THEEAR
THEEAR
EXTERNAL EAR
• Auricle or pinna
• Tube leading through temporal bone = ear canal
o 1¼ inches long
o Modified sweat glands secrete cerumen
o Tympanic membrane across auditory canal - Protects middle ear
MIDDLE EAR
• Malleus, incus, stapes (spec. bones to ear)
o All are attached and play a role in the hearing process
• Several openings into middle ear canal
o Eustachian Tube - Opens into middle ear which allows for more routes of infection
o E-Tube purpose is to equalize pressure against the tympanic membrane
Ear problems affecting balance are the cause of 100,000 people breaking their hips every year
An elderly person with an inner ear infection will lose their balance then possible fall
GENERAL TERMS AND INFORMATION
• Dizziness
o Altered sensation of orientation and space – nonspecific term
• Vertigo
o Hallucination or illusion of motion.
o Spinning sensation; objects moving around them – inner ear
• Ataxia
o Not truly R/T ear but can be present with inner ear but more associated with
musculoskeletal
o Cerebral palsy.
• Syncope
o Not characteristic of ear; “Fainting or LOC” not ear clarify with description
HEARING LOSS
• Conductive Loss
o External Ear Disorders
You cannot get the sound to the inner part to be processed. Problem with
transmission of sound
• Wax build up
• Otitis Media – The fluid buildup is blocking the sound getting to the inner ear
• Sensorineural
o Inner ear and the nerves and the actual hearing process itself
o Problems with the cochlear or vestibular nerve
o Cranial nerve and function inner ear
• Mixed
o Combination of both
• Function Psychogenic
o Somatoform
o When you lose your hearing for no physical reason
GERONTOLOGIC CONSIDERATION
• Cerumen
o Become harder and drier (natural with aging)
o Increases chances of Impaction within ear
• Middle Ear
o Atrophy and become sclerotic (don’t know why)– decrease in function
o The tympanic membrane can atrophy
• Inner Ear
o Degenerative changes: family history important (natural process as get older)
• Presbycusis
o Progressive hearing loss associated with aging
PSYCHOSOCIAL CONSIDERATIONS
• People don’t like to admit they have problems hearing
• Adults
o Communication with volume, change in personality, change in surroundings. May
walk out in front of a car
• Children
o Inattention; schoolwork and loud speech
• Not eager to seek med attention because of fear of hearing aid
ASSESSMENT
• Ear examination of external ear
o Inspect and palpate, looking for anything unusual or any nodules (gout-tophi)
o It should not hurt to touch the ear
• Middle Ear OTOSCOPIC EXAM
Child – Down and back
o Otoscope visualize canal and tympanic membrane Adult – Up and back
• Inner Ear Child must be restrained to
perform an examination
o Problem with coordination
• Placement of ear in reference to head
o placement with Down’s syndrome, Mental retardation, renal abnormalities
• Position: Pinna out from skull not greatly enlarged
o Note any Swelling that occurs along back of ear – May be infection
o Skin tags or anything unusual about the ear (tophi)
o Flat ear with infant on side too long especially premature
AUDITORY ASSESSMENT
• Reflexes – Newborn should be startled when a loud noise is present
• Response to noise
o Clapping or ringing bell
o Should grimace or blinking
• Crib-O-Gram
o May not be used as much – Omits noise and records infants response
• Tympanometry
o Measure middle ear air pressure assess for middle ear disease
• Audiometry
o Tones and loudness
• Brainstem – Auditory Evoked Response
o Used neonatal nursery - Electrodes attached to head look at electrical waves
o Used routinely in premature infants; may do other babies
MASTOIDITIS
• Inflammation of mastoid R/T middle ear infection
• Major Complication of otitis media invasion – a Hematogonous infection
MENIERE’S DISEASE
• Thought was brain disease
• Condition of inner ear characterized by triad of symptoms (Classic)
o Episodic Incapacitating Vertigo
