Indezine Template

Chapter 51
Care of Patients with Ear and Hearing Problems
Mrs. Marion Kreisel MSN, RNAdult Health 2 NU230Fall 2011

External Otitis
Painful condition caused when irritating or infective agents come into contact with the skin of the external earCommonly called swimmers earTreatment focused on reducing inflammation, edema, and pain with heat, bedrest, limited head movement, topical antibiotic and steroid therapy, and analgesics

Earwick

Furuncle
Localized external otitis caused by bacterial infection of a hair follicleHearing impaired if the lesion blocks the canal, most commonly cerumen (wax)Treatment with local and systemic antibiotics, heat application, earwick with one-half strength Burows solution to relieve pain, and possible incision and drainage

Perichondritis
Infection of the perichondrium, a tough, fibrous tissue layer that surrounds the cartilage and gives shape to the pinna

Cerumen or Foreign Bodies
Cerumen (wax) is the most common cause of an impacted canal. Other blockages include vegetables, beads, pencil erasers, insects.Irrigate canal with a mixture of water and hydrogen peroxide at body temperature for impacted cerumen; Cerumenex softens wax.Carefully remove foreign object.

Irrigation of the External Ear

Otitis Media
Three types of otitis media are:Acute otitis mediaChronic otitis mediaSerous otitis media

Nonsurgical Management
Quiet environmentBedrest with limited head movementHeat and cold applicationsSystemic and topical antibiotic therapyAnalgesicsAntihistaminesDecongestants

Surgical Management
Myringotomy is a surgical opening of the pars tensa of the eardrum.Operative procedure includes grommet (polyethylene tube) placed through the tympanic membrane.Postoperative carekeep external ear and canal free of other substances while the incision is healing, and keep head dry for several days.

Tympanic Membrane

Mastoiditis
Infection of the mastoid air cells caused by untreated or inadequately treated otitis mediaNonsurgical managementantibioticsSurgical managementsimple or modified radical mastoidectomy with tympanoplastyComplicationsdamage to cranial nerves, vertigo, meningitis, brain abscess, chronic purulent otitis media, and wound infection

Trauma
Trauma and damage to the eardrum and ossicles may occur by infection, by direct damage, or through rapid changes in the middle-ear cavity pressure.Eardrum perforations usually heal within 24 hours.Use preventive measures to protect the ear from trauma.

Neoplasms
Tumors are removed by surgery, which often destroys hearing in affected ear.Benign lesions are removed because, with continued growth of the neoplasm, other structures can be affected, damaging the facial or trigeminal nerve.When possible, reconstruction of the middle ear structures is performed.

Tinnitus
Continuous ringing or noise perception is one of the most common problems with ear or hearing disorders.Tinnitus cannot be observed or confirmed with diagnostic tests. When no cause is found, therapy focuses on masking the tinnitus with background sound, noisemakers, and music during sleeping hours.

Vertigo and Dizziness
Common manifestations of many ear disorders Advise patient to:Restrict head motions and move more slowlyMaintain adequate hydrationTake antivertiginous drugsPrevent loss-of-balance accidents

Labyrinthitis
Infection of the labyrinthMeningitis a common complication of labyrinthitisTreatment with systemic antibiotics, bedrest in a darkened room, antiemetics, antivertiginous medications, psychosocial support

Mnire's Disease
Tinnitus, one-sided sensorineural hearing loss, and vertigo occur in attacks that can last for several days.Nonsurgical management includes slow head movements, diet and lifestyle changes, smoking cessation.Drug therapydiuretics, nicotinic acid, antihistamines, antiemetics, intratympanic therapy with gentamycin and steroids.Meniett device.ATTACKS USUALLY COME WITHOUT WARNING

Mnires Disease: Surgical Management
Surgical management is a last resort because hearing in the affected ear is often lost from the procedure.Labyrinthectomy.Endolymphatic decompression.

