CH 59 Hearing.pptx

Assessment and Management of Patients with Hearing and Balance Disorders Chapter 59 Anatomy of the Ear Anatomy of the Inner Ear Bone Conduction Compared With Air Conduction Assessment of Hearing and Balance  Inspection of the external ear  Otoscopic examination  Gross auditory acuity  Whisper te...

Assessment and Management of Patients with Hearing and Balance Disorders Chapter 59 Anatomy of the Ear Anatomy of the Inner Ear Bone Conduction Compared With Air Conduction Assessment of Hearing and Balance  Inspection of the external ear  Otoscopic examination  Gross auditory acuity  Whisper test  Weber test  Rinne test Weber Test and Rinne Test Question #1 What assessment is completed with the Weber test? A. Air conduction of sound B. Bone conduction of sound C. Air and bone conduction of sound D. Neither air or bone conduction of sound Answer to Question #1 B. Bone conduction of sound Rationale: The Weber test assesses bone conduction of sound. The Rinne test assesses both air and bone conduction of sound. Diagnostic Evaluation - 1  Audiometry  Tympanogram  Auditory brainstem response  Electronystagmography Diagnostic Evaluation - 2  Platform posturography  Sinusoidal harmonic acceleration  Middle ear endoscopy Hearing Loss  Prevalence increases with age; 50% over the age of 70 (Table 59-2)  Increased incidence with age—presbycusis  Risk factors include exposure to excessive noise levels  Types  Conductive; caused by external of middle ear problem  Sensorineural; caused by damage to the cochlea or vestibulocochlear nerve  Mixed; both conductive and sensorineural  Functional (psychogenic); caused by emotional problem Manifestations of Hearing Loss  Early symptoms  Tinnitus: perception of sound; often “ringing in the ears”  Increased inability to hear in a group  Turning up the volume on the TV  Impairment may be gradual and not recognized by the person experiencing the loss  As hearing loss increases, person may experience deterioration of speech, fatigue, indifference, social isolation or withdrawal, and other symptoms Guidelines for Communicating with Hearing Impaired Persons  Determine how the person prefers to communicate  Use a low-tone, normal voice  Speak slowly and distinctly  Reduce background noise and distractions  Face the person and get their attention  Speak into the less impaired ear  Use gestures and facial expressions  If necessary, write out information or obtain a sign language translator Conditions of the External Ear #1  Cerumen impaction  Removal may be by irrigation, suction, or instrumentation  Gentle irrigation should be used with lowest pressure, directing stream behind the obstruction. Glycerin, mineral oil, halfstrength H2O2, or peroxide in glyceryl may help soften cerumen Conditions of the External Ear #2  Foreign bodies  Removal may be by irrigation, suction, or instrumentation  Objects that may swell (e.g., vegetables or insects) should not be irrigated  Foreign body removal can be dangerous and may require extraction in the operating room Conditions of the External Ear #3  External otitis  Inflammation most commonly caused by bacteria Staphylococcus or Pseudomonas, or fungal infection from Aspergillus spp  Manifestations include pain and tenderness, discharge, edema, erythema, pruritus, hearing loss, feelings of fullness in the ear  Therapy is aimed at reducing discomfort, reducing edema, and treating the infection  A wick may be inserted in the canal to keep it open and facilitate medication administration  Malignant external otitis: rare, progressive infection that affects the external auditory canal, surrounding tissues, and skull Question #2 Is the following statement true or false? Otalgia is a sensation of fullness or pain in the ear. Answer to Question #2 True Rationale: Otalgia is a sensation of fullness or pain in the ear and can occur with or without hearing loss. When occurring with acute otitis externa the pain may be persistent and awaken the patient at night. When occurring with acute otitis media the pain may be relieved if the tympanic membrane ruptures. Conditions of the Middle Ear #1  Tympanic membrane perforation  Acute otitis media  Most frequently seen in children  Pathogens are most commonly bacterial or viral  Manifestations include otalgia (ear pain), fever, and hearing loss  Treatment  Antibiotic therapy  Myringotomy or tympanotomy Conditions of the Middle Ear #2  Serous otitis media: fluid in the middle ear without evidence of infection  Chronic otitis media  Result of recurrent acute otitis media  Chronic infection damages the tympanic membrane, ossicle, and involves the mastoid  Treatment  Prevent by treatment of acute otitis  Tympanoplasty, ossiculoplasty, or mastoidectomy Middle Ear Surgical Procedures  Tympanoplasty  Reconstruction of the tympanic