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EARS

Alvarillo, Dana
Mappatao, Kam
Siervo, Christine
ANATOMY
PHYSIOLOGY

• Hearing is the process by which • The ossicles push against the oval
the ear transforms sound window, displacing fluid within the
vibrations in the cochlea
external environment into nerve • Movement of the cochlear fluid
impulses that are conveyed to the affects the position of cilia on
brain, where they are interpreted sensory hair cells
as sounds.
• Sound travels as pressure waves in • Activation of the hair cells
the air which push the membrane generates nerve impulses which
of the eardrum, causing it to are transmitted via the auditory
vibrate nerve to the brain
• The ear drum pushes on the bones • The kinetic motion of the cochlear
of the middle ear (the ossicles), fluid is dissipated by the
which magnify the vibrations (~ 20 movement of the round window
times)
PHYSIOLOGY
HEARING LOSS
• 1. Conductive Hearing Loss - hearing loss caused by diseases found in
the external or middle ear
• 2. Sensory Hearing Loss - hearing loss caused by problems in the
cochlea
• 3. Neural Hearing Loss - hearing loss caused by damage to any neural
pathway that leads to the auditory nerve then to the brain
• 4. Sensorineural Hearing Loss - hearing loss arising from either
problems in the inner ear or neural pathway
FACTORS
• ABC’s of Hearing Loss Risk Factors
A – APGAR score of less than 5 in 5 minuted
B – Bacterial Infection
C – Congenital Hearing Impairment
D – Defects of the head and neck
E – Elevated bilirubin level
F – Gram weight of less than 1500 grams
H – History of NICU confinement
I – Intake of ototoxic drugs
DIAGNOSIS
• Physical Exam
• General screening tests
• Tuning fork tests
• Audiometer tests
TREATMENT
• Removing earwax blockage
• Surgical procedures
• Hearing aids
• Cochlear implants
OTITIS MEDIA
DESCRIPTION
• Infections of the middle ear are one of the most common reasons for
children to see a doctor.
FACTORS

Risk Factors Contributing Factors


• being between air pollution • Children are more likely to have
6 and 36 months • experiencing ear infections like otitis media that
old changes in come from bacteria or viruses than
• using a pacifier climate adults because of their developing
ear anatomy.
• attending • being in a cold
daycare climate
• being exposed • having had a
to cigarette recent cold, flu,
smoke sinus, or ear
• being exposed infection
to high levels of
MANIFESTATIONS
• crying • fluid drainage from the ear
• irritability • a fever
• sleeplessness • vomiting
• pulling on the ears • diarrhea
• ear pain • irritability
• a headache • a lack of balance
• neck pain • hearing loss
• a feeling of fullness in the ear
DIAGNOSTICS AND LABS
• Otoscope- the doctor uses an instrument called an otoscope to look into
your child’s ear and detect:
• redness
• swelling
• blood
• pus
• air bubbles
• fluid in the middle ear
• perforation of the eardrum
DIAGNOSTICS AND LABS

• Tympanometry
• determines if the eardrum is ruptured.
• Reflectometry
• determines if there’s fluid in the ear by listening to the sound reflected
back from the ear.
• Hearing test
• determines if the patient is experiencing hearing loss.
NURSING DIAGNOSIS
• 1. Acute Pain / Chronic Pain related to the inflammatory process.
• 2. Impaired verbal communication related to the effects of hearing loss.
• 3. Disturbed Sensory perception: hearing related to obstruction, infection of the
middle ear or auditory nerve damage.
• 4. Risk for injury related to hearing loss, decreased visual acuity.
• 5. Anxiety related to surgical procedure, diagnosis, prognosis, anesthesia, pain,
loss of function, the possibility of a greater hearing loss after surgery.
NURSING MANAGEMENT
• Assess the level of intensity of the client and client's coping
mechanisms.
• Give analgesics as indicated.
• Distract the patient by using relaxation techniques: distraction, guided
imagination, touching
• Provide good lighting when the client relies on the lips.
• Using the signs of non-verbal and other communications.
• Instruct family or the people closest to the client on how techniques of
effective communication so that they can interact with clients.
• If patient is notably disturbed, consider using a special safety bed that
surrounds patient.
OTHER MANAGEMENT
• Medication- prescribes eardrops for pain relief and other pain relievers.
- prescribe antibiotics if your symptoms don’t go away after a
few days of home treatment.
• Surgery
• Adenoid removal- adenoids be surgically removed if they’re enlarged
or infected due to recurrent ear infections.
• Ear tubes- insert tiny tubes in the patient’s ear. The tubes allow air and
fluid to drain from the middle ear.
MÉNIÈRE'S DISEASE
DESCRIPTION
• a chronic disorder of the inner ear involving sensorineural hearing loss,
severe vertigo and tinnitus
FACTORS

