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