400 Level Lecture Notes on Special Senses PDF

# 400 LEVEL LECTURE NOTES ON SPECIAL SENSES ## STRUCTURES, FUNCTIONS AND DISORDERS OF SPECIAL SENSES * **Special and General Senses:** * Special senses include vision (eyes), hearing and balance (ears), taste (tongue), and smell (nasal passages). * General senses, in contrast, are all asso...

# 400 LEVEL LECTURE NOTES ON SPECIAL SENSES ## STRUCTURES, FUNCTIONS AND DISORDERS OF SPECIAL SENSES * **Special and General Senses:** * Special senses include vision (eyes), hearing and balance (ears), taste (tongue), and smell (nasal passages). * General senses, in contrast, are all associated with the sense of touch, special sense organs. ## THE EYE **Eye structure and function** * **Cornea:** Light enters through the cornea, **transparent outer covering of the eye**. * The eyeball is rounded, so the cornea acts as a **lens** that **bends or refracts light**. * **Aqueous Humor:** The fluid beneath the cornea has a composition similar to blood plasma. The **aqueous humor helps shape the cornea** and provides **nourishment to the eye**. * **Iris and Pupil:** Light passes through the cornea and aqueous humor through an opening called the **pupil**. * The size of the pupil is determined by the **iris**, the **contractile ring** that is associated with the **color**. * As the pupil **dilates** (gets bigger), more light enters the eye. * **Lens:** While most of the focusing of light is done by the cornea, the lens allows the eye to focus on either **near or distant objects**. * **Ciliary muscles** surround the lens, **relaxing to flatten it to image distant objects and contracting to thicken the lens to image close-up objects**. * **Vitreous humor:** A certain distance is required to focus light. The **vitreous humor is transparent watery gel** that **supports the eye and allows for this distance**. **Physiology of sight** Sight begins when light rays from an object enter the eye through the cornea, the **clear front window of the eyeball**. * The cornea is **actually responsible for about sixty percent of the eyeball's light-ray-bending capacity**. * The cornea's **refractive power bends the light rays** in such a way that they pass freely through the pupil, the **size-changing hole in the iris**. * **Iris:** The structure that **gives the eyes color. Works** like a **shutter in a cornea. It has the ability to enlarge and shrink, depending on how much light the environment is sending into the pupil**. * **Lens:** After passing through the iris, the light rays strike the eye's **crystalline lens. The clear, flexible structure works much like the lens in a camera-shortening and lengthening its width in order to focus light rays properly**. * **Vitreous humor:** In a normal eyeball, after existing the back of the lens, the light rays passes through the vitreous-a **clear, jelly-like substance that fills the globe of the eyeball**. The vitreous humor helps the eye **sharp focusing point on the retina**. * **Retina:** The **retina's function is much like a camera film**. It is responsible for **capturing all of the light rays, processing them into light impulses through millions of tiny nerve endings, and then sending these light impulses** through over a million nerve fibers to the optic nerve. * **Optic nerve** : sort of like an extension of the brain. It is **a bundled core of more than a million nerve fibers**. * The light impulses travel through this **nerve fiber to the brain** where they are interpreted as an image. ## THE NOSE **Nasal structure and function:** The nose and **nasal cavity form the external for the respiratory system** and are the first section of the **body's airway (respiratory tract)** through which air moves. The nose is **a structure of the face made of cartilage, bone, muscle, and skin that supports and protects the anterior portion of the nasal cavity. The nasal cavity is a hollow space within the nose and skull that is lined with hairs and mucus membrane. The function of the nasal cavity is to warm, moisturize, and filter air entering the body** before it reaches the lungs. Hair and mucus lining the nasal cavity help to trap dust, mold pollen and other environment contaminants before they can reach the inner portion of the body. Air exiting the body through the nose returns moisture and heat to the nasal cavity before being exhaled into the environment. ## SENSE OF SMELL (OLFACTION) Our sense of smell works by the **detection of