Anatomy and physiology of the EAR

Anatomy of the Ear

Anatomy of the Inner Ear

Sound wave conduction

Sound collects by pinna

Sounds passes through the EAC

TM amplifies the sound

Transmitted to the ossicles

Enter the OW and exit in RW

Sound energy transforma tion in the cochlea

Transmitted to brain stem via acoustic nerve

Decoding of sounds

hearing

Assessment and diagnostic exams

PHYSICAL ASSESSMENTy Inspection/palpation of external ears y Otoscopy y Test for auditory acuityy Weber/rinne/whisper test

y Test for vestibular acuityy Romberg test y Test for nystagmus

Technique for Using an Otoscope

otoscopy

Weber Test

Rinne Test

VESTIBULAR ASSESSMENT OF THE EAR

TEST FOR FALLINGThe examiner asks the client to stand with the feet together & arms hanging loosely at the sides & eyes closed The client normally remains erect with slight swayingABNORMAL RESULT: (+) ROMBERG SIGN

- presence of significant swaying

ASSESSMENT OF THE EARVOICE TESTAsk the client to block one external canal The examiner stands 1-2 ft away & quickly whispers a statement The client is asked to repeat the whispered statement Each ear is tested separately

WATCH TESTA ticking watch is used to test the high-frequency sounds The examiner holds a ticking watch about 5 inches from each ear & asks the client if the ticking is heard

VESTIBULAR ASSESSMENT OF THE EAR GAZE NYSTAGMUS EVALUATIONExamine the client s eyes as they look straight ahead, 30 degrees to each side, upward & downward

FINDINGSAny spontaneous nystagmus is a (+) result - ABNORMAL FINDING - a constant involuntary cyclic movement of the eyeball in any direction represents a problem with the vestibular system

diagnostics CT scan/MRI detect tumor Arteriography assess vascular abnormalities in the temboral

bone Tympanometry measures movement and mobility of middle ear (TM and ossicles) when sounds produced Audiography assessment of air and bone conduction, use of earphones (air), oscillator behind ear(bone)

diagnostics Brain stem response electrodes in scalp, present sound in

the ear, measure brain stem response Electrocochleography measure response of cochlea, CN VIII to acoustic stimulation, putting electrode in TM, abnormal result: menieres disease OAE recording of sound produce by cochlear vibration

DIAGNOSTIC TESTS FOR THE EARAUDIOMETRY- measures hearing acuity - uses 2 types: PURE TONE AUDIOMETRY & SPEECH AUDIOMETRY - after testing, audiogram patterns are depicted on a graph to determine the type & level of hearing loss PURE TONE AUDIOMETRY - used to identify problems with hearing, speech, music & other sounds in the environment SPEECH AUDIOMETRY - the client s ability to hear spoken words is measured

NURSING CAREInform the client regarding the procedure Instruct the client to identify the sounds as they are heard

Audiogram for determining the audibility curve for pure-tone hearing loss at various frequency levels

DIAGNOSTIC TESTS FOR THE EARTOMOGRAPHY- 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 CAREAll jewelry are removed Lead eye shields are used to cover the cornea to diminish the radiation dose to the eyes The client must remain still in a supine position No follow-up care is required

LABORATORYy Blood test/CBC detect infection y C & S identify infecting organisms choose antibiotic y Test for the presence of CSF to diagnose fistula in the ear y Tissue biopsy rule out malignancy

DISORDERS OF THE EAR

CERUMEN & FOREIGN BODIESCERUMEN/EAR WAX- the most common cause of impacted canals

FOREIGN BODIES- can include vegetables, beads, pencil erasers & insects

ASSESSMENT Sensation of fullness in the ear with or without hearing loss

Pain, itching or bleeding

EXTERNAL OTITIS- 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 S/S 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 SWIMMER S EAR - occurs more often in hot, humid environments - prevention includes the elimination of irritating or infecting agents

EXTERNAL OTITISASSESSMENT Pain

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

OTITIS MEDIA- 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 Fever Irritability, restlessness & loss of appetite Rolling of head from side to side Pulling on or rubbing the ear Earache or pain Signs of hearing loss Purulent ear drainage Red, opaque, bulging or retracting tympanic membrane

MYRINGOTOMY- insertion of tympanoplasty tubes in the middle ear to equalize pressure & keep the ears dry

POSTPOST-OP NURSING CAREInstruct the parents & child to keep the ears dry Earplugs should be worn during bathing, shampooing & swimming Diving & submerging under water are not allowed

CHRONIC OTITIS MEDIA- a chronic infective, inflammatory, or allergic response involving the structure of the middle ear - surgical treatment is necessary to restore hearing - the type of surgery can vary & include a simple reconstruction of the tympanic membrane, a myringotomy, or replacement of the ossicles within the middle ear

TYMPANOPLASTY- a reconstruction of the middle ear may be attempted to improve conductive hearing loss

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

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

ACOUSTIC NEUROMA- 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

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

OTOSCLEROSIS- disease of the labyrinthine capsule of the middle ear that results in a bony overgrowth of the tissue surrounding the ossicles - causes the dev t of irregular areas of new bone formation & causes fixation of the bones - stapes fixation leads to CONDUCTIVE HEARING LOSS - if the disease involves the inner ear, SENSORINEURAL HEARING LOSS 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 PARTIAL STAPEDECTOMY or COMPLETE STAPEDECTOMY WITH PROSTHESIS (FENESTRATION) may be surgically performed

OTOSCLEROSISASSESSMENT Slowly progressing conductive hearing loss

Bilateral hearing loss A ringing or roaring type of constant tinnitus Loud sounds heard in the ear when chewing Pinkish discoloration (SCHWARTZE S SIGN) of the tympanic membrane - indicates vascular changes in the ear (-) Rinne test Weber test shows lateralization of the sound to the ear with the most conductive hearing loss

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

ASSESSMENT Hearing loss that may be permanent on the affected side Tinnitus Spontaneous nystagmus to the affected side Vertigo Nausea & vomiting

MENIERES SYNDROME- a syndrome also called

ENDOLYMPHATIC

HYDROPS- 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

MENIERES SYNDROMECAUSES Any factor that increases endolymphatic secretion in the labyrinth Viral & bacterial infections Allergic reactions Biochemical disturbances Vascular disturbances producing changes in the microcirculation in the labyrinth

MENIERES SYNDROMEASSESSMENT Feelings of fullness in the ear Tinnitus, as a continuous low-pitched roar or humming sound - is present most of the time but worsens just before & during severe attacks Hearing loss is worse during an attack 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 Nausea & vomiting Nystagmus Severe headaches

Menieres

MENIERES SYNDROMESURGICAL MANAGEMENT- performed when medical therapy is ineffective & the functional level of the client has decreased significantly

ENDOLYMPHATIC DRAINAGE & INSERTION OF THE SHUNT- may be performed early in the course of the disease to assist with the drainage of excess fluids

RESECTION OF THE VESTIBULAR NERVE LABYRINTHECTOMY- removal of the labyrinth may be performed

PRESBYCUSIS- 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 Hearing loss is gradual & bilateral

Client states that he/she has no problem with hearing but can t understand what the words are Client thinks that the speaker is mumbling

COCHLEAR IMPLANTATION- 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

HEARING AIDS- 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

Stapedectomy for Otosclerosis

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