p




  p
p
 

p
  


 
 

Enter
Sound Sounds
the Sound Transmitted
collects passes TM Transmitted energy to brain
OW Decoding
through amplifies to the transforma stem via
of sounds hearing
by the sound ossicles and tion in the acoustic
the nerve
pinna exit in cochlea
EAC
RW
p

 





¢

pp


à —nspection/palpation of external ears
à Otoscopy
à Test for auditory acuity
à Weber/rinne/whisper test
à Test for vestibular acuity
à Romberg test
à Test for nystagmus
 
 




ï 

 

Œ
 




  


TEST FOR FALLING

ƥ The examiner asks the client to stand with the feet together &
arms hanging loosely at the sides & eyes closed
ƥ The client normally remains erect with slight swaying

p
p 
  

- presence of significant swaying





   
ŒOICE TEST
ƥ Ask the client to block one external canal
ƥ The examiner stands 1-2 ft away & quickly whispers a statement
ƥ The client is asked to repeat the whispered statement
ƥ Each ear is tested separately

ïATCH TEST
ƥ A ticking watch is used to test the high-frequency sounds
ƥ The examiner holds a ticking watch about 5 inches from each
ear & asks the client if the ticking is heard
 ŒESTIBULAR ASSESSMENT OF
THE EAR

GAZE NYSTAGMUS EŒALUATION

ƥ Examine the clientƞs eyes as they look straight ahead, 30
degrees to each side, upward & downward

º


ƥ Any spontaneous nystagmus is a  
 p
pº


- a constant involuntary cyclic movement of the eyeball in any
direction represents a problem with the vestibular system




 CT scan/MR— ² detect tumor

 Arteriography ² assess vascular abnormalities in the temboral
bone
 Tympanometry ² measures movement and mobility of
middle ear (TM and ossicles) when sounds produced
 Audiography ² assessment of air and bone conduction, use of
earphones (air), oscillator behind ear(bone)




 £rain stem response ² electrodes in scalp, present sound in

the ear, measure brain stem response
 Electrocochleography ² measure response of cochlea, CN
V——— to acoustic stimulation, putting electrode in TM,
abnormal result: meniere·s disease
 OAE ² recording of sound produce by cochlear vibration
 ðIAGNOSTIC TESTS FOR THE EAR
AUðIOMETRY
- measures hearing acuity
- uses 2 types: ¢ 

p 
¢p 

- after testing, audiogram patterns are depicted on a graph to determine
the type & level of hearing loss
¢ 

p 

- used to identify problems with hearing, speech, music & other sounds in
the environment
¢p 

- the clientƞs ability to hear spoken words is measured

NURSING CARE
ƥ Inform the client regarding the procedure
ƥ Instruct the client to identify the sounds as they are heard
p
 




 
  


 





 ð
 

  

TOMOGRAPHY
- may be performed with or without contract medium
- assesses the mastoid, middle ear & inner ear structures
- multiple x-rays of the head are done

NURSING CARE
ƥ All jewelry are removed
ƥ Lead eye shields are used to cover the cornea to diminish the radiation dose
to the eyes
ƥ The client must remain still in a supine position
ƥ No follow-up care is required
p!p

à £lood test/C£C ² detect infection
à C & S ² identify infecting organisms ² choose antibiotic
à Test for the presence of CSF ² to diagnose fistula in the ear
à Tissue biopsy ² rule out malignancy
ð
ð

 
r
  
ð 

CERUMEN/EAR ïAX
 the most common cause of impacted canals

FOREIGN BOðIES
 can include vegetables, beads, pencil erasers & insects

ASSESSMENT
Ê
ensation of fullness in the ear with or without hearing loss
Ê Pain, itching or bleeding
á
á


- infective inflammatory or allergic responses involving the
structure of the external auditory canal or the auricles
- an irritating or infective agent comes into contact with
epithelial layer of the external ear
- this leads to either an allergic response or

of infection
- the skin becomes red, swollen, & tender to touch on
movement
- the excessive swelling of the canal lead to conductive
hearing loss
- due to obstruction
- more common in children & termed as Ñp
- occurs more often in hot, humid environments
- prevention includes the elimination of irritating or infecting agents
á
á


ASSESSMENT
Ê Pain
Ê Itching
Ê Plugged feeling in the ear
Ê Redness & edema
Ê Exudate
Ê Hearing loss
 

 
á
- infection of the middle ear occurring as a result of a blocked
eustachian tube, which prevents normal drainage
- a common complication of an acute respiratory infection
- infants & children are more prone
- their eustachian tubes are shorter, wider & straighter

ASSESSMENT
Ê ºever
Ê Irritability, restlessness & loss of appetite
ÊRolling of head from side to side
Ê Pulling on or rubbing the ear
Ê Earache or pain
Ê
igns of hearing loss
Ê Purulent ear drainage
Ê Red, opaque, bulging or retracting tympanic membrane
  
- insertion of tympanoplasty tubes in the middle ear to
equalize pressure & keep the ears dry

POST--OP NURSING CARE

POST
ƥ Instruct the parents & child to keep the ears dry
ƥ Earplugs should be worn during bathing, shampooing &
swimming
ƥ Diving & submerging under water are not allowed
r
r


Î   

     

 !!  
""  
Î !   
       