odors**. Olfaction epithelium located in the nose contains millions of chemical receptors that detect odors. When we sniff, chemical in the air are dissolved in mucus, **odor receptor neurons in olfactory epithelium detect these odors and send the signals on to the olfactory bulbs**. These signals are then sent along olfactory tracts to the olfactory cortex of the brain. * **Olfactory cortex:** vital for the **processing and perception of odor**. It is located in the temporal lobe of the brain, which is **involved in organizing sensory input**. The olfactory cortex is also a component of the limbic system. This system is involved in the **processing of our emotions, survival instincts, and memory formation**. * The olfactory cortex has connection with other limbic system structure such as the amygdala hippocampus and hypothalamus. * The **amygdala is involved in forming emotional responses (particularly fear responses) and memories**, the hippocampus **indexes and stores memories, and the hypothalamus regulates emotional responses**. * It is the **limbic system that connects senses, such as odours, to our memories and emotions**. ## THE EAR **Structure and function of the ear** The ear is the **organ of hearing and balance**. The **parts of the ear include:** * **External or outer ear, consisting of:** * **Pinna or auricle.** This the outer part of the ear. * **External auditory canal or tube.** This is the tube that connects the outer ear to the inside or middle ear. * **Tympanic membrane (eardrum).** The tympanic membrane divides the external ear from the middle ear. * **Middle ear (tympanic cavity), consisting of:** * **Ossicles.** Three small bones that connect and transmit the sound waves to the inner ear. The bones are called: malleus, incus stapes. * **Inner ear, consisting of:** * **Cochlea.** This contains the nerves for hearing. * **Vestibule.** This contains receptors for balance. * **Semicircular canals.** This contains receptors for balance. **Physiology of hearing** Hearing starts with the outer ear. When a sound is made outside the outer ear, the **sound waves or vibrations, travel down the external auditory canal and strike the eardrum (tympanic membrane). The eardrum vibrates. The vibration are then passed to 3 tiny bones in the middle ear called the ossicles**. The ossicles amplify the sound. **They send the sound waves to the inner ear and into the fluid-filled hearing organ (cochlea)**. Once the sound waves reach the inner ear, **they are converted into electrical impulses. The auditory nerve send these impulses to the brain. The brain then translates these electrical impulses as sound**. ## THE TONGUE **Structure and mechanism of taste ** The mammalian tongue consists of a mass of interwoven, **striated muscle interspaced with glands and fat and covered with mucous membrane**. In humans the front tips and margins of the tongue usually touch the teeth, aiding in swallowing and speech. The top surface, or dorsum, **contains numerous projections of the mucous membrane called papillae. They contain taste buds, which are sensitive to chemical constituents of food, and serious glands that secrete some of the fluid in saliva, a substance that moistens the oral cavity and helps lubricate food particles.** The base, or upper rear portion, of the tongue has no papillae, but aggregated **lymphatic tissue (lingual tonsils) and serious and mucus-secreting glands are present.** The inferior, or under surface leads from the tip to the tongue to the floor of the mouth; its **mucous membrane is smooth, devoid of papillae, and purple in colour from the many blood vessels present.** The root, the reminder of the outside that lies on the mouth's floor, **contains bundle of nerves, arteries, and muscles that branch to the other tongue regions**. ## REFRACTIVE ERRORS Refractive error, also known as refractive error, is a **problem with focusing light accurately onto the retina due to the shape of the eye.** The most common types of refractive error are **near-sightedness, far-sightedness, astigmatism.** **Causes** Refractive errors can be caused by: *Eyeball length (when the eye grows too long or too short) *Problem with the shape of the cornea (the clear outer layer of the eye) *Aging of the lens (an inner part of the eye that is normally clear and helps the eye focus) **Types** * **Nearsightedness (myopia):** This happens when the **optic are too powerful for the length of the eyeball. This can arise from a cornea or crystalline lens with too much curvature (refractive myopia) or an eyeball that is too long (axial myopia). Myopia can be corrected with a concave lens, which causes the divergence of light rays before they reach the cornea.