MSN QUESTION BANK- UNIT 1- ENT

LONG ESSAY 5M
1) Explain post operative management of Mastoiditis.
Mastoiditis is an infection of mastoid process, the portion of the temporal bone of the
skull that is behind the ear which contains open, air containing spaces.
Surgical management for mastoiditis includes: Myringotomy ( a small incision is
made in the tympanic membrane which helps to drain the pus from middle ear),
Mastoidectomy i.e. simple, radical or modified radical mastoidectomy (removal of
diseased tissue or the source of infection)

 After surgery on the middle ear: comfort, safety, prevention of infection, and
prevention of pressure on the tympanic membrane.
 Nausea common
 Assist patient first time out of bed, in case of dizziness.
 Patient should avoid activity that creates pressure on the tympanic
membrane(blowing the nose, coughing, sneezing, straining)
Medical management:

 Inspect the dressing and describe drainage but do not disturb or remove the
dressing.
 Medications: to prevent like hood of complications
o High dose of broad spectrum iv antibiotics for at least 48 hours
o Oral antibiotics may be used after 48 hours if clinically improving
o Analgesics
o Antipyretics

Nursing management:
NURSING DIAGNOSIS:
Anxiety related to surgical procedure, potential loss of hearing as manifested by facial
expression.

 Reinforce the information discussed by otologic surgeon.

 Explain regarding the anesthesia, location of the incision, and expected surgical
outcome.
Risk for infection related to mastoidectomy.

 The external auditory canal wick or packing may be kept with an antibiotic solution
before instillation.
 Prophylactic antibiotics are administered as prescribed.
 Instruct the patient to prevent water from entering the external auditory canal for 6
weeks.
 Place cotton balls or lamb wool covered with petroleum jelly loosely in the ear canal
to prevent water contamination.
 Report signs and symptoms of infection.
Disturbed auditory sensory perception related to surgery or packing as manifested by
presence of surgical dressing.

 To improve hearing:
 Reduce environmental noise.
 Facing the patient while speaking.
 Speak clearly and distinct.
 Provide good lighting if the patient relies on speech reading and use of non verbal
clues.
 Instruct family members about the effective way to communicate with the client.
Patient teaching after surgery:

 Take antibiotics and other medications as prescribed.

 Blow nose gently one side at a time for 1 week after surgery.
 Sneeze and cough with mouth open for few week after surgery.
 Avoid heavy lifting, straining and bending over for a few week after surgery.
 Crackling sensations in the operated ear are normal for approximately 3 to 5
weeks after surgery.
 Temporary hearing loss is normal in the operative ear due to fluid, blood, or
packing in the ear.
 Report excessive purulent discharge to the physician.
 Change the cotton balls in the ear as needed.
 Avoid getting wet in the operated ear for 2 weeks after surgery.
 Do not shampoo for one week.
(reference: Brunner &Suddarth’s, textbookof Medical-Surgical Nursing; South Asian edition,
Vol 1 Walters Kluwer. Page no: 1605

2) List the causes and management of Epitaxis.

Epitaxis is a hemorrhage from the nose, generally common in all age groups.
Causes of epitaxis:
 Local:
o Nose: i.e, in the nose or nasopharynx
i. Trauma – finger nail trauma, injuries of nose, intranasal surgery, fractures
of middle third of face and base of skull, hard blowing of nose, violent
sneeze.
ii. Infections: Acute: viral rhinitis, nasal diphtheria, acute sinusitis. Chronic:
all crust forming diseases e.g. atrophic rhinitis, rhinitis sicca, tuberculosis,
syphilis, septal perforation, granulomatous lesion of nose.
iii. Foreign bodies: nonliving:any neglected foreign body, rhinolith. Living:
maggots,leeches.
iv. Neoplasm of nose and paranasal sinuses: benign: haemangioma.
Malignant: carcinoma or sarcoma.
v. Atmospheric changes: high altitudes, sudden decompression.
vi. Deviated nasal septum.
o Naspharynx:
i. Adenoiditis
ii. Juvenile angiofibroma
 iii. Malignant tumors
 General causes:
a) Cardiovascular system: hypertension, atherosclerosis, mitral stenosis.
b) Disorders of blood and blood vessels: aplastic anaemia, leukemia,
thrombocytopenia and vascular purpura, haemophilia, scurvy, vitamin K
deficiency, Christmas disease.
c) Liver diseases: hepatic cirrhosis.
d) Kidney disease: chronic nephritis
e) Drugs: excessive use of salicyclates and other analgesics, anticoagulant
therapy.
f) Mediastinal compression
g) Acute general infection: influenza, measles, chickenpox, whooping cough,
rheumatic fever, typhoid, pneumonia, malaria, dengue fever.
Management of epitaxis:

 Management of epitaxis depends on its cause and the location of the bleeding site.
 A nasal speculum, penlight, or headlight may be used to identify the site of bleeding
in the nasal cavity.
 Initial treatment may include applying direct pressure.
 The patient should sits upright with the head tilted forward to prevent swallowing and
aspiration of blood
 It is directed to pinch the soft outer portion of the nose against the midline septum for
5 or 10 minutes continuously.
 Medical management:
o Application of decongestants (phenylephrine, one or two sprays)
o Visible bleeding sites may be cauterized with silver nitrate or electrocautery.
o A supplemental patch of Surgicel or Gelfoam may be used.
o Cotton tampon may be used to try to stop the bleeding.
o If the origin of the bleeding cannot be identified, the nose may be packed with
gauze impregnated with petrolatrum jelly or antibiotic ointment.
o A topical anesthetic spray and decongestant agent may be used before the
gauze packing is inserted, or ballon inflated catheter may be used.
 Nursing management:
NURSING DIAGNOSIS:
Risk for bleeding.

 Monitor the patients general condition.

 Monitor vital signs.
 Monitor the amount of bleeding patients.
 Monitor the event of anemia.
Ineffective airway clearance.

 Asses the sound or the depth of breathing and chest movement.

 Note the ability to remove mucous/ coughing effectively.
 Give fowlers or semi fowlers position.
 Clear secretions from the mouth and trachea.
Acute pain.

 Assess the level of pain.

