Chapter 51

1. Chapter 51 Care of Patients with Ear and Hearing Problems Mrs. Marion Kreisel MSN, RN Adult Health 2 NU230 Fall 2011

2. External Otitis • Painful condition caused when irritating or infective agents come into contact with the skin of the external ear • Commonly called swimmer’s ear • Treatment focused on reducing inflammation, edema, and pain with heat, bedrest, limited head movement, topical antibiotic and steroid therapy, and analgesics

3. Earwick

4. Furuncle • Localized external otitis caused by bacterial infection of a hair follicle • Hearing impaired if the lesion blocks the canal, most commonly cerumen (wax) • Treatment with local and systemic antibiotics, heat application, earwick with one-half strength Burow’s solution to relieve pain, and possible incision and drainage

5. Perichondritis • Infection of the perichondrium, a tough, fibrous tissue layer that surrounds the cartilage and gives shape to the pinna

6. Cerumen or Foreign Bodies • Cerumen (wax) is the most common cause of an impacted canal. • Other blockages include vegetables, beads, pencil erasers, insects. • Irrigate canal with a mixture of water and hydrogen peroxide at body temperature for impacted cerumen; Cerumenex softens wax. • Carefully remove foreign object.

7. Irrigation of the External Ear

8. Otitis Media • Three types of otitis media are: • Acute otitis media • Chronic otitis media • Serous otitis media

9. Nonsurgical Management • Quiet environment • Bedrest with limited head movement • Heat and cold applications • Systemic and topical antibiotic therapy • Analgesics • Antihistamines • Decongestants

10. Surgical Management • Myringotomy is a surgical opening of the pars tensa of the eardrum. • Operative procedure includes grommet (polyethylene tube) placed through the tympanic membrane. • Postoperative care—keep external ear and canal free of other substances while the incision is healing, and keep head dry for several days.

11. Tympanic Membrane

12. Mastoiditis • Infection of the mastoid air cells caused by untreated or inadequately treated otitis media • Nonsurgical management—antibiotics • Surgical management—simple or modified radical mastoidectomy with tympanoplasty • Complications—damage to cranial nerves, vertigo, meningitis, brain abscess, chronic purulent otitis media, and wound infection

13. Trauma • Trauma and damage to the eardrum and ossicles may occur by infection, by direct damage, or through rapid changes in the middle-ear cavity pressure. • Eardrum perforations usually heal within 24 hours. • Use preventive measures to protect the ear from trauma.

14. Neoplasms • Tumors are removed by surgery, which often destroys hearing in affected ear. • Benign lesions are removed because, with continued growth of the neoplasm, other structures can be affected, damaging the facial or trigeminal nerve. • When possible, reconstruction of the middle ear structures is performed.

15. Tinnitus • Continuous ringing or noise perception is one of the most common problems with ear or hearing disorders. • Tinnitus cannot be observed or confirmed with diagnostic tests. • When no cause is found, therapy focuses on masking the tinnitus with background sound, noisemakers, and music during sleeping hours.

16. Vertigo and Dizziness • Common manifestations of many ear disorders • Advise patient to: • Restrict head motions and move more slowly • Maintain adequate hydration • Take antivertiginous drugs • Prevent loss-of-balance accidents

17. Labyrinthitis • Infection of the labyrinth • Meningitis a common complication of labyrinthitis • Treatment with systemic antibiotics, bedrest in a darkened room, antiemetics, antivertiginous medications, psychosocial support

18. Ménière's Disease • Tinnitus, one-sided sensorineural hearing loss, and vertigo occur in attacks that can last for several days. • Nonsurgical management includes slow head movements, diet and lifestyle changes, smoking cessation. • Drug therapy—diuretics, nicotinic acid, antihistamines, antiemetics, intratympanic therapy with gentamycin and steroids. • Meniett device. • ATTACKS USUALLY COME WITHOUT WARNING

19. Ménière’s Disease: Surgical Management • Surgical management is a last resort because hearing in the affected ear is often lost from the procedure. • Labyrinthectomy. • Endolymphatic decompression.

20. Acoustic Neuroma • Benign tumor of eighth cranial nerve • Surgical removal via craniotomy • Extreme care taken to preserve the function of the facial nerve

21. Acoustic Neuroma (Cont’d)

22. Hearing Loss • One of the most common physical handicaps in North America. • Common causes of conductive hearing loss—any inflammation process or obstruction of the external or middle ear by cerumen or foreign objects.

23. Hearing Loss (Cont’d) • Common causes of sensorineural hearing loss—loud noise, drugs, presbycusis, atherosclerosis, hypertension, prolonged fever, Ménière's disease, diabetes mellitus, and ear surgery • Pathophysiology • Etiology and genetic risk • Incidence/prevalence • Health promotion and maintenance

24. Anatomy of Hearing Loss

25. Assessments • Tuning fork tests • Otoscopic examination • Psychosocial assessment • Laboratory tests • Imaging assessment • Other diagnostic assessments such as audiogram

26. Nonsurgical Treatment of Hearing Loss • Early detection • Drug therapy • Assistive devices: • Hearing aids • Cochlear implants

27. Surgical Treatment of Hearing Loss • Tympanoplasty: • Postoperative care includes antiseptic-soaked gauze packed in the ear canal, clean dressing, patient flat with head turned to the side and the operative ear facing up for at least 12 hours after surgery, prescribed antibiotics, activity restrictions.

28. Tympanoplasty

29. Ear Surgery

30. Stapedectomy • A partial or complete stapedectomy with a prosthesis corrects hearing loss and is most effective for hearing loss related to otosclerosis. • Hearing improvement may not occur until 6 weeks after surgery.

31. Stapedectomy (Cont’d) • Damage to cranial nerves, vertigo, and nausea and vomiting are common after surgery. • Pain medications and antibiotics are often used. • Safety measures should be implemented, and antivertiginous drugs should be given.

32. Community-Based Care • Home care management • Health teaching • Health care resources

33. Chapter 51 NCLEX TIME

34. Question 1 An expected complication for the patient who wears earphones all day while working may be the development of: • External otitis • Otitis media • Furuncle • Mastoiditis

35. Question 2 A priority nursing intervention for a patient with tinnitus is: • Evaluate medications for ototoxicity. • Encourage music or soft white noise during sleeping hours. • Acknowledge the psychological stressors of the disorder. • Provide education on level of music to prevent hearing loss.

36. Question 3 A patient is complaining of ear pressure, dizziness, and decreased hearing. The nurse should: • Examine the ear for excessive ear wax (cerumen). • Ask the patient if he is experiencing headaches, malaise, or pain. • Establish a time line for the patient’s symptoms. • Examine the patient’s hearing acuity.

37. Question 4 The older adult patient is expressing anxiety over his difficulty learning to lip-read. The nurse should: • Encourage the patient to verbalize his feelings related to his hearing loss. • Ask the physician to give the patient an antianxiety agent. • Encourage the patient to wear his eyeglasses when attempting to lip-read. • Assess the patient’s coping mechanisms regarding his hearing loss.

38. Question 5 How many people ages 65 to 75 years are estimated to have some degree of hearing loss? • 20% to 25% • 30% to 35% • 40% to 45% • 50% to 55%