** * **Farsightedness (hyperopia):** this happens when the **optic are too weak for the length of the eyeball. This can arise from a cornea or crystalline lens with not enough curvature (refractive hyperopia). This can be corrected with convex lenses, which cause light rays to converge prior to hitting the cornea.** * **Astigmatism:** a person with **astigmatic refractive error sees lines of a particular orientation less clearly than lines at right angles to them. This defect can be corrected by refracting light more in one meridian than the other. Cylindrical lenses**. **Signs and symptoms** The most common symptom is **blurry vision**. Other symptoms include: *Double vision. *Hazy vision *Seeing a glare or halo around bright lights. *Squinting *Headaches *Eye strain (when your eyes feel tired or sore) Trouble focusing when reading or looking at a computer. **Pathophysiology** As a result of etiology factors such as **infection degenerative changes causes gradual loss of elasticity of the lens which leads to a decreased ability to accommodate images** and subsequently lead to error in refraction. ## MANAGEMENT **Medical management** * Identify the_cause and eliminate it * Lens correction - a concave lens is used to correct the problem * Prevention of foreign particles from entering the eye. * Use of sunglasses * Use of antibiotics for infection. **Nursing management** Safe administration of the prescribed medication **and observe for any side effects.** * Proper documentation * Monitor the hemodynamic pressure, vitaLsigns, arterial blood gas. * Asses for any previous allergy to medicines, food etc. * Observe for response to treatment. **Nursing diagnosis** * Knowledge deficit * Altered visual perception * Altered comfort * Self-care deficit * Potential for loss of vision or visual impairment ## CONJUNCTIVITIS Conjunctivitis (pink eye) is an inflammation or infection of the transparent membrane. (Conjunctiva) that lines your eyelid and cover the white part of the eyeball. **Causes** Pink eye is commonly caused by a **bacterial or viral infection, an allergic reaction, or in babies an incompletely opened tear duct. Viruses**. * Bacteria * Allergies * A chemical splash in the eye. * A foreign object in the eye. * In newborns, a blocked tear duct. **Signs and symptoms** The most common **pink eyes symptoms includes:** * Redness in one or both eyes * Itchiness in one or both eyes * A gritty feeling in one or both eyes * A discharge in one or both eyes that forms a crust during the night that may prevent your eye or eyes from opening in the morning, * Tearing **Pathophysiology** When **small blood vessels in the conjunctiva become inflamed due to bacteria or allergies. They become more visible. This is what causes** the whites of the eyes to appear reddish or pink. **Prevention of conjunctivitis** Practice good hygiene to **control the spread of pink eye**. * Don't touch your eyes with your hands. * Wash your hands often. * Use a clean towel and washcloth daily. * Don't share towels or washcloths. * Change your pillowcases often. * Throw away your eye cosmetics, such as mascara. * Don't share eye cosmetics or personal eye care items. **Management** **Medical management** Pink eye (conjunctivitis) caused by **bacteria is treated with antibiotics which can be given as eye drops, ointments, or pills.** **Medicine cannot treat pink eye caused by a virus which often results from a common cold**. **Nursing management** * Avoid rubbing the eye(s) * Clean eye discharge with a tissue (dispose of carefully) * Apply warm compress over eye. * Do not share towels or clothing with other. * Teach parents to instill eye drops or apply ointment at home for continued treatment. **Nursing diagnosis** * Ineffective health maintenance. * Risk for injury. * Knowledge deficit. * Risk for infection. ## UVEITIS Uveitis is the inflammation of the uvea, the **pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea**. **Causes of uveitis** The exact cause of uveitis is often unclear but some factors increase the chance of it happening. These include: * Juvenile arthritis, psoriasis and other autoimmune disorder, such as rheumatoid arthritis. * Inflammatory disorder, such as