 Teach relaxation and distraction techniques.
 Observe vital signs.
Patient education about self care:

 Avoid vigorous exercise for several days.

 Avoid hot or spicy foods and tobacco.
 Discharge education includes reviewing ways to prevent epitaxis.
 Avoid forceful nose blowing, straining, high altitude and nasal trauma.
 Adequate humidification may prevent drying of the nasal passages.
Reference: Brunner &Suddarth’s, textbookof Medical-Surgical Nursing; South Asian
edition, Vol 1 Walters Kluwer. Page no: 1603

3) Explain the rehabilitation of patients with hearing loss.

Aural rehabilitation is the process of identifying and diagnosing a hearing loss, providing
different types of therapies to clients who are hearing impaired and implementing different
amplification devices to aid the clients hearing abilities. The purpose of the aural
rehabilitation is to maximize the hearing impaired client’s communication skills.

Aural rehabilitation is multifaceted process that includes auditory training (listening),speech

reading (lip reading) and the use of hearing aids.

1. Hearing aid orientation: The process of providing education and therapies to persons
(individual or group) and their families about the use and expectations of wearing
hearing aids to improve communication.
2. Listening strategies: The process of teaching hearing impaired persons common and
alternative strategies when listening with or without amplification to improve their
communication.
3. Speech reading: The process of using or teaching the understanding communication
using visual cues observed from the speakers mouth, facial expressions, and hand
movements.
4. Auditory training: The process of teaching an individual with a hearing loss the ability
to recognise speech sounds, patterns, words, phrases or sentences via audition.
5. Unisensory: Therapy philosophy that centers on extreme development of a single
sense for improving communication.
6. Cued speech: The process of using and teaching manual hand or facial movements
used to supplement an auditory-verbal approach to the development of
communication competence.
7. Total communication: The process of using and teaching speech, language and
communication skills simultaneously using manual communication, speech and
hearing.
 8. Manual communication: The process of using and teaching communication via finger
spelling and with a signed language.

Reference: Lewis's Medical -Surgical Nursing, Volume-I,page no; 398

4) Explain the management of common cold.

The common cold is a viral infection of the upper respiratory tract usually last approximately
7 days associated with a number of viruses.

Eg. Rhinovirus, parainfluenza virus

Symptoms

 Watery eyes
 Head ache
 Chills
 Dryness and stiffness in the nasopharynx
Management

 Antihistamines
 Decongestant
 Pain relievers
 Nasal strips
 Drinking plenty of fluids
 Resting
 Saltwater gargle
 Using saline nasal drops
Nursing diagnosis:

 ineffective airway clearance related to semithick nasal discharge as evidenced by

presence of mucus secretion.
 Ineffective breathing pattern related to airway spasm as evidenced by abnormal
breath sounds wheezes and crackles

Nursing interventions

 Administer analgesics as indicated

 Assisting with or providing balanced dietary intake of foods and fluids.
References: www.nandanursingcareplan.com, www.Slideshare.mob.com, Ncbi
5) Describe the nursing management of sinusitis.

Sinusitis is an inflammation of the mucus membrane of the paranasal sinuses

Medical management
  Antipyretics
 Analgesics
 Mucolytics
 Nasal decongestant
Nursing management

 For the first 24 hours after sinus surgery observe the client for nasal bleeding,
respiratory distress, orbital and facial edema.
 Explain the client to engage in minimal physical exercise.
 Teach the client to sneeze only with the mouth open
 Nasal saline spray may be started 3 to 5 days after the surgery to remove the
mucosa.
Nursing diagnosis

 Acute pain related to inflammation of nose

 Self concept disturbance related to bad breath and a runny nose
Nursing interventions

 Monitor vital signs

 Assess clients level of pain
References

http://nursingcareplan.blogspot.com, www.nandacareplan.com, www SlideShare.mob.com

6) Discuss the meaning, causes and clinical manifestations of pharyngitis.

Acute pharyngitis is a sudden painful inflammation of the pharynx, the back portion of the
throat that includes the posterior third of the tongue, soft palate, and tonsils. It is commonly
referred to as a sore throat.

Causes:

 Poorly ventilated rooms

 Viral infections: droplets of cough, and sneezes, unhygienic hands. It is high in winter
and early spring.
 Bacterial infections: caused mainly by Group A beta-hemolytic streptococcus.

Clinical Manifestations:

o Fiery-red pharyngeal membrane and tonsils,

o Lymphoid follicles are swollen and flecked with white-purple exudate,
o Enlarged and tender cervical lymph nodes,
 o No cough,
o Fever(>38.30C),
o Malaise,
o Sore throat,
o Vomiting,
o Anorexia,
o Scarlet fever-scarlatina-form rash with urticarial.

Streptococcal pharyngitis produces:

o Painful sore throat

o Malaise
o Fever with or without chills
o Headache
o Myalgia
o Painful cervical adenopathy
o Nausea
o Tonsillitis
o Petechiae
o Halitosis.

Reference: Brunner and Suddharth, Textbook of Medical-Surgical Nursing, South Asian

edition, Published by Wolters Kluwer Pvt. Ltd., New Delhi(2018), Page:1561.

7) Explain medical and nursing management of tonsillitis.

The tonsils are composed of lymphatic tissue and are situated on each side of the
oropharynx. The palatine tonsils and lingual tonsils are located behind the pillars of the
fauces and tongue. The inflammation of these sites are called as tonsillitis.

The symptoms include sore throat, fever, snoring, and dysphagia.

MEDICAL MANAGEMENT:

 Tonsillitis is treated with supportive measures that include increased fluid intake,
analgesics, salt water gargles, and rest. Bacterial infections are treated with penicillin
 (first line therapy) or cephalosporins (cefdinir, moxifloxacin). Viral tonsillitis is not
effectively treated with antibiotic therapy.
 Tonsillectomy continues to be a commonly performed surgical procedure and remains
the treatment of choice for patients with chronic tonsillitis. Tonsillectomy is indicated
if the patient has had repeated episodes of tonsillitis despite antibiotic therapy.
 The presence of persistent tonsillar asymmetry should prompt an excisional biopsy to
rule out lymphoma.

