Nursing Assessment: Ear Function and Hearing Loss
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Questions and Answers

What does the Weber test indicate when sound is heard best in the affected ear?

  • Mixed hearing loss
  • Sensorineural hearing loss
  • Conductive hearing loss (correct)
  • Normal hearing function

In the Rinne test, what does it mean if air conduction is audible longer than bone conduction in the affected ear?

  • Ideal hearing function
  • Acute ear infection
  • Sensorineural hearing loss (correct)
  • Conductive hearing loss

Which part of the ear is primarily assessed by the vestibular system in maintaining balance?

  • External ear
  • Middle ear
  • Inner ear (correct)
  • Eustachian tube

What effect does the hardening of cerumen have on hearing?

<p>Causes earwax accumulation leading to hearing impairment (D)</p> Signup and view all the answers

Which of the following describes a function of a cochlear implant?

<p>Bypasses damaged hair cells in the cochlea. (A)</p> Signup and view all the answers

Which assessment technique is used to evaluate hearing loss by whispering from a distance?

<p>Whisper test (D)</p> Signup and view all the answers

What is a common issue patients may experience with hearing aids?

<p>Whistling noises. (A)</p> Signup and view all the answers

Which intervention is important during the nursing management of a patient with hearing loss?

<p>Maintaining a quiet environment. (A)</p> Signup and view all the answers

What is a common complaint that may indicate hearing loss during a nursing assessment?

<p>Earache (A)</p> Signup and view all the answers

What may happen to older adults in relation to balance due to changes in vestibulospinal reflexes?

<p>Progressive imbalance leading to increased falls (D)</p> Signup and view all the answers

In post-operative care for tympanic membrane perforation, which practice should be avoided?

<p>Showering without ear protection. (C)</p> Signup and view all the answers

What should a nurse educate a patient about following tympanoplasty?

<p>Temporary hearing loss can occur due to residual packing. (C)</p> Signup and view all the answers

How does presbycusis affect communication in elderly patients?

<p>Causes loss of ability to discriminate words (D)</p> Signup and view all the answers

Which of the following is NOT a recommended practice for patients with cerumen impaction?

<p>Using cotton swabs for ear cleaning. (A)</p> Signup and view all the answers

What is a primary clinical manifestation of tympanic membrane perforation?

<p>Whistling sounds when sneezing. (B)</p> Signup and view all the answers

Which procedure assesses the function of the vestibular system?

<p>Vestibular assessment tests. (B)</p> Signup and view all the answers

What is the primary purpose of the Sinusoidal Harmonic Acceleration test?

<p>To evaluate balance and motion sensitivity (A)</p> Signup and view all the answers

Which of the following is NOT a risk factor for hearing loss?

<p>Infrequent earwax removal (B)</p> Signup and view all the answers

Which symptom is commonly associated with early manifestations of deafness?

<p>Tinnitus or ringing in the ears (D)</p> Signup and view all the answers

What physiological change can contribute to hearing loss in older adults?

<p>Atrophy of the tympanic membrane (A)</p> Signup and view all the answers

Which statement accurately defines sensorineural hearing loss?

<p>It's linked to dysfunction of the inner ear or auditory nerve. (D)</p> Signup and view all the answers

What is a potential psychological effect of hearing loss?

<p>Social withdrawal and loneliness (C)</p> Signup and view all the answers

How does chronic exposure to loud volume using headphones affect hearing?

<p>It may result in permanent sensorineural hearing loss. (C)</p> Signup and view all the answers

During a focused assessment of patients with hearing loss, which behavior should be observed as a potential indicator?

<p>Indifference and social withdrawal (A)</p> Signup and view all the answers

Which of the following is NOT classified as an ototoxic substance?

<p>Ibuprofen (B)</p> Signup and view all the answers

What is the primary cause of Benign Paroxysmal Positional Vertigo?

<p>Disruption of otoconia in the labyrinth (C)</p> Signup and view all the answers

Which of the following symptoms is most commonly associated with acoustic neuroma?

<p>Unilateral tinnitus and hearing loss (D)</p> Signup and view all the answers

Which treatment method is commonly used in the medical management of Benign Paroxysmal Positional Vertigo?

<p>Repositioning techniques (D)</p> Signup and view all the answers

What can occur if an acoustic neuroma grows large enough to affect the trigeminal nerve?

<p>Facial paresthesia (D)</p> Signup and view all the answers

Which of the following is a common vestibular suppressant used in managing vertigo?