crohn's disease, ulcerative colitis. * AIDS/HIV and other disease that weaken the immune system. * Infection that increase the risk of uveitis include HIV brucellosis, herpes simplex, herpes zoster, leptospirosis, lyme disease, syphilis, toxocraiasis, toxoplasmosis, and tuberculosis(TB). **Signs and symptoms** * General vision problems, including blurred or cloudy vision. * Floaters, spots in the eye that look like tiny rods or chains of transparent bubbles floating around in the field of vision. * Eye pain and redness. * Photophobia, an abnormal sensitivity to light headaches. * A small pupil. * Alteration of the color of the iris. **Pathophysiology** The pathophysiology of uveitis depends on the specific etiology but in all types there is **breach in the blood-eye barrier. The blood-eye barrier, similar to the blood-brain barrier normally prevents the cells and large protein entering the eye. Inflammation causes this barrier to break down, and WBCs enter the eye. Neutrophils predominate in acute uveitis cases, and mononuclear cells predon.. in chronic cases**. ## MANAGEMENT **Medical management** Several drugs are available for the management of noninfectious. Uveitis including corticosteroids, immunosuppressive agents, and more recently biologics. **Nursing management** * Patient education. * Focus on maintaining the therapeutic regimen. * Emphasize the need for adherence to therapy and continued care to prevent further vision loss. * Provide education regarding use and effects of medication. **Nursing diagnosis** * Pain of the /altered comfort. * Altered tissue integrity of the eye. * Knowledge deficit on possibility of secondary infection. Altered_visual perception. ## BLEPHARITIS Blepharitis is inflammation of the eyelids. It usually involves the part of the eyelid where the eyelashes grow and affects both eyelids. **Causes** The exact cause of blepharitis isn't clear. It may be associated with one or more factors, including; * Seborrheic dermatitis-dandruffof the scalp and eyebrows. * A bacterial infection. * Clogged or malfunctioning oil gland in your eyelids * Rosacea- a skin condition characterized by facial redness. * Allergies, including allergic reactions to eye medications, contact lens solution or eye makeup. * Eyelash mites or lice., **Signs and symptoms** Blepharitis symptoms and signs include: * Watery eyes. * Red eyes * A gritty, burning or stinging sensation in the eyes. * Eyelids that appear greasy. * Itchy eyelids. * Red, swollen eyelids. * Flaking of the skin around the eyes. * Crusted eyelashes upon awakening. * Eyelid sticking. * More frequent blinking. * Sensitivity to light. * Eyelashes that grow abnormally (misdirected eyelashes) * Loss of eyelashes. **Pathophysiology** The pathophysiology of blepharitis frequently involves bacterial colonization of the eyelids. This results in direct microbial invasion of tissues, immune system mediated damage, or damage caused by the production of bacterial toxins, waste products, and enzymes. ## MANAGEMENT **Medical management** Electrochemical lid margin debridement (blephex) This removes any mites, bacteria, and the biofilm that they create from the eyelids. It also opens any clogged meibomian glands. * Thermal pulsation treatment (lipiflow); this **melts any material that is obstructing the meibomian glands**. * Intense pulse light therapy (IPL): this **opens clogged eyelid glands**. * Sometimes, severe cases of blepharitis **may require antibiotics, either topical or oral**. **Nursing management** Same as uveitis **Nursing diagnosis** * Acute pain * Related to inflammation due to bacterial infection. * Anxiety related to visual impairment, damage to the eyelids. * Risk for injury * Related to the deficit of knowledge, blurred vision or decrease the sharpness of the eyes. * Knowledge deficit * Related to less information about the disease. ## STYE (STY) A stye also known as a hordeolum, is the **bacterial infection of an oil gland in the eyelid.** This result in **a red tender bump at the edge of the eyelid**. The outside or the inside of the eyelid can be affected. **Causes of stye** The cause of a stye is usually **a bacterial infection by staphylococcus aureus**. The internal ones are due to infection of the meibomian gland **while the external ones are due to an infection of the gland of zeis**. **Signs and symptoms** The first signs of a stye is a **small, yellowish spot at the center of the bump that develops as pus and expands in the area.