NURSING MANAGEMENT:

Postoperative care:

 Continuous nursing observation is required in the immediate postoperative and

recovery periods because of the risk of hemorrhage.
 The most comfortable position is prone, with the patient’s head turned to the side to
allow drainage from the mouth and the pharynx.
 The nurse must not remove the oral airway until the patient’s gag and swallowing
reflexes have returned. The nurse applies an ice collar to the neck, and a basin and
tissues are provided for the expectoration of blood and mucus.
 The symptoms of complications include fever, pain, and bleeding. Pain can be
controlled by analgesics. Occasionally, suture or ligation of a bleeding vessel is
needed. If there is no bleeding, water and ice chips are given to the patient as soon as
desired. The patient is instructed to refrain from too much talking and coughing,
because these activities can produce throat pain.

Educating patient about self-care:

 The patient is sent home from the recovery room once awake, oriented and able to
drink liquids and void.
 The nurse instructs the patient about the use of liquid acetaminophen/paracetamol
with or without codeine for pain control and explains the pain will subside during the
first 3-5 days.
 The nurse should explain to the patient that a sore throat, stiff neck, minor ear pain
and vomiting may occur in the first 24 hours.
  The patient should eat an adequate diet with soft foods. The patient should avoid
spicy, hot, acidic, or rough foods. Milk and milk products may be restricted. The
nurse instructs the patient to maintain good hydration.
 The patient is advised to avoid vigorous tooth brushing or gargling because these can
cause bleeding. The nurse encourages the patient to use the cool-mist vaporizer or
humidifier in the home.
 The patient should avoid smoking and heavy lifting or exertion for 10 days.

Reference: Brunner and Suddharth, Textbook of Medical-Surgical Nursing, South Asian

edition, Wolters Kluwer Pvt. Ltd., New Delhi 2018, Pages 1563-1564

8. Explain surgical and nursing management of tonsillitis.

Tonsillitis is the inflammation of palatine tonsils commonly caused by viral ( HSV ,
Measles) or bacterial infections ( S. areus , bacterial pneumonia).
Surgical management for tonsillitis is tonsillectomy in which both the palatine tonsils are
fully removed from the back of the throat. The procedure is mainly performed for
recurrent throat infections and obstructive sleep apnea (OSA).
Types of tonsillectomy:

1. Cold Scalpel or Cold Knife Surgery: This is the oldest form of tonsillectomy. Here they
don’t freeze the instruments and they don’t freeze your tonsils. “Cold” refers to the metal of
the scalpel. In this method, the tonsils and/or adenoids are removed completely using a
scalpel. The patient is under general anesthesia. There is minimal post-operative bleeding.

2. Ultrasonic or Harmonic Dissection:This method uses the blade of a very special scalpel.
This scalpel vibrates at high frequency. The energy from the vibration is transferred from the
blade to the tissue. The vibration is at such high frequency (55,000 cycles per second) that the
tissue is simultaneously cut and coagulated. ENTs like the very precise cutting afforded by
this method. The patient is under general anesthesia and there is little post-operative bleeding.

3. Electrocautery Tonsil Removal: This method burns the tonsils away. It simultaneously
removes the tonsil and cauterizes the area to stop bleeding. This method is safe, effective and
fairly common. It does run the risk of injury to the tissue around the tonsil and this can make
the post-operative recovery period more uncomfortable.

4. Microdebrider Tonsillectomy: A microdebrider is a rotary device that “shaves” tissue

away. When this method is removed, the entire tonsil is not removed. A layer of tonsil tissue
is left over the throat muscles. This procedure can be performed in the ENT’s office under
local anesthesia. The recovery period is minimal and there is very little post-operative pain.
However, this procedure is not recommended when tonsil removal is due to recurring
infection. This procedure is recommended when enlarged tonsils obstruct breathing.

5. Bipolar Radiofrequency Ablation: Bipolar refers to the method in which energy is

transferred to tissue. An ionized (or charged) saline layer is charged with radiofrequency
waves. This breaks molecular bonds in the tissue and separates it without causing harm to the
surrounding tissue. This method can be used to reduce the size of enlarged tonsils or to
completely remove the tonsils. This method has very little post-operative pain and the
recovery process is much easier.

Reference: https://scentmd.com/blog/5-types-of-tonsil-surgery

Nursing management:

 Continuous nursing observation is required in the immediate postoperative and

recovery periods because of the risk of haemorrhage, which may also
compromise the patient’s airway.
Nursing diagnosis:
1. Pain related to removal of tonsils as evidenced by pain score reading.
2. Ineffective airway clearance related to pain as evidenced by accumulation
of secretions.
3. Anxiety related to surgical intervention as evidenced by facial expression.
4. Risk for deficient fluid volume related to decreased intake of fluids.
5. Risk for infection related to surgery.
Interventions:
 Provide analgesics as prescribed.
 Provide comfortable position and bed
 Promote intake of sips of water
 Assess vital signs
 Look for complications.
 Prevent any further injury and infections.

Reference: (REF: Lewis’s medical surgical nursing)