Risk Factors Associated with


• Unknown • Aging
• Middle-ear infection
• Head trauma
MANIFESTION
• Sudden episodes of severe whirling vertigo, with an inability to stand or
walk; episode may last up to several hours
• Buzzing tinnitus (worsens before and during an episode)
• Nausea & vomiting
• brief loss of consciousness
DIAGNOSIS & LABS
• Audiometric testing reveals sensorineural hearing loss
NURSING DIAGNOSIS
• Risk for injury related to altered mobility.
• Risk for fluid volume imbalance and deficit related to increased fluid
output
• Ineffective coping related to personal vulnerability and unmet
expectations stemming from vertigo.
NURSING MANAGEMENT
• Provide nursing care during acute attack.
• Provide a safe, quiet, dimly lit environment and enforce bed rest
• Provide emotional support and reassurance to alleviate anxiety
• Administer prescribed medications, which may include antihistamines,
antiemetics, and possibly, mild diuretics
• Instruct the client on self-care instructions to control the number of
acute attacks.
• Discuss the nature of the disorder
• Discuss the need for a low-salt diet
• Explain the importance of avoiding stimulants and vasoconstrictions
(e.g. caffeine, decongestants, alcohol)
• Discuss, prepare and assist the client with surgical options.
OTHER MANAGEMENT
• Pharmacologic therapy
• Tranquilizers and antihistamines such as meclizine (Antivert) to control
vertigo and to suppress the vestibular system
• antiemetics for nausea and vomiting
• Diuretics to lower pressure in the endolymphatic system
• Vasodilators are often used in conjunction with other therapies
• streptomycin, gentamicin to eliminate vertigo
• Dietary Management- Low sodium (2,000 mg/day)
• Avoidance of alcohol, nicotine and caffeine
OTHER MANGAMENT

• Surgical Management
• Endolymphatic sac decompression or shunt Middle and inner ear
perfusion with placement of intraotologic catheters for drainage and
infusion of medication
• Labyrinthectomy (destruction of inner ear)Vestibular nerve section
(8th cranial nerve)
• An endolymphatic decompression consists of draining the
endolymphatic sac and inserting a shunt to enhance the fluid drainage
CANCERS OF THE EAR
DESCRIPTION
• There are different types of cancers (carcinomas and
melanomas) that can affect the ear.
• Most ear cancers are squamous cell carcinoma on the outer
ear, but basal cell carcinoma and malignant melanoma can
also occur inside the ear.
• Cancers of the ear usually occur on the skin of the outer ear.
OUTER EAR

Symptoms Cause Treatment


• Scabbed area of • Long • Surgery
skin that is periods • If the
jagged and of time in cancer is
irregular with the sun confined
crusting and
to the
• This area may be outer
present for many edge of
years and may or the ear,
may not be no
associated with a treatment
swelling or lump
in the neck.
AUDITORY CANAL

Symptoms Cause Treatment


• Discharge from • Unknown—but • Surgery to
the ear canal, may be more remove
often tinged with common in parts of the
blood adults with middle ear
• Hearing loss long history of
outer ear
• Sometimes facial infections
paralysis on the
side of the
affected ear
• Earache
MIDDLE EAR

Symptoms Cause Treatment


• Discharge from • Unknown—but • Surgery
ear for long may be more • Radiation,
period of time common in which targets
• Recent blood adults with rays of energy
stained history of at small areas
discharge discharge from of cancer
ears for long cells that
• Hearing loss periods of might not
• Sometimes facial time. have been
paralysis removed
during
surgery.
DIAGNOSIS & LABS
• Biopsy of the tumor
• Imaging tests, such as CT or MRI scans, are necessary to determine the
extent of the cancer.
NURSING DIAGNOSIS
• Impaired skin integrity related to presence of carcinoma/melanoma
• Fear/Anxiety related to threat of death (cancer)
NURSING MANAGEMENT
• Assess skin frequently for side effects of cancer therapy; note
breakdown and delayed wound healing.
• Avoid rubbing or use of soap, lotions, creams, ointments, powders on
area
• Encourage patient to share thoughts and feelings.
• Provide open environment in which patient feels safe to discuss
feelings or to refrain from talking.
• Maintain frequent contact with patient. Talk with and touch patient as
appropriate.
• Explain the recommended treatment, its purpose, and potential side
effects. Help patient prepare for treatments.
• Promote calm, quiet environment.
OTHER MANAGEMENT
• Medical
• Radiotherapy
• Chemotherapy
VESTIBULAR NEURITIS
DESCRIPTION
• Disorder that affects the nerve of the inner ear called the
vestibulocochlear nerve
FACTORS

Risk Factors Associated with


• can occur in people of all ages, but • Viral infection of the inner ear
is rarely reported in children. • Viral infection that has occurred
elsewhere in the body
MANIFESTION
• Sudden, severe vertigo
• Dizziness
• Balance difficulties
• Nausea, vomiting
• Concentration difficulties
DIAGNOSIS & LABS
• hearing tests
• Vestibular (balance) tests and a test to determine if a portion of the
vestibulocochlear nerve has been damaged.
• Head thrust test, examines how difficult it is to maintain focus on objects
during rapid head movements
NURSING DIAGNOSIS
• Risk for infection
• Risk for fall/injury related to difficulty in balance
NURSING MANAGEMENT
• Wash hands and teach patient and SO to wash hands before contact
with patients and between procedures with the patient.
• Encourage intake of protein-rich and calorie-rich foods.
• Place the patient in protective isolation if the patient is at very high
risk.
• Move items used by the patient within easy reach, such as call light,
urinal, water, and telephone.
• See to it that the beds are at the lowest possible position.
• Allow the patient to participate in a program of regular exercise and
gait training.
• Ask family to stay with the patient.
• Teach client how to safely ambulate at home, including using safety
measures such as handrails in bathroom.
OTHER MANAGEMENT
• Medical
• Treatment consists of managing the symptoms of vestibular neuritis,
treating a virus (if suspected), and participating in a balance
rehabilitation program.
• Pharmacologic
• To reduce nausea include ondansetron and metoclopramide
• To reduce dizziness, drugs such as meclizine, diazepam, compazine
and lorazepam
• Antiviral medicine such as acyclovir is used.
NOTES
• Vestibular neuritis and labyrinthitis are closely related disorders.
• Labyrinthitis involves the swelling of both branches of the
vestibulocochlear nerve that affects balance and hearing.
• The symptoms of labyrinthitis are the same as vestibular neuritis plus the
additional symptoms of tinnitus (ringing in the ears) and/or hearing loss.