Î     !     # !" 
 ! 
 


 

    
  
 $ 
""  


 

Î !  
""  
  
"  

"!   
 

- may be acute or chronic & results from untreated or inadequately
treated chronic or acute otitis media
- the pain is not relieved by myringotomy

ASSESSMENT
Ê
welling behind the ear & pain with minimal movement of the head
Ê Cellulitis on the skin or external scalp over the mastoid process
Ê A reddened, dull, thick, immobile tympanic membrane with or without
perforation
Ê Tender & enlarged post-auricular lymph nodes
Ê Low-grade fever
Ê Anorexia
 r

 r

- a benign tumor of the vestibular or acoustic nerve
- the tumor may cause damage to hearing & to facial
movements & sensations
- treatment includes surgical removal of the tumor via
craniotomy
- care is taken to preserve the function of the facial nerve
- the tumor rarely recurs after surgical removal
- post-op nursing care is similar to post-op craniotomy care

p

Ê
ymptoms usually begin with tinnitus & progress to gradual
sensorineural hearing loss
Ê As tumors enlarges, damage to adjacent cranial nerves occurs
 r

- disease of the labyrinthine capsule of the middle ear that results in a
bony overgrowth of the tissue surrounding the ossicles
- causes the devƞt of irregular areas of new bone formation & causes
fixation of the bones
- stapes fixation leads to 
 
 p

- if the disease involves the inner ear, 

 pp

 is present
- it is not uncommon to have bilateral involvement, although hearing loss
may be worse in one ear
- cause is unknown, although has familial tendency
- nonsurgical intervention promotes the improvement of hearing through
amplification
- surgical intervention involves removal of the bony growth that is
causing the hearing loss
- a ¢p
p
p¢
!¢

p¢


¢
º

p

 may be surgically performed
 r


ASSESSMENT
Ê
lowly progressing conductive hearing loss
Ê Bilateral hearing loss
Ê A ringing or roaring type of constant tinnitus
Ê Loud sounds heard in the ear when chewing
Ê Pinkish discoloration p
"
 of the tympanic
membrane
- indicates vascular changes in the ear
Ê ‰-) Rinne test
Ê Weber test shows lateralization of the sound to the ear with
the most conductive hearing loss
Ä

- infection of the labyrinth that occurs as a
complication of acute or chronic otitis media

ASSESSMENT
Ê Hearing loss that may be permanent on the
affected side
Ê Tinnitus
Ê
pontaneous nystagmus to the affected side
Ê Vertigo
Ê Nausea & vomiting

ááá  
á
- a syndrome also called 
¢p

¢
- refers to dilation of the endolympathic system by either
overproduction or decreased reabsorption of endolymphatic
fluid
- characterized by tinnitus, unilateral sensorineural hearing loss,
& vertigo
- symptoms occur in attacks & last for several days, & the client
becomes totally incapacitated
- initial hearing loss is reversible, but as the frequency of attacks
continues, hearing loss becomes permanent
- repeated damage to the cochlea caused by increased fluid
pressure leads to the permanent hearing loss

ááá  
á

CAUSES
Ê Any factor that increases endolymphatic secretion in
the labyrinth
Ê Viral & bacterial infections
Ê Allergic reactions
Ê Biochemical disturbances
Ê Vascular disturbances producing changes in the
microcirculation in the labyrinth

ááá  
á
ASSESSMENT
Ê ºeelings of fullness in the ear
Ê Tinnitus, as a continuous low-pitched roar or humming sound
- is present most of the time but worsens just before &
during severe attacks
Ê Hearing loss is worse during an attack
Ê Vertigo
- periods of whirling which might cause the client to fall to the
ground
- sometimes so intense that even when lying down, the client
holds the bed or ground in an attempt to prevent the whirling
Ê Nausea & vomiting
Ê Nystagmus
Ê
evere headaches
 "


ááá  
á
SURGICAL MANAGEMENT
- performed when medical therapy is ineffective & the
functional level of the client has decreased significantly

ƥ 
¢p
p
p



º


- may be performed early in the course of the disease to assist

with the drainage of excess fluids

ƥ 

º
 
 p
 
ƥ p 



- removal of the labyrinth may be performed
¢

- associated with aging
- leads to degeneration or atrophy of the ganglionic cells in
the cochlea & a loss of elasticity of the basilar membranes
- leads to compromise of the vascular supply to the inner ear
with changes in several areas of the ear structure

ASSESSMENT
Ê Hearing loss is gradual & bilateral
Ê Client states that he she has no problem with hearing but canƞt
understand what the words are
Ê Client thinks that the speaker is mumbling
r r

 


- used for sensorineural hearing loss

- a small computer converts sound waves into
electrical impulses
- electrodes are placed by the internal ear with
a computer device attached to the external
ear
- electronic impulses directly stimulate nerve
fibers
þá
- used for the client with conductive hearing
loss
- can help the client with sensorineural loss,
although it is not as effective
- a difficulty that exists in its use is the
amplification of background noise as well
as voices


 



 p#
$$$