** Other stye symptoms may include: * A lump on the top or bottom eyelid. * Localized pain. * Redness. * Tenderness. * Crushing of the eyelid margin. * Burning in the eye. * Droopiness of the eyelid. * Scratchy sensation on the eyeball. * (itching), **Blurred vision** * Mucouos discharge in the eye. * Irritation of the eye. * Light sensitivity. * Tearing * Discomfort during blinking * Sensation of a foreign body in the eye. **Pathophysiology** Three different gland within the eyelid are implicated in the pathogenesis of hordeolum when they become infected by s.aureus. infection of zeis and moll gland (ciliary glands) causes pain and swelling at the base of the eyelash with localized abscess formation termed external hordeolum, these produce the typical appearance of a stye with a localized pustule of the eyelid margin. When a meibomian gland becomes acutely infected, it result in an internal hordeolum. ## MANAGEMENT * **Apply a warm wash-cloth of the eyelid. Apply for 10 to 15 minutes at a time a day.re-warm wash-cloth as needed by soaking it in warm water. Wring out excess water, and then reapply to the eyelid.** * **Gently wipe away eyelid drainage with mild soap such as john's baby shampoo and water, or eyelid wipes (available in drug store).** * **Do not squeeze or pop a sty.** * **Do not rub or touch your eyelid.** * **Do not wear makeup or contact lens until the area has fully healed.** * **Treat symptoms. Most styes go away on their own in about a week. Apply a warm compress for 5 to 10 minutes several times a day.** * **Protect against infection. keep the area clean and avoid touching or rubbing the eyes. Don't squeeze the sty.** * **Follow up. In most cases, styes don't require medical care.** **Nursing diagnosis** Same as ## GLAUCOMA Glaucoma is a disease that damage the eye's optic nerve. It usually happens when fluid builds up in the front part of the eye. That extra fluid increase the pressure of the eye, damaging the optic nerve. **Causes of glaucoma** In most cases, glaucoma is caused by higher -than-normal pressure inside the eye, a condition called ocular hypertension. But sometimes glaucoma can occur even when pressure inside the eye called intraocular pressure or IOP is normal. **Signs and symptoms** Most types of glaucoma typically cause no pain and produce no symptoms until noticeable vision loss occurs. However, a less common type of glaucoma called acute angle closure glaucoma causes sudden, often severe symptoms of blurry vision, halos around lights, eye pain, nausea and vomiting. **Types of glaucoma** There are two major types of glaucoma. * Primary open-angle glaucoma * Angle-closure glaucoma (also called “closed-angle glaucoma” or “narrow-angle glaucoma”) This is the most common type of glaucoma. It happens gradually, where the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first. This type happens when an individual's iris is very close to the drainage angle in their eye. The iris can end up blocked, eye pressure rises very quickly. This is called an acute attack. It is a true eye emergency, and you should call the ophthalmologist right away or the individual might go blind. **Signs of an acute angle-closure glaucoma attack:** * Vision is suddenly blurry. * Severe eye pain. * Headache * Nausea * Vomiting * Seeing rainbow-colored ring or halos around lights. **Diagnostic evaluation** * Measuring intraocular pressure(tonometry) * Testing for optic nerve damage with a dilated eye examination and imaging tests. * Checking for areas of vision loss (visual field test) * Measuring corneal thickness (pachymetry) * Inspecting the drainage angle (gonioscopy) **Management** Glaucoma is managed by lowering the eye pressure (intraocular pressure). Depending on the situation. The options may include prescription eye drops. Oral medications, laser treatment surgery or a combination of any of these. **Nursing management** * Prevent further compromised vision. * Prevent injury: initiate fall precautions, remove any tripping hazards. * Appropriately assess vision. * Educate about appropriate eye drop administration. * Manage pain * Manage anxiety. **Nursing diagnosis** * Disturbed sensory perception: visual * Anxiety * Deficient knowledge * Trauma, risk for-poor vision * Social interaction, impaired ## CATARACT A cataract is a clouding of the lens in the eye which **leads to a decrease in vision**. Cataract often develop slowing and can affect one or both