Peter Glen L.

Reyes, PTRP,
RN,MAN
 Medical Surgical nursing

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 Hearing
Hearing- is a special sensory function that
incorporates the sound transmitting of the
external canal.

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Physiology of hearing
Sound waves enter the ear canal and strike the
tympanic membrane, causing it to vibrate; these
vibrations sequentially move the malleus, incus
and stapes
Movement of the stapes against the oval window
into which it fits starts a ripple in the perilymph,
which is transmitted to the endolymph inside the
cochlear duct and stimulates the organ of Corti
Cochlear
nerve
conducts
impulses from
the organ of
Corti to the
brain;
 Hearing
occurs when
impulses
reach the
auditory area
in temporal
Interpretation of sounds
 Loudness: neurologic or psychologic
interpretation of intensity, the greater
the intensity, the greater the size of
nerve impulse
Pitch: corresponds to frequency; the
higher the frequency, the higher the
pitch of the sound
Quality: sound rarely represents a pure
tone but many frequencies occurring
simultaneously
Auditory assessment
External ear
examination
- inspect and palpate the
auricle, auditory canal
and eardrum
- visualization is easier
by straightening the
auditory canal
Normal eardrum is
slightly conical
(externally concave),
shiny, and pearly gray
in
 CHANGE IN COLOR MAY INDICATE
DISEASE
BLUE- blood in the middle ear
(chemotympanum)
YELLOW OR AMBER- serum in the
middle ear
RED OR PINK- indicates middle ear
infection
Sound is measured in terms of
frequency and intensity
Frequency- is expressed by cycles /
seconds or Hertz.
normal individual can perceive only
from 20- 20,000 cycles, within this
only 500-2,000 are important in
understanding daily speech
Intensity or pitch- force movement of
vibrations measured by decibels
comfortable decibel is from 40 – 65
decibels
ordinary conversation is from 40-50
decibels
jet plane- 140 decibels
Anatomy of the ear
 External ear
 Pinna
 Eardrum
 Middle Ear
 3 bones
 Malleus
 Incus
 Stapes

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Middle ear
Tympanic
membrane- is thick
transparent sheet
tissue that provides
barrier between the
external ear and the
middle ear.
Eustachian tube-
opens into the
middle ear and
allows for
equalization of
pressure on both
sides of the tympanic
membrane.Copyright JMDairo08
Anatomy of the ear
Inner ear
Cochlea- is the spiral shape organ of
hearing.
Semicircular canal- contains
the membranous semicircular canals in
which located the crista ampullaris, the
sense organ for sensations of equilibrium
and head movements; vestibular nerve
supplies the crista
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Semicircular canals contain
fluids and hairs cells connected
to the sensory nerve fibers on
the vestibular portion of the
eight cranial nerve.
-The inner ear maintains sense
of balance or equilibrium.
-The cochlea is the spiral shape
organ of hearing.
-Eight cranial nerve
•The cochlear branch of the
nerve transmits neuroimpulses
from the cochlea to the brain
where they are interpreted as
sounds.
•Vestibular branch maintains
balance and equilibrium.
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Assessment of Ear
Inspection of the ear
Adults: Pull pinna BACKWARD and UPWARD

Pedia: Pull pinna BACKWARD and DOWNWARD

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Assessment of Ear
Otoscopy
Eardrum is conical.
Pearly gray and
shiny

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Assessment of Ear
Audiometer
Test of hearing
Measured in decibels

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Nursing Modalities for the
ear
Ear irrigation**
Use of peroxide or
normal saline
Solution should be
warmed
With a steady
stream, direct the
stream of solution
against the roof of
the canal
Position on the
irrigated side to
promote drainage
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Nursing Modalities for the
ear
Eardrops instillation
Use warm solution
Position patient on the side with the affected
ear uppermost
Straighten the ear by pulling pinna up and
back
Hold position for 5 minutes

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 Hearing loss
Hearing loss- represents impairment of the
ability to detect and perceive sound.

Conductive hearing loss- is caused by

disorders in which the auditory stimuli are not
transmitted through the structures of the
outer and middle ears to the sensory
receptors in the inner ear.

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Conductive hearing loss
A. Conductive hearing loss -occurs when the
sound waves are blocked to the inner ears
fibers because of external ear or middle ear
disorders.
Disorders can be often be corrected with no
damage to hearing or minimal permanent
hearing loss.

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Conductive hearing loss
Causes:
A. Any inflammatory process or obstruction of
the external or middle ear.(Impacted earwax
or foreign body)
B. Tumors
C. Otosclerosis
D. A build up of scar tissue on the ossicles
from the previous middle ear surgery.

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OTOSCLEROSIS
Formation of new spongy bone in the
labyrinth of the ear causing fixation
of the stapes in the oval window; this
prevents transmission of auditory
vibration to the inner ear
Common among women
Cause in unknown nut with familial
tendency
Sensorineural hearing
loss
Sensorineural hearing loss:
Description: Is a pathologic process of the
inner ear of the sensory fibers that lead to the
cerebral cortex.
Is often permanent and measures must be
taken to reduce further damage or attempt to
amplify sound as a means of improving
hearing some degree.