<p>Meclizine (C)</p> Signup and view all the answers

Which of these is NOT a characteristic symptom of tinnitus?

<p>Facial weakness (A)</p> Signup and view all the answers

Which medication type is commonly linked to causing ototoxicity?

<p>Antibiotics (C)</p> Signup and view all the answers

What does a normal result from the Weber test indicate?

<p>The sound is heard equally in both ears. (A)</p> Signup and view all the answers

What degree of hearing loss is categorized as moderate?

<p>Loss in 50-55 Decibels (D)</p> Signup and view all the answers

Which of the following tests helps differentiate between conductive and sensorineural hearing loss?

<p>Rinne test (C)</p> Signup and view all the answers

What is the purpose of the Auditory Brainstem-Evoked Response (ABR) test?

<p>To evaluate brain activity in response to sound (D)</p> Signup and view all the answers

What condition indicates a profound hearing loss?

<p>Loss in &gt; 90 Decibels (A)</p> Signup and view all the answers

What does a tympanogram measure?

<p>Eardrum movement in response to air pressure changes (A)</p> Signup and view all the answers

Which condition is assessed by Electronystagmography (ENG)?

<p>Balance disorders (A)</p> Signup and view all the answers

What signifies a slight hearing loss diagnosis according to audiometry?

<p>Loss in 15-25 Decibels (D)</p> Signup and view all the answers

What is a common clinical manifestation associated with the condition discussed?

<p>Episodic, incapacitating vertigo (D)</p> Signup and view all the answers

Which surgical management technique involves inserting a drain through a postauricular incision?

<p>Endolymphatic Sac Decompression (A)</p> Signup and view all the answers

Which of the following pharmacologic therapies is specifically used as an antiemetic?

<p>Promethazine (C)</p> Signup and view all the answers

What feeling may accompany the episodes of vertigo in this condition?

<p>A sensation of pressure or fullness in the ear (C)</p> Signup and view all the answers

Which demographic is more commonly affected by the condition described?

<p>Adults in their 40's (A)</p> Signup and view all the answers

What is a characteristic behavior of school-age children with hearing impairments?

<p>Answer questions inappropriately unless they can see the speaker's face. (B)</p> Signup and view all the answers

Which communication method allows children to 'see-hear' every spoken syllable?

<p>Cued Speech (A)</p> Signup and view all the answers

In the Total Communication approach, which of the following techniques is utilized?

<p>Hearing aids in combination with sign language (C)</p> Signup and view all the answers

What is an indicator of a child experiencing attention issues potentially linked to hearing impairment?

<p>Daydreaming and being easily distracted. (B)</p> Signup and view all the answers

Which characteristic is NOT associated with children who have hearing impairments?

<p>Consistent high performance in academics (B)</p> Signup and view all the answers

What is the most appropriate treatment for pediatric acoustic tumors?

<p>Surgical removal (D)</p> Signup and view all the answers

Which assessment method is most effective for detecting inner ear hearing loss?

<p>Otoacoustic emission (OAE) (D)</p> Signup and view all the answers

What is a common behavior observed in infants with hearing impairment?

<p>Diminished or absent startle reflex to loud sounds (C)</p> Signup and view all the answers

How is hearing impairment typically expressed in terms of severity?

<p>Decibels (dB) (B)</p> Signup and view all the answers

What age group may display behaviors such as appearing developmentally delayed or communicating needs through gestures?

<p>Toddlers and preschoolers (D)</p> Signup and view all the answers

What limitation is associated with the Auditory Brainstem Response (ABR) test?

<p>May show false-negatives for losses in the 500 to 2000 Hz range (A)</p> Signup and view all the answers

Which of the following indicates a potential hearing impairment in a toddler?

<p>Communicates primarily through gestures (A)</p> Signup and view all the answers

Which of the following frequencies is typically tested using the Auditory Brainstem Response (ABR)?

<p>2000 - 8000 Hz (C)</p> Signup and view all the answers

What is a common clinical manifestation of otosclerosis?

<p>Progressive conductive or mixed hearing loss (C)</p> Signup and view all the answers

Which type of otitis media is characterized by persistent inflammation and may require surgery?

<p>Chronic Otitis Media (D)</p> Signup and view all the answers

What is one common treatment method for motion sickness?

<p>Antihistamines like Meclizine (B)</p> Signup and view all the answers

Which of the following conditions is characterized by fluctuating hearing loss and vertigo?

<p>Meniere's disease (C)</p> Signup and view all the answers

What typically reveals a normal tympanic membrane in a patient with otosclerosis during examination?