9. Explain care of a patient with tracheostomy.

A tracheostomy is a surgically created opening in the trachea. A tracheostomy tube is placed
in the incision to secure an airway and to prevent it from closing. Tracheostomy care is
generally done every eight hours and involves cleaning around the incision, as well as
replacing the inner canula of the tracheostomy tube. After the site heals, the entire
trachoesotomy tube is replaced once or twice per week, depending on the physicians order.
Precautions:
 Extra precautions should be taken when performing site care during the first few days
after the tracheostomy is surgically created.
 The site is prone to bleeding and is sensitive to movement of the tracheostomy tube.
 It is recommended that another healthcare professional securely holds the tube while
site care is performed.
 Tracheostomy care should not be done while the patient is restless or agitated, since
this increases the chances that the tube may be pulled out and the airway lost.
Equipments:
1. Clean tray or trolley
2. Sterile dressing pack
3. Sterile gauze swabs (additional)
 4. Sterile gallipot (additional)
5. Sterile drape
6. Sterile gloves+ non sterile gloves
7. Sterile water
8. Sterile suction catheter
9. Hydrogen peroxide solution
10. Antiseptic solution
11. 2 tracheostomy tapes
12. Receptacle for soiled disposables
13. Suction apparatus
Procedure:
1. Explain the procedure to the patient to gain patients confidence and cooperation.
2. Ensure the patients privacy.
3. Wash and dry hands to prevent infection
4. Assist the patient to be in a comfortable position
5. Assess the condition of the stoma prior to conducting the procedure. Note redness,
swelling, type of secretions, presence of purulence or bleeding. The presence of skin
breakdown or infection must be monitored and reported. Culture of the site may be
warranted.
6. Cleaning of the fresh stoma should be performed every 8 hours or more frequently if
required.
 To prevent infection
 To prevent irritation
Preparatory phase:
1. Suction the trachea and pharynx thoroughly prior to tracheostomy care. Removal of
secretions prior to care keeps the site clean for a longer period.
2. Place sterile drape on patient’s chest under tracheostomy site. It provides sterile field.
3. Open dressing pack.
4. Pour antiseptic, hydrogen peroxide (diluted strength) and water into 3 separate sterile
containers. Antiseptic solution may be applied to fresh stoma or infected stoma.
Hydrogen peroxide is used for the removal of mucus and crust. The presence of which
promotes infection.
5. Place sterile tapes on sterile field.
6. Don sterile gloves.
Performance phase:
1. Clean the external end of the tracheostomy tube with 2 gauze swabs soaked with
hydrogen peroxide.
2. Clean the stoma with 2 gauze swabs with hydrogen peroxide. Make only a single
sweep with each swab then discard.
3. Loosen and remove any crusting with sterile cotton swabs.
4. Repeat step 2 using sterile water soaked gauze sponges to ensure that hydrogen
peroxide is removed.
5. Repeat the procedure using 2 dry swabs to ensure dryness of the area because
moisture promotes infection.
 6. An infected wound may be cleaned using gauze with antiseptic solution and then
dried. Use one swab one wipe technique. Apply antibiotic if prescribed, using cotton
swabs.
7. Change the tracheostomy tie tapes. Tape should be changed every 24 hours or when
soiled or wet.
 Cut soiled tape while holding the tube secured/ in place with the other hand
(two nurses may be required for this procedure step) to prevent accidental
dislodgement.
 Remove old tape carefully.
 Take one tape and isert through slit in tracheostomy tube wing. Pull through to
half the lenghth to form a loop. To assist in the prevention of irritation and
coughing due to the manipulation of the tube.
 Repeat procedure on second wing
 Tie the tape sat the side of theneck in a square knot. Alternate knot from side
to side each time tapes are changed to prevent irritation and to rotate pressure
site.
 Tapes should be tight enough to secure the tube in the stoma while facilitating
the access of two fingers between the tape and neck. Tightness of tape will
cause discomfort to the patient. Excessive tightness will compress the jugular
veins as well as decrease the blood circulation to the skin beneath the tapes.
8. Dressing to the stoma site is dependent upon the decision of practitioner.
9. Leave patient in a comfortable position
10. Clean and clear equipment
11. Wash and dry hands
12. Document procedure including observation of stoma as well as character of secretion.
10. Briefly describe the causes, signs and symptoms of Otitis media

Otitis media is defined as the inflammation of the middle ear characterized by the
accumulation of infected fluid in the middle ear, the area just behind the ear drum.

Causes:

 Bacteria: Streptococcus pneumonia, Hemophilus influenzae, Moraxella catarrhalis,

Group A Streptococcus, Staphylococcus aureus
 Virus: Adenovirus, Rhinovirus, Influenza virus
 Viral infection of Upper respiratory tract
 Anatomic obstruction caused by adenoids and nasopharyngeal tumors
 Infections of nose and throat
 Forcible blowing of nose
 Swimming
 Bottle feeding in supine or horizontal position
 Middle ear trauma
 Barotrauma
 Palatal disorders: cleft palate
  Nasal allergies

Signs and symptoms:

 Fullness in the ear

 Earache
 Deafness
 Tinnitus: is the perception of noise or ringing in the ears.
 Fever ( 102-1030 F)
 Ottorhoea: it is a serous, serosanguineous or purulent discharge from the ear
 Malaise: a general feeling of discomfort or illness
 Headache
 Vertigo: A sudden internal or external spinning sensation often triggered by moving
your head too quickly

Reference: Lewis's Medical -Surgical Nursing, Volume-I,page no; 395

11. Clinical manifestation and nursing management of patient with otitis media.

Otitis media is defined as the inflammation of the middle ear characterized by the
accumulation of infected fluid in the middle ear, the area just behind the ear drum.

Clinical manifestation:

 Fullness in the ear

 Earache
 Deafness
 Tinnitus: is the perception of noise or ringing in the ears.
 Fever ( 102-1030 F)
 Ottorhoea: it is a serous, serosanguineous or purulent discharge from the ear
 Malaise: a general feeling of discomfort or illness
 Headache
 Vertigo: A sudden internal or external spinning sensation often triggered by moving
your head too quickly.

Nursing management:

1. Acute ear pain related to infection, inflammation, swollen tympanic membrane as

evidenced by pain score reading.

2. Disturbed auditory sensory perception related to obstruction in ear as evidenced by hearing

loss.

3. Hyperthermia related to infection as evidenced by thermometer reading.

4. Anxiety related to progressive hearing loss as evidenced by facial expression.

5. Disturbed sleep related to pain as evidenced by drowsiness during the day.

Interventions:

 Check vital signs frequently

 Advice bed rest
 Report signs of infection
 Give medications as per physicians order
 Instruct patient to prevent water entering the ear for 6 weeks.
 Avoid any heavy lifting and blowing for 2-3 weeks.
 Reduce loud noise to improve hearing and communication
 Cold compress to reduce temperature ( take precautions so that water doesn’t enter
ear)

Reference: Lewis's Medical -Surgical Nursing, Volume-I,page no; 395

12. Discuss causes and signs and symptoms of speech disorders.

A speech disorder is a condition in which a person has problems creating or forming

the speech sounds needed to communicate with others

 Causes of speech disorders :

