgical (replacing stapes with prosthesis)

motion sickness

disturbance of equilibrium caused by vestibular overstimulation - constant motion (car, ship)

s/s of motion sickness

sweating, pallor, n/v

mgmt for motion sickness

antihistamines: dimenhydrinate (dramamine), meclizine (antivert) anticholinergics: scopolamine patch (transderm scop)

meunière disease

inner ear fluid imbalance

s/s of meunière disease

episodic vertigo, tinnitus, fluctuating hearing loss, N/V, diaphoresis, waking up with vertigo

meunière disease mgmt

- ensure safety (prevent falls, accidents while driving) {sit down as soon as feeling dizzy) - low sodium diet - meds that may cause tinnitus: ASA, loop diuretics - antihistamines: dimenhydrinate (Dramamine), Meclizine (antivert)

teaching for meclizine

don't operate macherinary or drive, cut back on sodium, no caffeinated drinks

Benign Paroxysmal Positional Vertigo (BPPV)

sudden vertigo associated with head movement - associated with debris (calcium carbonate) collected in the inner ear

s/s of BPPV

vertigo, N/V

mgmt of BPPV

- prevent trauma & injury due to fall and accidents, walking with cane, sit if feeling dizzy, risk of MVC- PT referral: epley manuever once leanred, may do independetly

meds for BPPV

antihistamines: dimenhydrinate (dramamine), meclizine (antivert)

aural rehabilitation

maxime communication skills

presbycusis

progressive hearing loss associated with aging