<p>Otoscopic examination (B)</p> Signup and view all the answers

What is the first-line intervention that may be used to slow the progression of otosclerosis?

<p>Sodium fluoride prescription (B)</p> Signup and view all the answers

Which type of otitis media is associated with fluid accumulation without infection?

<p>Serous Otitis Media (C)</p> Signup and view all the answers

What potential complication may arise from chronic otitis media?

<p>Hearing loss (C)</p> Signup and view all the answers

Flashcards

Cochlear Implant

An electronic device surgically implanted to help restore hearing in individuals with severe hearing loss.

Tympanic Membrane Perforation

A rupture of the eardrum, often caused by infection or trauma.

Hearing Aid Types: Body

A type of hearing aid that is positioned on the body, typically used for mild to profound hearing loss in people who have more severe issues.

Hearing Aid Types: Behind-the-ear

A type of hearing aid that is placed behind the ear and is fitted using a custom-fit earmold, often used for mild to profound hearing issues.

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Cerumen Impaction

Buildup of earwax that blocks the ear canal.

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Otitis Externa

Inflammation of the outer ear canal, sometimes referred to as "swimmer's ear".

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Hearing Aid Problem: Inadequate Amplification

Hearing aid not providing sufficient sound volume.

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Tympanoplasty

Surgical repair of the eardrum.

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External Ear

The outer part of the ear, including the auricle (pinna) and the external auditory canal, responsible for collecting sound waves.

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Middle Ear

An air-filled cavity located between the external and inner ear, containing the tympanic membrane (eardrum) and ossicles, transmitting sound vibrations.

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Inner Ear

The innermost part of the ear, housing the cochlea and vestibular system, responsible for converting sound vibrations into nerve impulses and maintaining balance.

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Conductive Hearing Loss

Hearing loss caused by problems with the outer or middle ear, preventing sound waves from reaching the inner ear.

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Sensorineural Hearing Loss

Hearing loss caused by damage to the inner ear or auditory nerve, interfering with the transmission of sound signals to the brain.

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Weber Test

A hearing test using a tuning fork to determine if sound is heard louder in one ear than the other, indicating conductive or sensorineural hearing loss.

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Rinne Test

A hearing test using a tuning fork to compare air conduction (sound through air) and bone conduction (sound through bone) to diagnose hearing loss.

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Presbycusis

Age-related hearing loss, characterized by difficulty understanding speech, particularly in noisy environments.

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Sinusoidal Harmonic Acceleration

A test that evaluates the vestibular system's function by subjecting the patient to controlled sinusoidal movements to assess balance and motion sensitivity.

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Middle Ear Endoscopy

A procedure using an endoscope to view the middle ear, diagnosing conditions like ear infections, fluid buildup, or abnormalities.

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Ototoxic Medications

Drugs that can damage the inner ear and cause hearing loss.

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Tinnitus

A ringing or buzzing sound in the ears in the absence of an external sound source.

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Hearing Loss and Quality of Life

Hearing loss impacts communication, awareness, and personal safety, significantly affecting a person's overall well-being.

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Audiometry

A test that measures hearing sensitivity at different frequencies. It helps determine the degree of hearing loss.

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Normal Hearing Loss

A loss in hearing between 0-15 Decibels.

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Tympanogram

A test that measures the movement of the eardrum. It helps assess the middle ear's function and detect issues like fluid buildup.

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Auditory Brainstem-Evoked Response (ABR)

A neurophysiological test that measures brain electrical activity in response to sound stimuli. It helps evaluate hearing ability and diagnose auditory nerve disorders.

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Electronystagmography (ENG)

A test that assesses the vestibular system by measuring eye movements. It helps diagnose balance disorders.

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Platform Posturography

A test that evaluates balance by measuring the ability to maintain stability on a moving platform. It helps identify balance impairments.

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Meniere's Disease Risk Factor

Meniere's disease is more common in adults in their 40s.

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Meniere's Disease: What is it?

Meniere's disease is a disorder of the inner ear that affects balance and hearing.

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Meniere's Disease: Symptoms

Symptoms of Meniere's disease include fluctuating hearing loss, tinnitus, ear pressure, and episodes of vertigo.

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Meniere's Disease: Medical Management

Treatment for Meniere's disease includes medications like antihistamines, antiemetics, and diuretics, as well as surgical options like endolymphatic sac decompression.