 Brain damage due to a stroke or head injury
 muscle weakness
 damaged vocal cords
 a degenerative disease, such as Huntington’s disease, Parkinson’s disease, or
amyotrophic lateral sclerosis
 dementia
 cancer that affects the mouth or throat
 autism
 Down syndrome
 hearing loss
 Signs and symptoms :
 repeating or prolonging sounds
 distorting sounds
 adding sounds or syllables to words
 rearranging syllables
 having difficulty pronouncing words correctly
 struggling to say the correct word or sound
 speaking with a hoarse or raspy voice
 speaking very softly
Bibliography:https://www.medicalnewstoday.com/articles/324764#symptoms

13. Explain the care and maintenance of hearing aids.

 Cleaning
 Keep in mind that the ear mold is the only part of the hearing aid that may be
washed frequently.
 Wash the ear mold daily with soup and water.
  Allow the ear mold to dry completely before it is snapped into the receiver.
 Clean the cannula with a small pipe cleaner-like device.
 Note that properly caring for the ear device and keeping the ear canal clean
and dry can prevent complications.
 Checking for Malfunctions
 Be aware that inadequate amplification, a whistling noise, or pain from the
mold can occur when a hearing aid is not functioning properly.
 Check for malfunctions;
 Is the switch on properly?
 Are the batteries charged and positioned correctly?
 Is the ear mold clogged with cerumen? Ear wax can be easily removed
with the pin, pipe cleaner, or wax loop.
 Notify the hearing aid dealer if the hearing aid is still not working properly.
 Keep in mind that if the unit requires extended time for repairs the dealer mat
lend you a hearing aid until the repair can be accomplished.
Bibliography: Brunner &Suddarth’s, textbookof Medical-Surgical Nursing; South Asian
edition, Vol 1 Walters Kluwer. Page no: 1606

14. Explain the role of nurse in communicating with hearing impaired patients.
 For the person who is hearing impaired whose speech is difficult to
understand:
 Consider how the person refers to communicate with others do not assume that
writing gestures on other means are the best or preferred technique.
 Consider is the person uses sign language interpreters are available from the
American sign language. Inc.,interpreting service (ASLI). These specialists provide
the best means of communication providing accurate professional services.
 Devote full attention to what the person is saying look and listen do not try to attend
to another task while listening.
 Engage the speaker in conversation when it is possible for you to anticipate the replies
this enables you to become accustomed to any peculiarities in speech patterns.
 Try to determine the essential context of what is being said you can often feel in the
details from context.
 Do not try to appear to appear as if you understand if you do not.
 If you cannot understand at all or have serious doubt about your ability to understand
what is being said, have the person write the message rather than risk
misunderstanding having the person repeat the message in speech after you know its
content also age u in becoming a custom to the persons pattern of speech.
 Written communication is an excellent research written material should be written at
the third grade level so that the maturity of people can understand it.
 For the person who is hearing-impaired who speech reads:-
 When speaking , always face the person as directly as possible.
 make sure your face is as clearly visible as possible.Locateyourself so that your face
is well lighted; avoid being silhouetted against light.Do not obscure the person's veiw
of your mouth in any way; avoid talking with any object held in your mouth.
  Be sure that patient knows the topic or subject before going ahead with what you plan
to say this enables the person to use contextual clues in speech reading .
 Speak slowly and distinctly passing more frequently than you would normally.
 If you question some important direction or instruction has been understood check to
be certain that the patient has the full meaning of your message .
 If for any reason your mouth must be covered (as with the mask ) and you must direct
or instruct the patient write the message.
Reference:Brunner and sudharth textbook of medical surgical nursing 11th edition volume
2 ,page number 2104.

SHORT ESSAYS-DK
1) Explain the nursing management of patients with Menieres disease
Meniere disease is a chronic disorder of the inner ear involving sensory neural hearing loss
senior vertigo and tinnitus.

Nursing diagnosis
 Risk for injury related to altered mobility because of get disturbed and vertigo .
 Adjustment related to disability requiring change in lifestyle because of
unpredictability of vertigo.
 Risk for fluid volume imbalance and deficit related to increase fluid output altered
intake and medications .
 Anxiety related to threat of or change in health status and disabling effects of
vertigo .
 Ineffective coping related to personal vulnerability and unmet expectations
stemming from vertigo.
 Feeding, bathing, hygiene, dressing and toileting self care deficit related to
labyrinth dysfunction and episodes of vertigo .
Nursing management:-
o Provide nursing care by during acute attack
o provide a safe, quiet, dimly lit environment and enforce bed rest .
o provide emotional support and assurance to elevate anxiety
o administer prescribed medications which may include antihistamines and
antiemetic and possibly mild diuretics.
o Instruct the client on self care instructions to control the number of acute attacks .
o Discuss the nature of the disorder.
o Discuss the need for a law salt diet .
o Explain the importance of avoiding stimulants and vasoconstrictions(example:-
caffeine decongestants and alcohols )
o discuss medications that may be prescribed to prevent attacks or self
administration of appropriate medications during an attacks, which may include
 anticholinergics,vasodilation, antihistamines and possibly Diuretics or nicotinic
acid .
o Discuss prepare and assist the client with surgical options
o A labyrinthectomy is the most radical procedure and involves resection of the
vestibular nerve or total removal of labyrinth performed by the transcanal route
which results indeafness in that ear.
o An Endolymphatic decompression consists of draining the endolymphatic sac and
inserting a shunt to enhance the fluid drainage.
Reference: https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-
notes/menieres-disease-nursing-management/

SHORT ANSWERS:
1. List four causes of deafness.

Deafness refers to complete or partial loss of ability to hear from one or both ears. The
level of impairment can be mild, moderate, severe or profound.

 External ear: Impacted cerumen, foreign bodies, external otitis.

 Middle ear: otitis media, serous otitis, otosclerosis.
 Inner ear: Meniere’s disease, noise exposure, presbycusis(age related hearing loss),
ototoxicity.

(REF: Lewis’s medical surgical nursing)

2) List down the classification of hearing loss.

Hearing loss can be classified by the decibel (dB) level or loss as recorded on the
audiogram. Normal hearing loss is in the 0-15 dB range.