eyes. **Causes of cataract** Most cataract develop when aging or injury changes the tissue that makes up your eye's lens. Some inherited genetic disorder that cause other health problem can increase your risk of cataracts. Besides advancing age, cataract risk factors include: * Ultraviolet radiation * Diabetes * Hypertension * Obesity * Smoking * Prolonged use of corticosteroid medications * Previous eye injury or inflammation. * Previous eye surgery * Hormone replacement therapy * Significant alcohol consumption * High myopia * Family history **Signs and symptoms** Signs and symptoms vary depending on the type of cataract, though considerable overlap occurs. Signs and symptoms of cataract includes: * Clouded, blurred or dim vision. * Increasing difficulty with vision at night. * Sensitivity to light and glare. * Need for brighter light for reading and other activities. * Seeing "halos" around light. * Frequent change in eyeglass or contact lens prescription. * Fading or yellowing of colors. * Double vision in a single eye. **Types of cataract** Cataract types includes: * Cataract affecting the center of the lens (nuclear cataract) * Cataract that affect the edge of the lens (cortical cataracts) * Cataract that affect the back of the lens (posterior subcapsular cataract) * Cataract are inborn (congenital cataracts). **Diagnostic evaluation** * Visual acuity test. A visual acuity test **uses an eye chart to measure how well you can read a series of letters.** * Slit-lamp examination. A slit lamp **allows your eye doctor to see the structure at the front of your eye under magnification.** * Retinal exam. **Prevention** No studies have proved how to prevent cataract or slow the progression of cataract. But several strategies may be helpful, including: * Have regular eye examinations. * Quit smoking. * Manage other health problems * Choose a healthy diet that includes plenty of fruits and vegetables. * Wear sunglasses. * Reduce alcohol use. ## MANAGEMENT **Non-surgical management** that can be considered includes: * Counseling the patient about cataract symptoms and how it may affect daily activities. * Advising the patients about minimizing their exposure to risk factors e.g. cessation of smoking, control of diabetes, alternate medications for people on oral or inhaled corticosteroids. * Prescribing spectacles or contact lenses to improve vision. * Using brimmed hats or sunglasses to minimize glare. * Dilating the pupil (if there is a small centrally located cataracts) **Surgery (cataract extraction)** remains the only effective treatment method in cataract patients to restore or maintain vision. **Nursing management** The patient with cataract should receive the usual preoperative care for ambulatory surgical patient undergoing eye surgery. The nurse should assess: * Recent medication intake. It is a common practice to withhold any anticoagulant therapy to reduce the risk of retrobulbar hemorrhage. * Preoperative tests. The standard battery of preoperative tests such as complete blood count, electrocardiogram, and urinarlysis are prescribed only if they are indicated by the patient's medical history. * Vital signs: Stable vital signs are needed before the patient is subjected to surgery. * Visual signs test results. Test result from snellen's and other visual acuity test are assessed. * Patient's medical history. The nurse assesses the patient's medical history to determine the preoperative test to be required. **Nursing diagnosis** * Disturbed visual sensory perception. * Risk for trauma. * Anxiety. * Deficient knowledge.. ## RHINITIS Rhinitis, also known as coryza, is **irritation and inflammation of the mucous membrane inside the nose**, common symptoms are a stuffy nose, runny nose, sneezing and post-nasal drip.. **Causes** The inflammation is caused by **viruses, bacteria, irritants or allergens. The most common kind of rhinitis is allergic rhinitis, which is usually triggered by airborne such as pollen and dander**. **Types** * **Non-allergic rhinitis** * **Infectious rhinitis** includes acute and chronic bacterial infections. * **Allergic rhinitis** **Signs and symptoms** * Sneezing. * A runny nose * A stuffy nose. * An itching nose. * Coughing. * A sore or scratching throat. * Itching eye. * Watery eyes. * Dark circle under the eyes. * Frequent headaches **Pathphysiology** In allergic rhinitis, the process of allergen sensitization involves the participation of antigen-presenting