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Sensorineural hearing
loss
Cause: Damage of the inner ear structures
- Damage of the eight cranial nerve
- Prolong exposure to loud noise
- Medications
- Trauma
- Inherited disorders
- Metabolic and circulatory disorders
- Infection
- Surgery
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Sensorineural hearing
loss
Trauma:
- head injury
- Noise
Central nervous system infection (meningitis)
Vascular: Atherosclerosis
Ototoxic drugs: Aminoglycosides, salicylates,
loop diuretics

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Sensorineural hearing
loss
Tumors:
-Vestibular Schawannoma ( acoustic
neuroma)
-Meningioma
-Metastatic tumor
Idiopathic:
-Meniere disease

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Sensorineural hearing
loss
Meniere’s Syndrome
Diabetis mellitus
Myxedema

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Mixed hearing loss
Is also known as conductive and
sensorineural hearing loss.
Signs and symptoms:
Frequent asking others to repeat
statement
Straining to hear
Turning head or leaning forward to favor
one ear.
Shouting in conversation
Ringing in ears

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Mixed hearing loss
Failing to respond when not looking in a
direction of the sound
Answer question incorrectly
Raising the volume of the radio or TV
Avoiding large groups
 Withdrawing from social interaction

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Hearing aids
Indicated for conductive hearing loss
Client education regarding hearing aids
- Encourage the client to use hearing aid
slowly
- Adjust the volume to the minimal hearing
level to prevent feedback squeaking.
-Teach the client to concentrate on the
sounds heard
- Instruct the client to clean the ear mold
with mild soap and water.

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Hearing aids
Avoid excessive wetting of the hearing aid
and try to dry after cleaning.
Clean the ear cannula with the aid
toothpick or pipe cleaner
Turn off the hearing aid when not use.
Keep extra batteries on hand
Keep hearing aid in safe place
Prevent hair sprays, oils or other hair and
face products from coming in contact with
the receiver of the hearing aid.

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Presbycusis
- Is associated with aging
- Leads to degeneration or atrophy of the
ganglion cells in the cochlea and loss of
elasticity of the basilar membranes
- Leads to compromise the vascular supply to
the inner ear with changes in several areas of
the ear structure.
Assessment:
Hearing loss gradual and bilateral

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Presbycusis
Client states that he or she has no hearing
problem with hearing but cannot understand
what the words are.
Client thinks that the speaker is numbling.

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Otitis media

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Otitis Media
Inflammation of the
MIDDLE ear

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Otitis Media
Etiologic Factors:
Strep pneumonia
Haemophilus influenzae
Moraxela catarrhalis

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Otitis Media
Pathophysiology
Inflammation
Exudative formation

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Otitis Media
Assessment
findings
 Ear pain
 Ear itchiness
Sense of fullness
Tinnitus/Vertigo
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Otitis Media
Assessment
findings
Decreased hearing
Redness
Drainage of exudates

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Otitis Media
Complications
 Abscess
 Meningitis
 Mastoiditis
Conductive Hearing
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Otitis Media
Medical Management
2.Antibiotics- systemic
and ear drops

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Otitis Media
Medical Management
IF CHRONIC CASE:
Tympanoplasty
And Mastoidectomy

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Otitis Media
Nursing Interventions
2.Manage the infection
– Giving antibiotics
– cleansing of the ear
– Instillation of ear
drops
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Otitis Media
Nursing Interventions
2. Perform ear
irrigation
 Neverdone if
tympanic membrane
is PERFORATED!!!
3. Promote safety
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Meniere’s Disease
The primary lesion appears to be in the
endolymphatic sac, which is thought to be
responsible endolymphatic filtration and
excretion.
- Increase production of endolymph, and
decrease production of perilymph

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Meniere’s Disease
Cause is UNKNOWN
- Proposed possible condition:
- Trauma
- Infection ( syphilis)
- Immunologic
- Endocrine ( Adrenal pituitary insufficiency
and hypothyroidism)
- Vascular disorders
- Viral or fluid transport system to the inner
ear.
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Meniere’s Disease
 Pathophysiology
There is INCREASED pressure of the fluid in the
cochlea
There is INCREASED fluid pressure in the
semicircular ducts

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Meniere’s Disease
 Pathophysiology
 INCREASED pressure attacks of

VERTIGO, TINNITUS
and HEARING LOSS

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Meniere’s Disease
ASSESSMENT findings
Vertigo- whirling sensation
Unilateral or bilateral
hearing loss
Vomiting
Diaphoresis
Nystagmus

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Meniere’s Disease
Medical management
1.Diuretics (acetazolamide,
furosemide) are given to
REDUCE the fluid pressure
and decrease sodium
2. LOW salt diet
3. Antihistamine and anti-
vertigo
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- Suppressant drugs ( prochlorazine,
promethazine, diazepam)
Corticosteroids ( prednisone )
- may be used in satisfactory hearing and
resolved dizziness
Gentamicin therapy -ablation of the vestibular
system- effective in controlling vertigo.
Surgical method- endolymphatic shunt

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Meniere’s Disease
 Nursing Management
2. Assist patient DURING attack
 Stand in front
 Encourage to change position
slowly
 Advise to lie down
 Avoid bright lights
 Support patient when
ambulating
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Meniere’s Disease
 Nursing Management
2. Administer medications
as prescribed
diuretics
anti-emetics

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Meniere’s Disease
 Nursing Management
3. Prevent the attacks of
Meniere’s
 Provide low salt diet
 Encourage to stop smoking
 Take medications as
prescribed
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Thank you