 Mild: between 25 and 40 dB

 Moderate: between 41 and 55 dB
 Moderately severe: between 56 and 70 Db
 Severe: between 71 and 90 dB
 Profound: 91 dB or greater

(REF: Lewis’s medical surgical nursing)

3) List four causes of speech disorders.

Speech defect is any condition that interferes with the mental formation of words or their
physical production.

 Secondary to paralysis, deafness, retardation or other mental disorders, and larynx

cancer.
  Organic defects include deafness, cleft palate, dental abnoormlities and brain
damage.
 Functional problems which are basically pycological.

(REF: Lewis’s medical surgical nursing)

4) List any two indications of speech therapy

Speech therapy mainly includes the components like biofeedback, music therapy and
meditation.

 Deafness
 Hoarseness
 Laryngeal neoplasms
 Speech disorders
 Otorhinolaryngologic disease
References: (REF: Lewis’s medical surgical nursing)

6) Define peritonsilar abscess.

 Peritonsillar abscess also known as qquinccy is a recognized complication of
tonsillitis and consists of pus beside the tonsil i.e. peritonsilar space mainly
caused by group A beta haemolytic streptococcus.

Reference: Lewis's Medical -Surgical Nursing, Volume-I,page no; 398

 A complication of tonsillitis in which the infections spreads behind the
tonsills. A peritonsilar abscess occurs when a collection of pus forms and
infection spreads beyond the tonsills.
Reference: https://en.m.wikipedia.org/wiki/peritonsillar_abscess

6) Define laryngitis.

Inflammation of the larynx , typically resulting in huskiness or loss of the voice, harsh
breathing and painful cough.

laryngitis is swelling and inflammation of the vocal cords it can be acute or chronic.

Reference

 SlideShare.mob.in
 Wikipedia
 Www.Myoclonic.com

7) Define adenoiditis.
  The adenoids or pharyngeal tonsils consist of lymphatic tissue near the center of the
posterior wall of the nasopharynx. Infection or the inflammation of the adenoids is
called as the adenoiditis.

The bacterial pathogens include GABHS.

The most common viral pathogens are Epstein-Barr virus, cytomegalovirus.

Reference:Brunner and Suddharth, Textbook of Medical-Surgical Nursing, South Asian Edition, Wolters
Kluwer Pvt. Ltd. 2018, Page 1563.

 Adenoiditis is an inflammation of the adenoids caused by the infection.Adenoids are

the first line of defense against viruses and bacterias, besides tonsils.

Symptoms include dry throat, snoring, runny nose, breathing through nose becomes difficult.

Adenoiditis can be caused by bacterial infection such as streptococcus and also by a number
of viruses like Epstein-Barr viruses, adenovirus, rhinovirus.

Refrence: Steve Kim, Brindles Lee Macon, healthline.com, January 6, 2016.

8) What is oral cancer?

 There are two types of oral cancers: oral cavity cancers and oropharyngeal cancers.

Most oral cancer lesions occur on the lower lip. Other sites include lateral border and
undersurface of tongue, labial commissure, and buccal mucosa.

Clinical Manifestations:

 Leukoplakia = smokers patch, a white patch on the mucosa.

 Erythroplakia = red velvety patch on the mouth
 Ulcer
 Soreness or pain
 Slurred speech
 Dysphagia
 Increased salivation.
 Toothache
 Earache
Refrence:Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX India Pvt. Ltd. 2018,
Page:853.

 Cancer is defined as the uncontrollable growth of the cells that invade and cause the
damage of the surrounding cells. Oral cancer appear as a growth or sore in the mouth
that does not go away.

Risk Factors:

 Smoking
 Tobacco users
 Family history of cancer
 Excess consumption of alcohol
 HPV

Reference: Michael Friedman, WebMD Medical Reference, October 10, 2019.

9) Define parotiditis.

 It is the inflammation of the parotid gland.

This is caused by streptococcus, staphylococcus species and also due to poor oral hygiene.

Clinical Manifestations:

 Pain
 Absence of salivation
 Purulent exudate

Treatment:

 Antibiotics
 Warm compress
 Mouthwashes
 Fluid intake
 Topical medications
 Soft, bland diet

Refrence:Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX India Pvt. Ltd. 2018,
Page:852.
  It is defined as the swelling in one or both of the parotid glands. This can be acute and
chronic parotitis.
Causes:
 Bacterial
 Viral
 Blockage of the saliva
Symptoms:
 Pain and swelling
 Redness
 Pus
 Dry mouth
 Milky discharge in the mouth=chronic
Risk Factors:
o Dehydration
o Recent surgery
o Tumor
o Salivary stone
o Eating disorders
o Depression
o Diabetes
o HIV infection
Refrence:Winchesterhospital.org, health –library.

10. What is audiometry?

 It is the measurement of the range and sensitivity of a person’s sense of hearing.

It is the measurement of hearing.
Reference: https://www.medicinenet.com

 It is the single most important diagnostic instrument. Audiometric testing is of two

types:
a) Pure tone audiometry
b) Speech audiometry
Reference: (Brunner and Suddharth's textbook of medical surgical nursing 11th edition volume 2,page number
2119.)

11. List two types of audiometry?

Pure tone audiometry
The sound stimulus consist of a pureor musical tone.The louder the tone before patient
perceives it,the greater the hearing loss.
Speech audiometry
The spoken word is used to determine the ability to hear and discriminate sounds and words.
Other types:
Suprathreshold Audiometry
Self recording Audiometry
Impedance Audiometry
Computer administered Audiometry
12. What are hearing aids?

 Hearing aid is a device through which speech and environmental sounds are received
by a microphone, converted to electrical signals, amplified and reconverted to
acoustic signals.
Reference: (Brunner and Suddharth's textbook of medical surgical nursing 11th edition volume 2,page number
2119.)

 A small amplifying device which fits on the ear worn by a partially deaf person
Reference: Oxford

 A hearing aid is a device designed to improve hearing by making sound audible to a

person with hearing loss.
Reference: Lewis's Medical -Surgical Nursing, Volume-I,page no; 398
13.Define tympanic membrane perforation?

Ans:A hole in the tissue that separates the ear canal from the middle ear.

A perforated eardrum may be caused by the loud sounds,a foreign object in the
ear,head trauma,a middle ear infections or rapid pressure changes.

