Nursing interventions for clients w/ ear disorders?

• speak clearly in a low tone of normal volume during frequent reorientations and teaching related to assistive hearing devices
• soft consonant sounds such as beginning and ending consonants should be clearly articulated
• the nurse should face the client if possible

occurs from obstructions of the outer or middle ear, such as an accumulation of cerumen in the external acoustic meatus, or a disease such as a failure of the tiny ear bones to vibrate

Conductive hearing loss

involves damage to the inner ear from conditions that affect the sensory hair cells or the nerves

• ex. atherosclerosis, tumors of the vestibulocochlear nerve, infections and drug toxicity

Sensorineural hearing loss

involves both conductive and sensorineural problems, involving damage within the outer or middle hear and in the inner ear or auditory nerve

Mixed hearing loss

involves injury or damage to the nerves or the nuclei of the CNS

Central hearing loss

hearing impairment that is associated w/ old age

Presbycusis

Possible reasons for hearing loss?

• presbycusis
• excessive noise
• loud environment from work
• fhx of sensorineural impairment
• congenital malformations
• ototoxic medications (ex. gentamycin, loop diuretics)
• bacterial meningitis
• perforation of the tympanic membrane

This client reports:

• words and other sounds that are muffled
• difficulty understanding conversations, esp. if there is other noise
• inability to hear complete words, esp. consonants
• request for frequent repetition during a convo
• increased volume on tvs, radios, and other devices
• sense that hearing problems are interfering w/ normal activities
• friends/family report client's speech has deteriorated and client is less understandable

Hearing loss

Examinations used to detect hearing loss?

• otoscopic exam: detects cerumen impaction or injury to tympanic membrane
• audiometry
• tuning fork
• client's hx for exposure to occupational or other noise
• fhx

Medical management for clients w/ hearing loss?

• recommendation for hearing aid
• American sign language
• Speech reading/lip reading
• light-activated alarms
• hearing dogs

Functions of a hearing aid?

• fits behind ear, in ear, or in the ear canal and amplifies sound
• amplifies sound but doesn't improve a client's ability to distinguish words or speech
• all sounds are amplified, including background noise
• clients must seek assistance when they having hearing aid problems

REVIEW CLIENT AND FAMILY TEACHING 43-1: TIPS FOR HEARING AID CARE AND MAINTENANCE

REVIEW CLIENT AND FAMILY TEACHING 43-1: TIPS FOR HEARING AID CARE AND MAINTENANCE

Is sensorineural hearing loss reversible or irreversible?

Irreversible

Surgical management for clients w/ hearing loss?

• cochlear implant

What is a cochlear implant?

an external microphone captures incoming sounds as wells as an external sound processor implanted behind the ear that captures sound, converts it to digital sounds and sends them to an internal plant

• doesn't restore normal hearing
• provides a means for clients to learn or relearn sounds in the environment and to understand speech

Nursing management for clients w/ hearing loss?

• observe for signs such as leaning forward and cupping the ear to hear better, asking that words be repeated
• determine the clarity of the client's speech and may recommend a referral for the dx and subsequent tx of a hearing impairment as well as speech therapy
• stress the importance of avoiding the purchas e of a hearing aid from a mail-order catalog or company salesperson
• obtain information about its severity and the methods used to understand the speech of others
• used illustrations, pamphlets, and written directions to aid teaching and include a family member
• ask the client to repeat info and demonstrate skills

accumulated earwax that obstructs the external acoustic meatus

• clients have excessive thick, dry cerumen

Impacted cerumen

this client presents w/:

• otalgia: fullness/pain in the ears
• diminished hearing
• asks for words to be repeated, misinterprets questions, raises tv or radio volume
• visual exam w/ otoscope shows orange-brown accumulation of cerumen in distal end of the external acoustic meatus

Impacted cerumen

Medical management for clients w/ impacted cerumen?

• instilling one or two drops of half-strength hydrogen peroxide, warm glycerin
• carbamide peroxide (debrox)
• triethanolamine (cerumenex)
• removed mechanically by irrigating the ear using a cerumen spoon or curette

Nursing management for clients w/ impacted cerumen?

• inspect ear and implement measures to remove excessive cerumen
• eardrops can be warmed by holding the container in the hand for a few moments or placing it in warm water
• be sure to warm ear drops to body temp b/c hot/cold liquids cause dizziness
• avoid inserting irrigation too deeply; direct the flow toward the roof of the canal rather the tympanic membrane
• teach clients to not clean the external auditory canal w/ cotton swabs or tooth picks

Medical management for clients w/ foreign objects in the ear?

This client may present w/:

• diminished hearing
• feels movement or a hears a buzzing sound
• discomfort

• mineral oil is instilled into the ear to smother an insect
• solid object
• the nurse instructs client to clean ears w/ a face cloth rather than inserting objects into the ears

inflammation of the tissue in the external auditory canal

can be caused by:

• psoriasis
• eczema
• seborrheic dermatitis
• allergies to hair products

Otitis externa

This client reports:

• external ear looks red
• swelling; can't see tympanic membrane
• discomfort increases w/ manipulation
• fever
• lymph nodes behind ear enlarge
• pus

Otitis externa

Medical management for clients w/ otitis externa?

• warm soaks
• analgesics
• antibiotic ear medication
• corticosteroid meds: (neomycin/polymyxin/hydrocortisone solution)

Nursing management for clients w/ otitis externa?

• provide teaching to prevent recurrence
• advise swimmers to wear soft plastic earplugs to prevent trapping of water in ear
• encourage client to eat soft foods or consume nourishing liquids to prevent discomfort
• advised client to avoid the use of non prescription remedies unless they have been approved by the PCP

REVIEW BOX 43-3: PREVENTING RECURRENT OTITIS EXTERNA

REVIEW BOX 43-3: PREVENTING RECURRENT OTITIS EXTERNA

Acute inflammation or infection of the middle ear

Otitis media

if otitis media is left untreated, it can lead to infection of the mastoid process ?