membrane  Ossiculoplasty  Reconstruction of the bones of the middle ear  Prostheses are used to reconnect the ossicles to reestablish sound conduction  Mastoidectomy  Removal of diseased bone, mastoid air cells, and cholesteatoma to create a noninfected, healthy ear  Cholesteatoma: benign tumor, an ingrowth of skin that causes persistently high pressure in the middle ear, which causes hearing loss and neurologic disorders and destroys structures Stapedectomy for Otosclerosis Assessment of the Patient Undergoing Mastoid Surgery  Health history  Include data related to the ear disorder, hearing loss, otalgia, otorrhea, and vertigo  Duration and intensity, causes, and previous treatments  Medications  Physical assessment  Erythema, edema, lesions  Discharge; color and odor  Review audiogram results Planning and Goals for the Patient Undergoing Mastoid Surgery  Major goals include:  Reduction of anxiety  Freedom from pain and discomfort  Prevention of infection  Stable or improved hearing and communication  Absence of vertigo and injury  Increased knowledge of disease, surgical procedure and postop care Nursing Interventions for the Patient Undergoing Mastoid Surgery #1  Reduction of anxiety  Reinforce information and patient education  Provide support and allow to discuss anxieties  Relieving pain  Medicate with analgesics for ear discomfort  Note: Occasional sharp, shooting pans may occur as the eustachian tube opens and allows air into the middle ear. Constant throbbing pain and fever may indicate infection  Preventing injury  Safety measures such as assisting with ambulation  Provide antiemetics or antivertigo medications Nursing Interventions for the Patient Undergoing Mastoid Surgery #2  Improving communication and hearing  Note: Hearing may reduce for several weeks after surgery because of edema, accumulation of blood and fluid in the middle ear, and dressings and packings  Use measures to improve hearing and communication as discussed in “Communicating with Hearing Impaired Persons.”  Preventing infection  Monitor for signs and symptoms of infection  Administer antibiotics as ordered  Prevent contamination of ear with water from showers, washing hair, and so on Patient Education for the Patient Undergoing Mastoid Surgery  Medication education: analgesics, antivertigo medications  Activity restrictions  Safety issues related to potential vertigo  Instruction regarding potential complications and reporting of problems  Follow-up care Question #3 What patient education for post mastoid surgery would be incorrect? A. Avoid getting water in the ear B. Constant throbbing pain may be a sign of infection C. Call for assistance to ambulate to prevent injury D. There are no activity restrictions after this procedure Answer to Question #3 D. There are no activity restrictions after this procedure Rationale: Patients should be taught to avoid getting water in the ear to prevent injury and potential infection. A constant throbbing pain may be a sign of infection. Patients should call for assistance to get up to prevent injury in case the patient experiences vertigo. There are activity restrictions after this procedure. Patients should be taught to only blow one side of nose at a time and avoid lifting and straining to prevent pressure changes within the ear that might damage the surgical intervention. Conditions of the Inner Ear #1  Disorders of the vestibular system may increase the risk of falls  Dizziness: any altered sense of orientation in space  Vertigo: the illusion of motion or a spinning sensation  Nystagmus: involuntary rhythmic movement of the eyes associated with vestibular dysfunction Conditions of the Inner Ear #2  Tinnitus  Labyrinthitis  Benign positional vertigo (BBPV)  Ototoxicity  Acoustic neuroma: tumor of the VIII cranial nerve Ménière Disease  Abnormal inner ear fluid balance cause by malabsorption of the endolymphatic sac or blockage of the endolymphatic duct  Manifestations include triad of symptoms: episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss. Feeling of pressure, nausea and vomiting  Treatment  Low-sodium diet; 1000 to 1500 mg/day  Meclizine (Antivert); tranquilizers—valium, antiemetics— promethazine, and diuretics may also be used  Surgical management to eliminate attacks of vertigo; endolymphatic sac decompression, middle and inner ear perfusion, and vestibular nerve sectioning Question #4 Is the following statement true or false? A cochlear implant is an auditory prosthesis used for people with profound sensorineural hearing loss bilaterally who do not benefit from conventional hearing aids. Answer to Question #4 True Rationale: A cochlear implant is an auditory prosthesis used for people with profound sensorineural hearing loss bilaterally who do not benefit from conventional hearing aids.