Link: https://g.co/kgs/rkvWDq

14.List the etiological factors of tympanic membrane?

Ans: Infection is the main cause of tympanic membrane. Others like direct force to the
ear,air pressure,head trauma, foreign objects in the middle ear,ear surgeries.

Link: https://www.bcm.edu

15. List the clinical manifestations of tympanic membrane?

Ans: -otalgia

-fullness, discomfort

-blood tinged discharge from ear

-hearing loss
 -vertigo

-tinnitus

Link: https://www.mayoclinic.org

16. Define otosclerosis?

 Otosclerosis involves the stapes and is thought to result from the formation of
new, abnormal spongy bone, especially around the oval window, with resulting
fixation of the stapes. The efficient transmission of sound is prevented because
the stapes cannot vibrate and carry the sound as conducted from the malleus and
incus to the inner cut. Otosclerosis is more common in women, is a familial
condition and can progress to complete deafness
Bibliography: Brunner &Suddarth’s, textbook of Medical-Surgical Nursing; South Asian
edition, Vol 1 Walters Kluwer. Page no: 1599

 The abnormal formation of new bone in the middle ear that gradually
immobilizes the stapes (stirrup bone) and prevents it from vibrating in response
to sound, causing a progressive conductive loss of hearing. Otosclerosis usually
affects both ears. It is a common disorder, especially among young
women. Pregnancy may trigger it.
Bibliography:https://www.medicinenet.com/script/main/art.asp?articlekey=25696

 Otosclerosis is a rare condition that causes hearing loss. It happens when a small

bone in your middle ear -- usually the one called the stapes -- gets stuck in place.
Most of the time, this happens when bone tissue in your middle ear grows
around the stapes in a way it shouldn't.
Symptoms:
 Dizziness or balance problems
 Tinnitus, or ringing, roaring, or hissing
Bibliography:https://www.webmd.com/cold-and-flu/ear-infection/otosclerosis-facts#1
 Otosclerosis is a form of hearing loss that occurs due to abnormal bone growth
in your middle ear. The presence of this bone disrupts the complex series of
energy transformations that ultimately allow us to hear. 
Symptoms:
 Common symptoms of otosclerosis are gradual hearing loss as well
as tinnitus (or ringing in the ears), As well, people with the condition
may experience dizziness or the sensation of vertigo
Bibliography:https://www.healthyhearing.com/report/53072-Otosclerosis
17. Define Meniere’s disease?

 Meniere’s disease is an abnormality in an inner ear fluied balance caused by

malabsorbtion in the endolymphatic sac or a blockage in the endolmphatic duct
 Endolymphatic hydrops develops, and either increased pressure in the system or
rupture of the inner ear membrane occurs, producing symptoms of Meniere
disease.
Clinical Manifestations

 Episodic vertigo, tinnitus(unwanted noises in the head or ear), and fluctuating

sensorneural hearing loss.
Bibliography: Brunner &Suddarth’s, textbook of Medical-Surgical Nursing; South Asian
edition, Vol 1 Walters Kluwer. Page no: 1600

 Meniere's disease is a disorder of the inner ear that can lead to dizzy spells
(vertigo) and hearing loss. In most cases, Meniere's disease affects only one ear.
Meniere's disease can occur at any age, but it usually starts between young and
middle-aged adulthood. It's considered a chronic condition, but various treatments
can help relieve symptoms and minimize the long-term impact on your life.

Symptoms:

 Recurring episodes of vertigo. 

 Hearing loss
 Ringing in the ear (tinnitus). 
 Feeling of fullness in the ear
Bibliography:https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-
causes/syc-20374910

 Meniere’s disease is a disorder that affects the inner ear. The inner ear is
responsible for hearing and balance. The condition causes vertigo, the sensation of
spinning. It also leads to hearing problems and a ringing sound in the ear.
Meniere’s disease usually affects only one ear.
Symptoms:

o vertigo, with attacks lasting anywhere from a few minutes to 24 hours

o loss of hearing in the affected ear
o tinnitus, or the sensation of ringing, in the affected ear
o aural fullness, or the feeling that the ear is full or plugged
o loss of balance
o headaches
o nausea, vomiting, and sweating caused by severe vertigo
Bibliography:https://www.healthline.com/health/menieres-disease#causes

2 MARKS (MK)
1.Define otalgia.

 Otalgia is defined as ear pain. Two separate and distinct types of otalgia exist.

Pain that originates within the ear is primary otalgia; pain that originates outside
the ear is referred otalgia. Typical sources of primary otalgia are external otitis,
otitis media, mastoiditis, and auricular infections.
Reference: https://emedicine.medscape.com/article/845173-overview

 It is the pain in the ear due to lesions in the ear itself or due to the conditions in the
surrounding areas.
 Types of otelgia
1. Primary orelgia is ear pain caused by a problem directly associated to
the ear, such as an ear infection.
2. Refferedotelgia is from pain that originates from outside the ear.
Reference: :Lewis's Medical -Surgical Nursing, Volume-I,page no; 395
2) Write the method of foreign body removal from the throat?

1. Common removal methods include use of Forceps, water irrigation and suction
catheters.
2. Pharyngeal/ tracheal foreign bodies are medical emergencies requiring surgical
consultations.
Refrence:https://www.aafp.org/afp/2007/1015/p1185.html

3) what are the clinical manifestations of foreign body in the ear?

 Pain or bleeding:-If object abrade the ear can ,rupture of the tympanic
member,or from the patient's attempt to remove the object.
 Later stage :- Erythema and swelling of the canal and a foul smelling
discharge may be present.
 Live insects may cause a buzzing in the ear.
 The appearance will vary according to the object and length of the time it has
been in theear.
Reference:
(https://www.medicinenet.com/objects_or_insects_in_ear/article.htm#what_types_of_objects
_get_stuck_in_the_ear_causes)
4)List types of Otalgia.

It is a pain in the ear due to lesions in the ear itself/ due to the condition in the surrounding
area.
Types-
Primary Otalgia- pain caused by a problem directly associated to the ear, such as ear
infection.
Referred Otalgia-Is the pain that originates from outside the ear.Pain that has referred to the
ear from another source of the body.
(https://www.slideshare.net/mobile/mamoon901/otalgiaearache)
5) Enumurate the causes of nasal obstruction.