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Meniere's Disease: Vestibular Nerve Sectioning

In severe cases, cutting the vestibular nerve can prevent the brain from receiving signals about balance, which helps control vertigo.

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Otosclerosis

A condition where the bones in the middle ear harden, causing progressive conductive or mixed hearing loss.

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Otosclerosis: Symptoms

Otosclerosis can affect one or both ears, resulting in progressive hearing loss, often with tinnitus (ringing in the ears).

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Otosclerosis: Diagnosis

Otosclerosis is diagnosed through audiometry, which confirms conductive or mixed hearing loss, especially in low frequencies. A normal tympanic membrane is usually observed.

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Acute Otitis Media

A sudden onset of ear pain, often with fever, usually following a respiratory infection. Often treated with antibiotics.

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Chronic Otitis Media

Persistent ear inflammation lasting weeks or more, potentially leading to hearing loss and ear drainage. May require surgery or ongoing management.

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Serous Otitis Media

Fluid buildup in the middle ear without infection, often following respiratory issues. Causes a feeling of fullness and mild hearing loss. May be treated with observation or drainage procedures.

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Motion Sickness

Discomfort caused by vestibular system overstimulation, leading to nausea, vomiting, diaphoresis, and pallor.

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Meniere's disease

A disorder of the inner ear characterized by recurrent episodes of vertigo, tinnitus, a feeling of fullness in the ear, and fluctuating hearing loss.

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Ototoxic Substances

Chemicals or drugs that can damage the inner ear and cause hearing loss.

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Diuretics

Medications that help the body eliminate excess fluid. Some can damage the inner ear.

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Cisplatin

A chemotherapy drug known to cause hearing loss in some patients.

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Benign Paroxysmal Positional Vertigo (BPPV)

A condition caused by dislodged calcium crystals in the inner ear, leading to dizziness and vertigo.

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BPPV: How it is diagnosed?

BPPV is often diagnosed based on the pattern of dizziness and vertigo. The doctor may perform maneuvers to trigger symptoms.

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BPPV: Treatment

Treatment often involves repositioning exercises to move the crystals back to their proper place. Medications may also be used to manage dizziness.

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Acoustic Neuroma

A non-cancerous tumor on the auditory nerve, often causing hearing loss and tinnitus.

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Acoustic Neuroma: Symptoms?

Common symptoms include unilateral hearing loss, tinnitus, and sometimes dizziness or balance issues. It can also affect facial sensations.

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OAE (Otoacoustic Emission)

A test that measures sound waves from the inner ear to assess cochlear and hair cell function. It involves placing a probe in the ear canal and emitting clicks.

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ABR (Auditory Brainstem Response)

A test that measures electrical activity in the brain in response to sound. It helps identify hearing loss and detects damage to cranial nerve VIII or the brainstem.

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Hearing Impairment in Infants

Signs include lack of startle reflex to loud sounds, not awakening to noise, not turning head towards sound, and limited babbling.

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Hearing Impairment in Toddlers/Preschoolers

Signs include unintelligible speech, monotone voice, lack of communication, developmental delay, and emotional immaturity. They may prefer playing alone.

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Hearing Impairment: dB Levels

Hearing loss is measured in decibels (dB). Higher dB means louder sounds, and different dB levels indicate severity of loss.

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OAE Limitations

OAE may not detect hearing loss below 1500Hz or give false-negative results for losses below 1000-1500Hz.

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ABR Limitations

ABR may show false-negative results for losses in the 500 to 2000Hz levels.

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Acoustic Tumor Treatment

Surgical removal is the preferred treatment for acoustic tumors, as they don't respond well to radiation or chemotherapy.

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What are some communication challenges faced by children with hearing impairments?

Children with hearing impairments may struggle with understanding speech, particularly if they cannot see the speaker's face. This can lead to difficulty following conversations, answering questions appropriately, and participating in class. They may also exhibit inattentive behavior, daydreaming, poor academic performance, speech abnormalities, and a preference for solitary play.

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What is Cued Speech?

Cued Speech is a visual communication system that uses hand shapes and facial positions to represent different sounds. It's designed to supplement lipreading and allow children to 'see-hear' every spoken syllable, making understanding spoken language easier.

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What's the Oral Approach to communication for hearing impaired children?

The Oral Approach emphasizes spoken language as the primary mode of communication for children with hearing impairments. It relies on hearing aids and residual hearing to maximize the child's ability to understand speech.

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What is Total Communication?