cells. T lymphocytes and B lymphocytes and depends on environmental allergen exposure sensitization or exposure results in the generation of allergen-specific IgE that circulates in the peripheral blood and attaches itself on the surface of all mast cells and basophils including those at the nasal mucous. Subsequent nasal exposure to allergen activates these cells and, through the release of the classic mediators of the allergic reaction, **produces acute nasal symptoms**. **Management** The **management of allergic rhinitis (AR) can be divided into 3 categories:** * Avoidance of allergens or environmental controls. * Medications (Antihistamines, intranasal corticosteroids, intranasal decongestants etc). * Allergen-specific immunotheraphy (sublingual or allergy shots) **Nursing Management** * Avoid or decrease exposure to allergens and irritants. * Controlling the environment. * Technique of administering nasal medications. * Hygiene, blow the nose before medication. * Treat symptoms.. **Nursing diagnosis** * Ineffective airway clearance * Related to obstruction or presence of thickened secretion. * Disturbed sleep pattern related to obstruction of the nose. * Self-concept disturbance related to the condition. * ANXIETY * Related to lack of knownledge about the disease and medical action procedure. ## SINUSITIS Sinusitis is an inflammation or swelling of the tissue lining the sinuses. Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow and cause an infection. **Conditions that can cause sinus blockage include:** * The common cold. * Allergic rhinitis which is swelling of the lining of the nose. * Small growths in the lining of the nose called nasal polyps. * A deviated spetum which is a shift in the nasal cavity. **Types of sinusitis** * **Acute sinusitis** which usually starts with cold like symptoms such as nunny stuffy nose and facial pain. It may start suddenly and lasts 2-4 weeks. * **Sub-acute sinus inflammation** which usually lasts 4 to 12 weeks. * **Chronic inflammation symptoms** which last 12 weeks or longer. * **Recurrent sinusitis** which happens several times a year. **Acute sinusitis symptoms** The main signs include: * Facial pain or pressure * "stuffed-up" nose * Runny nose * Loss of smell * Cough * Or congestion * Fever * Bad breath * Fatigue * Dental pain **Chronic sinusitis symptoms** These symptoms may last for 12 weeks or more: * A feeling of congestion or fullness in your face. * A nasal obstruction or nasal blockage * Pus in the nasal cavity. * Fever * Runny nose or discolored postnasal drainage. **Diagnostic evaluation** Methods for diagnosing chronic sinusitis include: * Imaging tests: images taken using MRI can show details of your sinuses and nasalarea. * Looking into the sinuses: using a thin flexible tube with a fiber-optic light inserted through the nose. * An allergy test. * Samples from nasal and sinus discharge (cultures) ## MANAGEMENT OF SINUSITIS **General management** or home remedies for sinusitis include: * Nasal corticosteroids. **These nasal sprays help prevent and treat inflammation.** Examples include fluticasone triamcinolone, budesonide, mometasone and beclomethasone. * Saline nasal irrigation, with nasal sprays or solutions, reduce drainage and rinses away irritants and allergies. * Oral or injected corticosteroids. **These medications are used to relieve inflammation from severe sinusitis.** * Antibiotics. Antibiotics are sometimes necessary for sinusitis if it's a bacterial infection. * Endoscopic sinus surgery. **In cases resistant to treatment or medication, endoscopic sinus surgery might be an option.** **Nursing management** * Teach patient self-care practice * Promote drainage of the sinuses, **including humidification of the air in the home and use of steam inhalation and warm compress to relieve pressure**. * Advice to avoid swimming, diving and air travel during the acute infection. * Instrucť immediately to stop smoking or using any form to tobacco. * Referral to a physician if per orbital edema and severe pain on palpation occur. **Nursing diagnosis** * Ineffective airway clearance. * Acute pain * Difficulty in breathing * Impaired verbal communication. ## NOSEBLEED (EPISTAXIS) The definition of a nosebleed is simply bleeding from the blood vessels in the nose. The medical term for nosebleed is epistaxis nosebleeds are common due to the location of the nose on the face,and the large amount of blood vessels in the nose. The most common causes of nosebleed are **drying of the nasal membranes** and nose picking, which can be prevented with proper lubrication of the nasal passage and not picking the nose. **Trauma to the face or directly to the nose is also a common cause**. The following risk factors predispose people to nosebleeds: * Infection * Trauma, including **self-induced by nose picking** (this is a common cause of nosebleeds in children) * Allergic and non-allergic rhinitis * Hypertension(high blood pressure) * Use of blood thinning medications * Alcohol abuse * Less common causes of nosebleeds include **tumor and inherited bleeding problems.