4-9-08 Jennifer Jenkins

Sensory Ear Disorders

Anatomy of the Ear
o Consists of three parts:
o External Ear
o Middle Ear
o Inner Ear
External Ear
o Housed in the temporal bone & includes:
o Auricle or pinna
o External auditory canal
Middle Ear
o Air filled cavity that is connected by the eustachian tube to the
nasopharynx. It includes:
o Tympanic membrane
o Ossicles
Inner Ear
o Hearing:
o Balance:
o Cranial nerve: VII & VIII
Functions
o Hearing
o Balance & equilibrium
Assessment: INSPECTION
o Deformities (one ear larger than the other, one ear may be missing,
are they the same on each side)
o Lesions or cuts
o Discharge
o Size
o Symmetry
o Angle of attachment to the head
o Pain when you touch them, is there any tenderness
o Dermatitis or inflammation
Otoscopic Examination
o Otoscope
o Positioning
o Discharge
o Inflammation
o Foreign bodies
o Tympanic membrane
o Fluid-DO NOT FLUSH EAR WITH COLD WATER, FLUSH WITH WARM
WATER to remove ear wax
o Air bubbles
o Blood
o Masses
Evaluation of Gross Auditory Acuity
o Whisper Test
o Weber Test-tuning fork to test bone conduction (should be same on
both sides)
o Rinne Test-tuning fork held away from the ear to conduct air
Diagnostic Evaluation
o Audiometry
o Clinical Hearing Tests
Hearing Loss
o More than 26 million people affected
o Appropriately 10 million have irreversible hearing loss
o Occupational exposure
o Types of Hearing Loss
o Conductive
o Sensorineural
o Mixed
o Functional
Clinical manifestations:
o Tinnitus-ringing in the ears (aspirin causes this if you take it
chronically)
o Increase inability to hear in groups
o Need to turn up the volume on the television set
o Change in attitude
o Disinterests and inattentive, failing grades
Gerontologic considerations:
o Age
o Cerumen
o Atrophy of the tympanic membrane
o Cochlear degeneration
o Familial
o Lifelong exposure to loud noises
o Medication
o Psychogenic factors and other disease processes
Management:
o Prevention
o Surgical
o Aural rehabilitation
o Nursing care
Cerumen Impaction
• Cerumen normally accumulates in the external ear canal.
• It does not usually need to be removed. (it normally removes itself)
• More common in the elderly
Management:
o Irrigation
o Suction
o Instrumentation-curex
o Referral
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Foreign Bodies
o Beads
o Pebbles
o Peas
o Earrings
o Insects
Management:
o Three standard methods
o Irrigation
o Suction
o Instrumentation
o Referral
External Otitis (Otitis Externa) pg. 1802
Know difference between otitis media and otitis externa

o Inflammation of the external auditory canal

Causes:
o Water in the ear canal (use ear plugs, cotton balls with Vaseline on
them) when swimming
o Trauma
o Bacterial & fungal
o Dermatitis
o Allergic reactions to hair products
Clinical manifestations:
o Pain
o Discharge
o Aural tenderness
o Fever
o Pruritus
o Hearing loss
o Feeling of fullness
o Erythematous & edematous ear canal
o Cellulitis & lymphadenopathy
Medical Management
o Analgesic
o Antibiotics
o Corticosteroids
o Antifungals
Nursing Management
o Keep the external ear canal clear of drainage.
o Avoid allowing water to enter the ear canal.
o Barrier (ear plugs, etc.)
o Antiseptic otic preparations should be kept at room temperature

Gapping Earring Puncture

o Wearing heavy pierced earrings
 o After an infection
o Allergic reaction
o Wearing more than one earring
Management:
 Surgery
Tympanic Membrane Perforation
Causes
o Infection
o Trauma
o Foreign objects
Medical Management:
o Spontaneous healing
o Protect from water
Surgical management:
o Tympanoplasty
Acute Otitis Media
o Infection of the middle ear lasting less than 6 weeks
Causes:
o Streptococcus pneumonias, Haemophilus influenzae, Moraxella
catarrhalis
o Obstruction of the eustachian tube
o Bacteria can enter the eustachian tube from contaminated
secretions in the nasopharynx & middle ear, from a perforated
tympanic membrane.
Clinical manifestations:
o Symptoms varies with severity
o Otorrhea
o No aural tenderness
o Fever
o Tympanic membrane erythematous & bulging
o Hearing loss
o Otalgia
• Poor feeding in children