Severe loss of function
Extremely serious vertigo
It comes and goes
o Tinnitus
Severe extreme ringing in the ears
o Fluctuating Sensorineural Hearing Loss
Loss of hearing
• Etiology is unknown
• Theories
o Abnormal hormonal and neurochemical influence on blood flow to labyrinth
o Electrolyte disturbance within labyrinth fluids
o Allergic reaction
o Autoimmune disorders
o Too much circulating fluid
• Endolymphatic hydrops: Dilation (swelling) in endolymphatic space develops and produces
symptoms
• Either pressure in system or rupture of inner ear membrane
• Incidence: More common in adults with onset in 40’s
• Reported in children as young as 4 y/o and adults all ages to 90’s
• Gender, ear affected equally - Genetic disposition
CLINICAL MANIFESTATIONS
• *Fluctuating, progressive sensorineural hearing loss – it gets worse
• *Tinnitus or a roaring sound
• *Feeling of pressure or fullness in ear
• *Episodic, incapacitating vertigo often accompanied by nausea and/or vomiting
At onset of the disease perhaps only one to two symptoms will manifest
MEDICAL MANAGEMENT
• No cure for this disease
• Successful treatment with diet and medication therapy
o Low Na
2000 mg/day
o Avoid caffeine
o Avoid nicotine
o Avoid alcohol
o Avoid any stimulant
o Lifestyle, habits
• Pharmacologic Therapy
o Antihistamines
Antivert – Medizine
• For vertigo and dizziness
o Tranquilizers
Diazepam – Valium
• Cannot be used long term - Short term therapy
o Antiemetics
Promethazine – Phenergan for nausea and vomiting
o Diuretic Therapy
Hydrochlorothiazide – Dyazide
• Decreases pressure
• Intake of the following – bananas, tomatoes, oranges
o Vasodilators
Used in conjunction with other therapy
• Nicotinic Acid
• Papaveine Hydrochloride – Pavabid
• Methantheline Bromide – Bauthine
• Surgical Management
• Labrynthectomy
o Remove part of the labrynth
o Destroy auditory function of inner ear – Loss of some hearing
o Complications
Facial nerve injury
Cerebrospinal fluid leak – meningitis
Total hearing loss
NURSING DIAGNOSIS
• High R/F injury R/T Vertigo
• Impaired adjustment
• R/F Fluid volume deficit – meds
• Anxiety – change in health status
• R/F Trauma – balance
• Ineffective individual coping R/T dz process, function
• Diversion activity deficit
• Self care deficit R/T vertigo
• Powerlessness – Loss of all control
OTOSCLEROSIS
• Seen in adults
• Aggressive deafness
• Involves stapes
o Is thought to result from a formation of new, abnormal spongy bone (middle ear),
especially around oval window with resulting fixation of stapes
• Efficient transmission of sound prevented because stapes cannot vibrate and carry sound
as conducted from malleus and incus to inner ear
• More common in females and is frequently hereditary
• One or both ears
• May be worsened by pregnancy
• DO in fact have hearing loss
CLINICAL MANIFESTATIONS
• Involve one or both ears
• Presents as progressive conductive or mixed hearing loss
• May or may not C/O tinnitus
• Normal tympanic membrane with otoscopic exam
DIAGNOSTIC TESTS
• Otoscopic exam
o Will be normal
• Look at symptoms
• Rhinne test (bone conduction) will be better than air
• Audiogram confirms conductive hearing loss or mixed loss especially low frequency
o Conductive because the sound cannot get to inner ear due to hardened stapes
MEDICAL MANAGEMENT
• No know non surgical treatment
• Auditory rehab: hearing aids or surgery
• Surgical Management
o Stapedectomy
Performed through canal
Removing the entire stapes superstructure and part of foot plate and inserting
tissue graft and suitable prosthesis
Balance disturbance or true vertigo can occur for short time after
stapedectomy
o Stapendotomy
Some elect to remove only small part of stapes foot plate
Prosthesis bridges gap between incus and inner ear providing better sound
conduction
Very successful in improving hearing
The tube leading from the auricle to the temporal bone is the ear canal.
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