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A. Description
B. ETIOLOGY
C. PATHOPHYSIOLOGY
↓↓↓
↓↓↓
Hearing Loss
Clinical manifestations :
Medical Management/Treatment:
a. HEARING AIDS
b. Other Aids : Alert and signal devices, assisted – listening devices from
telephone companies
D. NURSING MANAGEMENT:
1. Instruct the client about the correct way to remove impacted cerumen
6. Discuss, prepare and assist the client with ostosclerosis for surgery, as
indicated
Diagnosis :
1. Tuning Forks
2. Audioscopes
b. Other Aids : Alert and signal devices, assisted – listening devices from
telephone companies
CLINICAL MANIFESTATIONS
MANAGEMENT
.Use of hearing aids or other assistive devices can help many clients
with hearing deficits by amplifying the sound presented to the
hearing apparatus of the ear
.
NURSING MANAGEMENT
.Encourage to talk about the loss of hearing and its effect on activities
of daily living
.Provide information about the type of hearing loss
.Encourage to interact with friends and family on a one-to-one basis in
quiet settings
.Treat with dignity and remind friends and family that a hearing
deficit
does not mean of mental faculties
.Involve in activities that do not require acute hearing, such as
checkers and chess
.Refer client to an audiologist for evaluation and possible hearing-aid
fitting
OTITIS EXTERNA
↓ ↓
Entry and Growth of Infectious Agents
↓
Inflammation and Infection of an External Ear
Clinical Manifestations:
-otalgia
-aural fullness
-itching
-ear discharge initially clear and odorless, but quickly becomes
purulent and foul smelling)
-decreased hearing
-tinnitus
-tragal tenderness with manipulation
-erythematous and edematous external auditory canal
-presence of spores and hyphae if etiology is fungal
-fever (uncommon)
Complications:
NURSING MANAGEMENT:
Preventive Measures :
Stay out of the water until the acute inflammatory process
is completely resolved
Take precautions to keep the ear canal dry while in the water
immediately after swimming, dry the ear canal
Do not insert cotton swabs or other objects into the ear canal to
dry it. This removes the protective layer of cerumen and may
damage the skin of the canal, increasing the risk of bacterial
infection.
PHARMACOLOGIC MANAGEMENT:
PATHOPHYSIOLOGY :
Repeated episodes of ACM
CLINICAL MANIFESTATIONS
1. Painless or dull ache and tenderness of mastoid.
2. Otorrhea may be odorless or foul smelling.
3. Vertigo and pain may be present if CNS complications
have occurred.
4. History will indicate several episodes of acute otitis
media, possible rupture or tympanic membrane.
5. Fever and postauricular erythema and edema.
DIAGNOSTIC EVALUATION
MANAGEMENT
Note: If advanced chronic ear disease is left untreated,
inner ear and life-threatening CNS complications may
develop because of erosion of surrounding structures.
Medical Therapy
1. Antibiotic and steroid eardrops may control middle ear
infection and inflammation, but once mastoiditis
develops, parenteral antibiotic therapy is necessary.
2. Eardrops containing neomycin, garamycin, tobramycin,
and quinolones such as Ciprofoxacin (cipro) are
instilled into the middle ear when the tympanic
membrane is ruptured.
3. IV antibiotics must cover beta-lactase-producing
organisms-ampicillin-sulbactam (Unasyn), cefuroxime
(Ceftin).
4. Frequent removal of epithelial debris and purulent
drainage may protect tissue from damage.
SURGICAL INTERVENTIONS
1. Indicated when cholesteatoma is present.
2. Indicated when there is pain, profound deafness,
dizziness, sudden facial paralysis, or stiff neck (may
lead to meningitis or brain abscess).
3. Types of procedures:
a. Simple mastoidectomy-removal of diseased bone
and insertion of a drain; indicated when there is
persistent infection and signs of intracranial
complications.
b. Radical mastoidectomy-removal of posterior wall
of ear canal, remnants of the tympanic
membrane, and the malleous and incus.
c. Posteroanterior mastoidectomy-combines simple
mastoidectomy with tympanoplasty
(reconstruction of middle ear structures).
COMPLICATIONS
NURSING ASSESSMENT
1. Assess for history of ear infection and treatment
compliance.
2. Assess for ear drainage, patency of tympanic
membrane
3. Assess for hearing loss
4. Palpitate for mastoid tenderness
MASTOIDITIS
Incidence : children
The infection may spread from the ear to the mastoid bone of the
skull. ↓
The mastoid bone fills with infected materials and its honeycomb-
like structure may deteriorate.
Symptoms
SURGERY ;
• Dizziness or vertigo
• Epidural abscess
• Facial paralysis
• Meningitis
• Partial or complete hearing loss
• Spread of infection to the brain or throughout the body
Prevention
Promptly and completely treating ear infections reduces the risk of
mastoiditis.