Medical Management
o Antibiotics
o Antipyretics-for fever
o Analgesics
Surgical Management:
o Myringotomy or Tympanotomy-incision into the membrane
o Pressure Equalizing (PE) Tubes usually in children-keeps open

Serous Otitis Media

o Fluid without evidence of infection in the middle ear
o Primarily in children
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o Frequently seen in patients after radiation therapy

o Eustachian tube dysfunction
o Barotrauma
o Carcinoma
Clinical manifestations:
o Hearing loss
o Feeling of fullness
o Popping & crackling noises
o Dull tympanic membrane
o Air bubbles
Management:
o No treatment needed if infection not present
o Myringotomy
o PE Tubes
o Corticosteroids
o Valsalve maneuver-pinch the nose and blow
Chronic Otitis Media
o Repeated episodes of acute otitis media.
 causing
o Irreversible tissue pathology
 and
o Persistent perforation of the tympanic membrane
Clinical manifestations:
o Hearing loss
o Foul-smelling otorrhea or drainage
o Absence of pain
o Perforated tympanic membrane
o Cholesteatoma-white mass behind the tympanic membrane
Medical management:
o Suctioning
o Antibiotic otic drops
o Systemic antibiotics
Surgical Management:
o Tympanoplasty-re-establish function
o Ossiculoplasty-reconstruction of middle ear bones
o Mastoidectomy-remove cholesteatoma

Otosclerosis
o Involves the stapes
o Results from the formation of new abnormal spongy bone, with
resulting fixation of the stapes
o Transmission of sound is prevented.
o Common in women
 o Hereditary
o Pregnancy worsens the condition
Clinical Manifestations:
o May involve one or both ears
o Progressive conductive hearing loss
o or
o Mixed hearing loss
o Tympanic membrane is normal
o Bone conduction is better than air conduction
Medical management:
o No known non-surgical treatment.
o Florical-supplement to help mature bone growth
o Amplification
Surgical management:
o Stapedectomy-removal of stapes and insert graft
Conditions of the Inner Ear
Motion Sickness
 Disturbance of equilibrium caused by constant motion
o Clinical Manifestations
o Sweating
o Pallor
o Nausea
o Vomiting
o Management:
o Antihistamines-benadryl
o Anticholinergics-dramamine, procalamine patches
Meniere’s Disease
o Abnormal inner ear fluid balance
o Common in adults
o Average age of onset 40s
o Both ears affected equally
o Bilaterally in 20% of patients
o Twenty percent have a positive family history
Clinical Manifestations
o Fluctuating, progressive sensorineural hearing loss
o Tinnitus
o Feeling of pressure or fullness in the ear
o Episodic, incapacitating vertigo
o Nausea & vomiting
Assessment & Diagnostic Findings:
o Vertigo
o Diaphoresis
o Imbalance or disequilibrium
o Attacks may awaken at night
o Hearing loss fluctuates with tinnitus & aural pressure
Physical Exam:
o Normal PE
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o Weber test lateralizes to ear opposite the hearing loss

o Audiogram reveals sensorineural hearing loss in the affected ear
o No absolute diagnostic test
Management:
o Diet
o 2000mg/day Sodium Diet
o Medication
o Antihistamines-meclazine
o Tranquilizers-valium
o Antiemetics-pheregan
o Diuretics-HCTZ
o Psychological
o Surgical
o To eliminate attacks of vertigo
Ototoxicity
Medications:
o Aspirin
o Quinine
o Aminoglycosides
Prevention
o Patients should be counseled about side effects of ototoxic
medications.
o Blood levels should be monitored
o Audiogram twice weekly during therapy
Common Nursing Diagnoses
o Risk for injury
o Pain
o Sensory perceptual alteration
o Alteration in comfort
o Ineffective coping
o Fear
o Anxiety
Acoustic Neuroma
Benign Tumor of Cranial Nerve VIII
 Usually arise from the Schwann cell
 Account for 5-10% of all intracranial tumors
 Occur equally in men and women at any age
 Most are unilateral
Management
o Surgery to remove-can develop paralysis on one side, meningitis
o Gamma Knife if surgery is refused
Assessment/Diagnostic
o Unilateral tinnitus and hearing loss with or without vertigo and
balance disturbances
o Conventional Audiometry most useful
o MRI with a paramagnetic agent
o CT with contrast