** * Hormonal cgange during pregnancy may increase the risk of nosebleeds. **Management** Most people who develop nose bleeding can manage the problem without the need of a treatment by a health-care professional if they follow the step-by-step first aid recommendations below on how to stop a nosebleed: 1. Lean forward slightly with the head tilted forward. Leaning back or tilting head back allows the blood to run back into the sinuses and throat, and can gagging or inhaling of blood. 2. Spit out any blood that may collect in your mouth and throat. It may cause nausea, vomiting, or diarrhea it swallowed. 3. Gently blow any blood clots out of your nose. The nosebleed may worsen slightly when you do this, but this is expected. 4. Pinch all the soft parts of the nose together between the thumb and index finger. 5. Press firmly toward the face -compressing the pinched parts of the nose against the bones of the face. Breathe through your mouth as you do this. 6. Hold the nose for at least five minutes. Repeat as necessary until the nose has stopped bleeding. 7. Sit quietly, keeping the head higher than the level of the heart. Do not lay flat or put your head between your legs. 8. Apply ice (wrapped in a towel) to nose and checks afterwards. **Nursing disgnosis** * Acute pain. * Risk for bleeding * Ineffective airway clearance. ## EAR DISEASES **(a) Tympanic Membrane Perforation** This usually caused by infection or trauma. **Sources of trauma includes** * Severe blow to the ear * Pricking of the ear by foreign objects * Fraction of skull * Injury from explosion **Management** * Anti-biotic (broad spectrum) for infection * Surgical repair of the tympanic membrane such as tympaanoplasty **(b)otitis media** Middle ear infection is **common in children.** It is defined as the inflammation of the middle ear in which the three ossicles are infected. **It could be viral or bacterial**. **Causes includes** * Upper respiratory tract infection * Allergic rhinitis **Signs and symptoms** * Otalagia (severe ear pain) * Drainage from ear * Hearing loss * Foul smelling ottonhea **Management** * Instillation of anti-biotic drops * Surgical management including tympanoplasty, ossiculoplasty and mastoidectomy. **Meniere disease** This is **abnormality in inner ear fluid balance caused by amalabsorption in the endolymphatic sac or a blockage in the endolymphatic duct.** It is more common in adults. It is also common in both men and women and is usually bilateral. **Signs and symptoms** * Vertigo * Tinnitus (unwanted noises in the ear) * Hearing loss * Feeling of fullness in the ear * Nausea * Vomiting **Management** Patients can be successfully treated with diet and medication. **Diet** * Low salt diet * Low sugar * Eat meals and snacks at regular intervals to stay hydrated as missing meals or snacks may alter the fluid level in the inner ear. * Eat fresh fruits, vegetables and whole grains limit the amount of canned frozen or processed foods with high sodium content. * Drink copious fluids daily water, milk and low sugar fruit juices are recommended. * Limit intake of coffee, tea and soft drinks caffeine has diuretic effects hence it should be avoided, * Limit alcohol intake * Avoid aspirin which may cause tinnitus and dizziness. **Medication** * Anti-histamines -this shorteus the attack e.g. tab meclizine. * Tranquilizer such as diazepam (valium) may be used in acute phase to control vertigo. * Anti-emetic such as promethazine (Phenergan) help control the nausea and vomiting and the vertigo. * Diuretic therapy such as hydrochlorothiazide may relieve symptoms by lowering the pressure in the endolymphatic system. * Antibiotic such as gentamycin * Surgery * Surgical approach is to treat the vertigo of Meniere disease because it is relatively simple and safe and can be performed on an outpatient basis.