Acoustic Neuroma
Benign tumor of eighth cranial nerveSurgical removal via craniotomyExtreme care taken to preserve the function of the facial nerve

Acoustic Neuroma (Contd)

Hearing Loss
One of the most common physical handicaps in North America.Common causes of conductive hearing lossany inflammation process or obstruction of the external or middle ear by cerumen or foreign objects.

Hearing Loss (Contd)
Common causes of sensorineural hearing lossloud noise, drugs, presbycusis, atherosclerosis, hypertension, prolonged fever, Mnire's disease, diabetes mellitus, and ear surgeryPathophysiologyEtiology and genetic riskIncidence/prevalenceHealth promotion and maintenance

Anatomy of Hearing Loss

Assessments
Tuning fork testsOtoscopic examinationPsychosocial assessmentLaboratory testsImaging assessmentOther diagnostic assessments such as audiogram

Nonsurgical Treatment of Hearing Loss
Early detectionDrug therapyAssistive devices:Hearing aidsCochlear implants

Surgical Treatment of Hearing Loss
Tympanoplasty:Postoperative care includes antiseptic-soaked gauze packed in the ear canal, clean dressing, patient flat with head turned to the side and the operative ear facing up for at least 12 hours after surgery, prescribed antibiotics, activity restrictions.

Tympanoplasty

Ear Surgery

Stapedectomy
A partial or complete stapedectomy with a prosthesis corrects hearing loss and is most effective for hearing loss related to otosclerosis.Hearing improvement may not occur until 6 weeks after surgery.

Stapedectomy (Contd)
Damage to cranial nerves, vertigo, and nausea and vomiting are common after surgery.Pain medications and antibiotics are often used.Safety measures should be implemented, and antivertiginous drugs should be given.

Community-Based Care
Home care managementHealth teachingHealth care resources

Chapter 51
NCLEX TIME

Question 1
An expected complication for the patient whowears earphones all day while working may be the development of:

External otitis Otitis mediaFuruncleMastoiditis

Question 2
A priority nursing intervention for a patient with tinnitus is: Evaluate medications for ototoxicity.Encourage music or soft white noise during sleeping hours.Acknowledge the psychological stressors of the disorder.Provide education on level of music to prevent hearing loss.

Question 3
A patient is complaining of ear pressure, dizziness, and decreased hearing. The nurse should:

Examine the ear for excessive ear wax (cerumen). Ask the patient if he is experiencing headaches, malaise, or pain. Establish a time line for the patients symptoms. Examine the patients hearing acuity.

Question 4
The older adult patient is expressing anxiety over his difficulty learning to lip-read. The nurse should:

Encourage the patient to verbalize his feelings related to his hearing loss.Ask the physician to give the patient an antianxiety agent.Encourage the patient to wear his eyeglasses when attempting to lip-read.Assess the patients coping mechanisms regarding his hearing loss.

Question 5
How many people ages 65 to 75 years are estimated to have some degree of hearing loss?

20% to 25%30% to 35%40% to 45%50% to 55%

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Answer: ARationale: Allergic external otitis is commonly associated with contact with earphones. There is no evidence that frequent use of earphones is connected with development of otitis media, furuncle, or mastoiditis.
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Answer: BRationale: Tinnitus is a challenging hearing condition that lacks exact diagnostic testing. Tinnitus can disturb sleep patterns. Thus offering soft music or white noise can help the patient sleep. Other interventions include reviewing medications that may exacerbate the condition or alter hearing, exploring the patients coping and stress related to the condition, and discussing noise levels that may muffle the ringing sensation without damaging hearing. Source: www.ata.org/index.php
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Answer: BRationale: Acute and/or chronic otitis media will have multi-symptom presentation that includes conductive hearing loss, pain, headaches, malaise, fever, dizziness, nausea, and vomiting. Excessive ear wax can obscure hearing acuity and is a common condition in older adults. Patients may develop chronic otitis media, and frequency/pattern of symptoms is important for treatment.
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Answer: CRationale: Because hearing is assisted by even minimal lip-reading, urge patients to wear their eyeglasses when talking with someone to see lip movement.
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Answer: BRationale: It is estimated that 30% to 35% of people ages 65 to 75 years have some degree of hearing loss.