• or travel deeper to the inner ear?

• Mastoiditis
• labyrinthitis

This client presents w/:

• hx of having a recent upper respiratory infection or seasonal allergies
• fever
• tinnitus
• malaise
• severe earache
• diminished hearing
• tenderness behind the ear=mastoiditis
• tympanic membrane looks red and bulging
• pressure of middle ear causes n/v and dizziness
• increased WBC

Otitis media

Medical/surgical management for clients w/ otitis media?

• prompt tx prevents rupture of the tympanic membrane
• fluid aspiration by needle
• antibiotics
• myringotomy/tympanotomy: facilitates drainage of purulent material, eases pressure, and relieves throbbing pain
• myringoplasty
• mastoidectomy (removes diseased tissue; mastoiditis is rare)

Nursing management for clients w/ otitis media?

• after a myringotomy, the discharge from the ear is bloody and then purulent
• to remove the drainage, the nurse wipes the external ear repeatedly w/ a dry sterile cotton applicator
• insert a loose (not tightly packed) cotton pledget in the external ear to collect drainage.
• change pledget when it becomes moist

result of a bony overgrowth of the stapes and a common cause of hearing impairment among adults

• interferes w/ the vibration of the stapes and the transmission of sound to the inner ear

Otosclerosis

This client reports:

• progressive, b/l loss of hearing
• tympanic membrane appears pinkish-orange from structural changes in the middle ear
• interference with the ability to follow conversation
• difficulty hearing others

Otosclerosis

When the rinne test is performed where is the best sound heart when the tuning fork is applied?

the sound is best heart when tuning fork is applied behind the ear

Medical/surgical management for clients w/ otosclerosis?

• otosclerosis has no cure
• hearing aid may help
• surgical option: stapedectomy is performed on ear most affected

Complications associated w/ a stapedectomy?

• continued hearing loss
• infection
• dizziness
• facial nerve damage

Nursing management for clients w/ otosclerosis?

• give pre-op client an explanation of what to expect in post-op period
• client activity is restricted for 24 hours or more post-surgery
• hearing may be temporarily or the same as or worse than before surgery
• post-op, position client on non-operative side
• prevent dislodgment of the prosthesis as a result of coughing, sneezing, or vomiting
• nausea and dizziness are common problems
• assess facial nerve function by checking symmetry when the client smiles or frowns

REVIEW NURSING PROCESS FOR CLIENT RECOVERING FROM STAPEDECTOMY

REVIEW NURSING PROCESS FOR CLIENT RECOVERING FROM STAPEDECTOMY

sensation of movement when there is none, or a sense of exaggerated motion when movement

two types:

• objective: person is stationary and the environment is moving
• subjective: a person feels motion but the surrounding environment is stationary (spinning sensation)

Vertigo

Nursing care for clients w/ vertigo focuses on what?

• tx of symptoms
• maintenance of the client's safety

Medications used to tx Vertigo?

• Meclizine
• Dimenhydrinate
• Benzos (end in -pam)
• Antidepressants

• form of physiologic vertigo
• repeated and constant motion causes this
• clients experience this while in a car or plane, on a boat, or on carnival rides

s/s:

• nausea and vomiting
• pallor
• diaphoresis

treatment:

• dimenhydrinate
• meclizine
• scopolamine patches

Motion sickness

involves brief periods of severe vertigo when clients move their heads, particularly if they move their head back and toward the affect ear

• many clients experience it when they roll over in bed onto their side

treatment:

• meclizine
• vestibular rehab therapy (VRT)

Benign paroxysmal positional vertigo

disorder is characterized by fluctuations in the fluid volume and pressure in the endolymphatic sac of the inner ear

• causes distention of the endolymphatic compartment, leading to hearing loss, tinnitus, and vertigo
• generally affects one ear, but can affect both
• idiopathic

Meniere disease

This client presents w/:

• s/s that are sudden, occur daily or infrequently
• vertigo is the most incapacitating symptom
• whirling dizziness and need to lie dow
• nausea/vomiting/abdominal discomfort
• tinnitus
• hearing loss
• headaches
• nystagmus
• hearing returns b/t attacks but gradually becomes worse w/ repeated attacks

Meniere disease

Medical/surgical management for clients w/ Meniere disease?

• tx aims at reducing fluid production of inner ear, facilitating drainage, and tx'ing symptoms that accompany attack
• low-sodium diet
• no smoking
• tx of allergy and avoidance of allergen is recommended
• bed rest
• meclizine
• diazepam
• promethazine
• hydrochlorothiazide (watch potassium level)
• avoid monosodium glutamate
• avoid aspirin and aspirin products

Medical/surgical management for clients w/ Meniere disease?

• assess gross hearing and perform Rinne test and Weber tests
• determine extent and effect of the client's disability
• provide emotional support
• be available, empathic, and responsive
• low-sodium diet to decrease edema
• advise clients that have allergies to avoid allergens and take antihistamines

detrimental effect of certain medications on the 8th cranial nerve or hearing structures

• drugs associated: salicylates, loop diuretics, quinidine, quinine, aminoglycosides

s/s:

• tinnitus
• sensorineural hearing loss
• lightheadness
• vertigo
• n/v

nurses must be knowledge about the ototoxic effects of certain medications

nurses must carefully monitor the dosage and frequency of administration as well as asses the client for changes in hearing

Ototoxicity

benign Schwann cell tumor that progressively enlarges and adversely affects cranial nerve 8

acoustic neuroma