Total Communication utilizes a multi-modal approach, combining spoken language, sign language, fingerspelling, lipreading, and residual hearing to meet the child's individual needs. The child selects the communication method based on the situation and their preferences.

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What are some key communication strategies for working with children who have hearing impairments?

When working with children who have hearing impairments, it is important to ensure that they can see you while you are speaking. Use clear, concise language, and repeat instructions as needed. Pay attention to their nonverbal cues and adjust your communication style to meet their individual needs.

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Study Notes

Nursing Assessment: Sensorineural Function (Ear)

  • Anatomy (EAR):
    • External ear: auricle (pinna) and external auditory canal
    • Middle ear: air-filled cavity, tympanic membrane, otic capsule
    • Inner ear: housed deep within the temporal bone
    • Hearing: conducted via air and bone pathways
    • Balance and Equilibrium: maintained by muscles, joints, eyes, and labyrinth
  • Gerontological Considerations:
    • Atrophy of external ears
    • Thinning/drying of ear canal
    • Hardening of cerumen (earwax)
    • Thickening of eardrum
    • Impaired sound transmission (vestibulospinal reflex changes, progressive imbalance, organ of Corti degeneration)
  • Hearing Loss:
    • Conductive:
      • Weber Test: sound heard best in affected ear
      • Rinne Test: sound heard as long or longer in affected ear
    • Sensorineural:
      • Weber Test: sound heard best in normal hearing ear
      • Rinne Test: air conduction audible longer than bone conduction
    • Mixed: conductive and sensorineural
  • Assessment-History:
    • Patient health history (common complaints, past medical history, infections, medications)
    • Family history
    • Social history (withdrawal from communication, depression, inability to continue profession due to hearing loss)
  • Assessment-Physical:
    • Inspection/palpation of external ear & internal ear (using otoscope)
    • Hearing evaluation methods:
      • Whisper test
      • Weber test
      • Rinne test
  • Diagnostic Evaluation:
    • Audiometry:
      • Hearing loss ratings in decibel ranges (0-15dB normal, >90dB profound)
    • Imaging:
      • Tympanogram: assesses middle ear function
      • Auditory Brainstem-Evoked Response (ABR): evaluates hearing ability and diagnoses auditory nerve disorders
      • Electronystagmography (ENG): assesses vestibular system
      • Platform Posturography: evaluates balance
    • Sinusoidal Harmonic Acceleration: evaluates vestibular system function
    • Middle Ear Endoscopy: visualizes middle ear

Chapter 49: Nursing Management: Patients with Hearing and balance disorders

  • Hearing loss:
    • Pathophysiology: conduction problem, sensorineural loss or mix of both, or psychogenic issues
    • Risk factors: family history, congenital malformations, low birth weight, ototoxic medications, recurrent ear infections, chronic noise exposure, perforated tympanic membrane
    • Focused Assessment: speech deterioration, fatigue, indifference, social withdrawal, insecurity, procrastination, suspiciousness
    • Clinical manifestations: tinnitus, increasing inability to hear in a group, need to turn up volume, changes in attitude, communication, awareness, and quality of life
    • Gerontologic considerations: cerumen hardens, dries, tympanic membrane atrophies, cochlear degeneration
    • Medical management: implanted hearing devices, aural rehabilitation, hearing aids

Chapter 49 (continued)

  • Conditions affecting the external ear: cerumen impaction, foreign bodies, otitis externa (swimmer's ear)
  • Conditions affecting the middle ear: tympanic membrane perforation (clinical manifestations, medical & nursing management)
  • Conditions affecting the inner ear: motion sickness, Meniere's disease (pathophysiology, clinical manifestations, risk factors, medical management)
  • Otitis media: acute, chronic, serous
  • Conditions affecting inner ear (continued): ototoxicity, causes, effects, and clinical manifestations
  • Otitis media: Pathophysiology , medical and nursing management
  • Otosclerosis: clinical manifestation, audiogram
  • Tinnitus: Pathophysiology, medical and nursing management

Chapter 49 continued: Specific Topics

  • Pediatric Impairment: Hearing impairment, Otoacoustic emission (OAE) testing, auditory brainstem response (ABR), hearing loss behaviors (toddlers, preschoolers; school-age children and adolescents)

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Nursing Assessment: Sensorineural Function (Ear) Student Outline PDF

Description

This quiz covers the anatomy of the ear, including the external, middle, and inner ear structures. It also addresses gerontological considerations and differentiates between conductive and sensorineural hearing loss. Test your knowledge of auditory function and nursing assessments related to ear health.

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