LABYRINTHITIS
PATHOPHYSIOLOGY
DIAGNOSTIC EVALUATION
MANAGEMENT
COMPLICATIONS
NURSING DIAGNOSIS
NURSING INTERVENTIONS:
Preventing Injury
MINIMIZING ANXIETY
ENCOURAGING SELF-CARE
OUTCOME-BASED EVALUATION
MENIERE’S DISEASE
Meniere’s disease (endolymphatic hydrops) is a chronic
disease that involves the inner ear and causes a triad of
symptoms—vertigo, hearing loss, and tinnitus.
Incidence :
PATHOPHYSIOLOGY :
CLINICAL MANIFESTATIONS
DIAGNOSTIC EVALUATION
MEDICAL MANAGEMENT
SURGICAL
1. Conservative-simple endolymphatic sa
decompression or endolymphatic subarachnoid or
mastoid shunt to relieve symptoms without
destroying function.
2. Destructive surgery;
a. Labyrinthectomy-recommended if the patient
experiences progressive hearing loss and severe
vertigo attacks so normal tasks cannot be
performed; results in total deafness of affected
ear.
b. Vestibular nerve section-neurosurgical
suboccipital approach to the cerebellopontine
angle for intracranial vestibular nerve
neurectomy.
COMPLICATIONS
NURSING ASSESSMENT
1. Assess for frequency and severity of attacks.
2. Provide screening hearing tests.
3. Evaluate effect on patient’s activities, potential for
fall or injury.
NURSING DIAGNOSIS
NURSING INTERVENTIONS
Ensuring Safety
OTOSCLEROSIS
-is a pathologic condition in which there is formation of
new spongy bone in the labyrinth, fixation of the stapes, and
prevention of sound transmission through the ossicles to the
inner fluids, resulting in deafness.
PATHOPHYSIOLOGY :
MANAGEMENT
PRESBYCUSIS
PATHOPHYSIOLOGY :
MANAGEMENT :
ACOUSTIC NEUROMA
- slow growing benign, tumor of CN VIII, arise from
Schwann cells of vestibular portion of the nerve
Assessment
Diagnostic Exams
MRI
CT scan
Management
1. surgery
SINUSITIS
PATHOPHYSIOLOGY :
viral upper respiratory infection / nasal allergy
↓
Allergic reaction
↓
Inflammation of sinuses
CLINICAL MANIFESTATIONS
Acute Sinusitis
1. Pain—stabbing or aching, over the infected sinus and
referred to face and head.
2. Nasal congestion and discharge; may or may not be
present
3. Anosmia (lack of smell); inspired or expired air cannot
reach the olfactory groove
4. Red and edematous nasal mucosa
5. May have fever
CHRONIC SINUSITIS
DIAGNOSTIC EVALUATION
1. Sinus x-rays and CT Scan show air-fluid level in acute
sinusitis; thickening of sinus mucous membranes,
opacification,and anatomic obstruction patterns in
chronic sinusitis.
2. Antral puncture and lavage-provides culture material
to identify infectious organism; also a therapeutic
modality to clear of bacteria, fluid, and inflammatory
cells.
3. Nasal and sinus endoscopy (the sinuses can be easily
accessed after the patient has had an antrostomy).
MANAGEMENT
COMPLICATIONS
Depend on anatomic location of sinus involved.
1. Extension of infection to the orbital contents and
eyelids.
2. Bone infection (osteomyelitis) may spread by direct
extension or through blood vessels. Frontal bone
commonly affected.
RHINITIS
PATHOPHYSIOLOGY
Allergic type
Allergen inhaled
↓
Triggers antibody production
↓
Antibodies bind to mast cells,
↓
Mast cells stimulated
↓
Allergic reaction
↓
Histamine and other chemicals released
↓
Itching, swelling and mucus production
CLINICAL MANIFESTATIONS
MANAGEMENT
EPISTAXIS
-refers to nosebleed or hemorrhage from the nose.
PATHOPHYSIOLOGY
1. Local Causes:
a. Dryness leading to crust formation-bleeding
occurs with removal of crusts by nose picking,
rubbing or blowing.
b. Trauma-direct blows
DIAGNOSTIC EVALUATION
MANAGEMENT
COMPLICATIONS
NASAL OBSTRUCTION
PATHOPHYSIOLOGY
PF:
.Allergic reaction
.Common cold or influenza
.Hay fever, allergic reaction to pollen or grass
.Sinusitis or sinus infection
S/SX
-Breathing difficulty
-Blocked nose
-Runny nose
-Decreased sense of smell
-Postnasal drip
DRUGS
SURGERY
DIAGNOSTICS
NSG MGMT