1
Q
function of ear
A
- promote auditory sensory perception which occurs when sound is delivered through air to external canal
- sound waves strike eardrum
- receptors at cochlea change vibrations into action and are conducted to brain as nerve impulses
2
Q
how often should older adults be screened for hearing acuity?
A
on a regular basis
3
Q
age-related changes in the ear
A
- drier, impacted cerumen
- loss of tympanic membrane elasticity
- degenerative changes of pinna and cochlea
- diminished hearing acuity
- disturbed vestibular function
- decreased ability to hear high-frequency sounds
4
Q
conductive hearing loss: causes
A
- cerumen
- foreign body
- edema
- infection
- tumor
- perf tympanic membrane
5
Q
conductive hearing loss: assessment findings
A
- evidence of obstruction with otoscope
- abnormal tymp membrane
- speaking softly
- hearing better in noisy places
*No permanent damage/hear loss
6
Q
sensorineural hearing loss: causes
A
- prolonged exposure to noise
- presbycusis
- ototoxic drugs
- Menieres disease
- Acoustic neuroma
- DM
7
Q
sensorineural hearing loss: assessment findings
A
- normal appearance of external canal and tymp membrane
- occasional dizziness
- speaking loudly
- hearing poorly in loud places
*Hearing loss often permanent
8
Q
which type of hearing loss is often permanent?
A
sensorineural
9
Q
assessment clues of hearing loss
A
- during interview, face patient and assess their posture and responses: tilting head to one side or leaning forward
- ask questions about any history of hearing issues, exposure to loud noise
- ask questions about meds- anything ototoxic like NSAIDS, diuretics, or certain antibiotics
10
Q
tests to assess hearing
A
- voice test
- watch test
- tuning fork tests: weber, rinne
- audiometry
11
Q
weber test
A
- tuning fork hearing test used to screen for conductive or sensorineural hearing loss
- heard midline
12
Q
rinne test
A
- tuning fork hearing test used to screen for conductive or sensorineural hearing loss
- positive in healthy individuals: indicates air conduction is more beneficial than bone conduction
13
Q
gross hearing acuity tests
A
- assess clients response to normal voice tones
- watch tick test
- tuning fork tests: weber’s test, Rinne test
14
Q
non-surgical/medical interventions for hearing loss
A
- early detection
- safety measures (d/t hearing loss)
- medications
- assistive devices: hearing aids
15
Q
surgical interventions for hearing loss
A
- tympanoplasty
- implants (ie cochlear devices)
16
Q
tympanoplasty
A
microsurgery ― surgery using a microscope or endoscope― to fix holes in the eardrum that do not heal on their own
17
Q
cochlear implant
A
A cochlear implant is an implanted electronic hearing device, designed to produce useful hearing sensations to a person with severe to profound nerve deafness by electrically stimulating nerves inside the inner ear
18
Q
interventions for hearing loss
A
- surgical
- nonsurgical
- maximize communication
- community resources (support groups)
19
Q
how can you maximize communication in a patient with hearing loss?
A
- lip-reading
- sign language
- collaborate with speech therapist/audiologist
- manage anxiety
20
Q
3 types of otitis media
A
- acute
- chronic
- serous
21
Q
acute otitis media
A
- sudden onset of ear pain
- lasts a few days - few weeks (depending on if receive treatment)
- treatment: oral antibiotics (amoxicillin)
22
Q
chronic otitis media
A
- continually getting acute otitis media several times a year
- treatment: tubes put into ears
23
Q
serous otitis media
A
- typical inflammation of otitis media but with fluid build up in middle ear
24
Q
otitis media: assessment
A
- ear pain: most common sx
- patient may report tinnitus, HA, malaise, fever, N/V, dizziness
- otoscopic findings will vary depending on the condition’s stage
- eardrum may be spontaneously perforated
25
otitis media: nonsurgical management
- quiet environment
- bedrest with limited head movement
- heat and cold applications
- systemic and topical antibiotic therapy
- analgesics
- antihistamines
- decongestants
26
earwick
If the ear canal is very swollen, it can make using ear drops difficult. Your doctor may insert a tiny sponge called an ear wick into the canal to help carry the medicine into the ear.
27
irrigation of the external ear
a procedure in which nurses flush their patient's ear canal with sterile water or saline solution
28
surgical management of otitis media
myringotomy
- surgical opening of the pars tensa of the eardrum
- operative procedure includes grommet (polyethylene tube) placed through the tympanic membrane to drain fluid from ears
29
post-operative care (post-myringotomy)
- keep external ear and canal free of other substances while the incision is healing
- keep head dry for several days
- no showering!
30
mastoiditis
infection of mastoid air cells caused by progressive otitis media
31
clinical manifestations of mastoiditis
- swelling behind ear
- pain when moving ear or head
- red, dull, thick, immobile eardrum
32
treatment of mastoiditis
- antibiotics
- surgical removal of infected tissue if no response to antibiotics
33
tinnitius
continuous ringing or noise perception
- cannot be observed or confirmed with dx tests
- one of the most common problems with ear or hearing disorders
34
one of the most common problems with ear or hearing disorders
tinnitus
35
diagnostic tests for tinnitus
there are none
- cannot be observed or confirmed with dx tests
*continuous ringing is the typical dx sx
36
if no cause of tinnitus is found, therapy focuses on ___
- masking the tinnitus with background sound, noisemakers, and music during sleeping hours
37
common manifestations of many ear disorders
- vertigo
- dizziness
38
if a patient feels vertigo or dizziness, advise them to
- restrict (fast) head motions and move more slowly
- maintain adequate hydration
- take anti-vertiginous drugs (on an as needed basis)
- prevent loss-of-balance accidents
39
Ménière's Disease
condition with classic trio of symptoms:
1. tinnitus
2. one-sided sensorineural hearing loss
3. vertigo
- occur in attacks that can last for several days
- common in adults 20-40 years old
40
Ménière's Disease: nonsurgical management
- slow head movements
- diet (low sodium/salt) and lifestyle changes
- smoking cessation
41
Ménière's Disease: drug therapy
- *diuretics (Furosemide)
- nicotinic acid
- antihistamines (Meclizine)
- *antiemetics (Meclizine, Promethazine, Ondansetron)
- intratympanic therapy with gentamycin and steroids.
*most common
42
Ménière's Disease: surgical management
- labyrinthectomy
* last resort because hearing in the affected ear is often lost from the procedure
43
Ménière's Disease: Meniett device
The Meniett device is a minimally invasive, nondestructive treatment that may be used to provide longer-term reduction of vestibular symptoms in patients with Ménière's disease
44
most common cause of impacted ear canal
cerumen
45
symptoms of impacted ear canal
- fullness of ear with or without hearing loss
- may have pain
- itching
- dizziness
- bleeding from the ear
46
management of impacted ear
- referral to ENT
- liquid agents that can dissolve the wax in the ear: cerumenolytic agent
- watchful waiting
- manual removal
47
if mastoiditis is not treated, complications:
- brain abscess
48
causes of tinnitus
- age
- ototoxic drugs: NSAIDS (ASA, Ibup), diuretics (lasix), certain antibiotics (ie. genomyacin)
- loud noise
49
common in adults 20-40 years old
Ménière's Disease
NU 340
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