Assisting in Otolaryngology

1. Assisting in Otolaryngology Chapter 37 Part II

2. Learning Objectives Identify the structures and explain the functions of the external, middle, and internal ear. Describe the conditions that can lead to hearing loss, including conductive, neurogenic, and congenital hearing losses. Define the major disorders of the ear, including otitis, impacted cerumen, and Ménière’s disease. Explain the various otic diagnostic procedures. Accurately measure the hearing acuity of a patient by using an audiometer.

3. Learning Objectives Identify the purpose of ear irrigations and instillation of ear medication. Demonstrate ear irrigations. Accurately instill otic drops. Summarize the nose and throat examination. Perform a throat culture. Describe the effect of sensory loss on patient education.

4. Anatomy and Physiology of the Ear The external ear consists of the auricle or pinna and the external auditory canal, which transmits sound waves to the tympanic membrane. The middle ear is an air-filled cavity that contains the ossicles (malleus, incus, stapes). The sound vibration passes through the tympanic membrane, causing the ossicles to vibrate. This bone-conducted vibration passes through the oval window into the inner ear. The organ of Corti in the cochlea of the inner ear converts the sound waves into nervous energy that is sent to the brain for interpretation. The semicircular canals in the inner ear maintain equilibrium.

5. Anatomy of the Ear Modified from Jarvis C: Physical examination and health assessment, ed 4, Philadelphia, 2004, Saunders.

6. Disorders of the Ear Conductive hearing loss originates in the external or middle ear; prevents sound vibrations from passing through the external auditory canal, limits vibration of the tympanic membrane, or interferes with passage of bone-conducted sound in the middle ear. Patient can benefit from a hearing aid. Caused by impacted cerumen trauma to tympanic membrane otosclerosis chronic otitis media

7. Disorders of the Ear Sensorineural hearing loss – results from damage to the organ of Corti or the auditory nerve; prevents sound vibration from becoming nervous stimuli that can be interpreted by the brain as sound. Caused by rubella in utero, influenza, head trauma, ototoxic medications, prolonged exposure to loud noise Presbycusis – hearing loss that affects aging people, is caused by a reduced number of receptor cells in the organ of Corti Tinnitus – ringing in the ears

8. Disorders of the Ear Otitis- inflammation of the ear Two common types: Otitisexterna: Affects the external ear canal and is called otitisexterna, or swimmer's ear Caused by bacterial or fungal infection, psoriasis, trauma to the canal Otitis media: -inflammation of the normally air filled middle ear that results in a collection of water behind the tympanic membrane. -may be fluid or pus filled -assocoated with UR tract infection such as seen with a virus or allergies that swells the eustachian tubes. -Children are more prone because their eustachian tubes are shorter and narrower thus blocking the tubes and cause fluid to collect and infect and may cause temporary hearing loss.

9. Disorders of the Ear Impacted cerumen An excessive secretion of cerumen can gradually cause hearing loss, tinnitus, a feeling of fullness, and otalgia (ear pain). Cerumen pushed tightly up against the eardrum; frequent cause of conductive hearing loss Individuals with psoriasis, abnormally narrow ear canals, or an excessive amount of hair growing within the ear canals are more prone to this condition. Treated with ear irrigation.

10. Disorders of the Ear Ménière’s disease is a chronic, progressive condition that affects the labyrinth and causes recurring attacks of vertigo, tinnitus, a sensation of pressure in the affected ear, and advancing hearing loss. Treatment—salt-restricted diet, medications for nausea and vomiting, diuretics, antihistamines Can result in permanent deafness

11. Diagnostic Ear Procedures The ear examination begins with an otoscopic examination Tuning fork tests Rinne test Weber test Audiometric testing

12. Treatment Procedures Ear irrigation—to remove excess cerumen Direct solution toward roof of canal Abbreviations—AU (both), AD (right), AS (left) Straightening ear canal Adult—pull pinna up and back Child under 3 years—pull ear lobe down and back

13. Irrigation and Medication Ear irrigation is used to remove excessive or impacted cerumen; to remove a foreign body; or to treat the inflamed ear with an antiseptic solution. Medication instilled into the ear generally softens impacted cerumen, relieves pain, or fights an infectious pathogen.

14. Examination of Nose and Throat Examination of the nose and throat begins with the nasal cavity, then the throat and the nasopharynx Throat cultures may be done to determine the presence of a streptococcal infection collected by gently swabbing the back of the throat and the surfaces of the tonsils with a sterile swab mouth and tongue should be avoided to prevent contamination of the swab

15. Patient Education: Hearing Deficits Individuals with hearing deficits may benefit from printed instructions, demonstrations of how to manage treatments, or even sign language interpretation. Family members should be included in the patient’s treatment plan, and referrals to appropriate community or professional resources may be very beneficial.

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