Ans. Most common conditions to impact patients are

 Septal deviation
 Nasal valve collapse
 Lateral wall collapse
 Equal or even exceed septal deviation as the prime cause of nasal airway
obstruction.

Reference
 Wikipedia
 SlideShare.mob.in
 Medical news
6)list the complication of supportive otitismedia.

Otitis media with effusion or suppurative OM is an inflammation of the middle ear with a
collection of fluid in the middle ear space. The fluid may be thin, mucoid, or purulent.

It is common to have otitis media with effusion for weeks to months after an episode of acute
otitis media. It usually resolves without treatment but may recur.

Complications are:

 Chronic otitis media

 Postauricular abscess
 Facial nerve paresis
 Labyrinthitis
 Labyrinthine fistula
 Mastoiditis
 Temporal abscess
 Petrositis
 Otitic hydrocephalous
Reference: https://www.slideshare.net/mobile/sidranawaz/complications-of-suppurative-
otitis-media

7) List surgical interventions of suppurative otitis media.

Otitis media with effusion or suppurative OM is an inflammation of the middle ear with a
collection of fluid in the middle ear space. The fluid may be thin, mucoid, or purulent.

It is common to have otitis media with effusion for weeks to months after an episode of acute
otitis media. It usually resolves without treatment but may recur.

Surgical Management:

 The goals of the treatment are to clear the middle ear off the infection, any
perforations, and preserve hearing.
 Tympanoplasty (myringoplasty) involves reconstruction of the TM and the
ossicles.
 A mastoidectomy is often performed with a tympanoplasty to remove the infected
portions of the mastoid bone.

REFERENCE: Sharon L. Lewis, Medical-Surgical Nursing, Third South Asia edition, RELX
India Pvt. Ltd. 2018, Pages 339-340.

8) Enumerate the indications for Otoscopic examination.

The tympanic membrane is inspected with an otoscope and indirect palpation with a
pneumatic otoscope.

Indications:

External auditory canal:

o Discharge
o Inflammation
o A foreign body

Middle ear:

o Fluid
o Air bubbles
 o Blood
o Masses

Refrence; Brunner and Suddharth,Textbook of Medical-Surgical Nursing, South Asian

Edition, Wolters Kluwer Pvt. Ltd. 2018, Page 1586.

9. List indications for ear irrigation?

Ear irrigation is a routine procedure used to remove excess ear wax and foreign material from
the ear.
Indications:

 Difficulty in examining the full tympanic membrane.

 Otitis externa.
 Wax occlusion of the external ear canal.
 As part of the workup for conductive hearing loss.
 Prior to taking the impression for hearing aid fitting.
 Suspected external ear canal or middle ear cholesteatoma.
Reference: https://www.google.com/search?q=indications+for+ear+irrigation&rlz

10. Define Quinsy?

 Peritonsillar abscess, also known as a quinsy is recognised complication of tonsillitis

and consists of a collection of pus beside the tonsil i.e. peritonsillar space. It is mainly
caused by group A beta-hemolytic streptococcus.

Reference: Brunner and Suddharth's textbook of medical surgical nursing 11th edition volume
2

 Quinsy is also known as peritonsillar abscess is a recognised complication of

recurrent untreated tonsillitis and consists of collection of pus inside the tonsils
commonly caused by group A beta haemolytic streptococcus.

Reference: Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX
India Pvt. Ltd. 2018, Page:852

11) What is impacted wax?

 Ear wax is the waxy ,yellowish substance that lines the inside of your ear
canal. This wax helps to protect your canal from water, infection, injury and
foreign body. But too much wax buildup can cause problems. This buildup is
called impacted earwax.

Reference: https://www.cedars-sinai.org/health-library/diseases-and-conditions/i/impacted-
earwax.html
  Ear wax is a natural protective oily substance which is produced in the outer
third of the ear canal. Excessive collection of thick ear wax is known as
impacted wax.

Reference: https://slideshare.net/mobile/sanilmlore/impacted-wax

12) what is tympanoplasty?

 Tympanoplasty is a surgical operation performed for the reconstruction of the

eardrum and/or the small bones of the middle ear.

Reference: https://en.m.wikipedia.org/wiki/tympanoplasty

 Tympanoplasty also called eardrum repair, refer to surgery performe to

reconstruct a perforated tympanic membrane of the middle ear.

Reference: https://www.surgeryencyclopedia.com/st-wr/tympanoplasty.html

13. What is nasal septal deviation?

 Nasal septal deviation is a deflection of the normally straight nasal septum.It is

most commonly caused by trauma to the nose or congenital disproportion.

Reference: Lewis medical surgical nursing 9e page no 532

 Sideways displacement of the wall between the nostrils is known as nasal septal
deviation.
Deviation of the nasal septum may be congenital or occur later from trauma. The
major problem that it tends to cause is airway obstruction.Can be treated by surgery

Reference: Otorhinolaryngology, Head and Neck Surgeryedited by Matti Anniko, Manuel

Bernal-Sprekelsen, Victor Bonkowsky, Patrick Bradley, Salvatore Iuratopg; 191

14. List the types of hearing aids?

 A hearing aid is a device to amplify sounds reaching the ear

Types of hearing aids are:-

Air Conduction Hearing Aid. In this, the amplifiedsound is transmitted via the ear canal to
the tympanicmembrane
Bone Conduction Hearing Aid. Instead of a receiver,it has a bone vibrator which snugly fits
on the mastoidand directly stimulates the cochlea
Most of the aids are air conduction type. They can be
 1.Body-worn types. Most common typemicrophone and amplifier along with the
battery are
 in one case worn at the chest level while receiver issituated at the ear level.
 2.Behind-the-ear (BTE) types. Here microphone, amplifier,receiver and battery are
all in one unit whichis worn behind the ear
  3.Spectacle types. It is a modification of the “behindthe-ear” type and the unit is
housed in the auricularpart of the spectacle frame. It is useful to persons who
 need both eye glasses for vision and a hearing aid
 4.In-the-ear (ITE) types. The entire hearing aid ishoused in an earmould which can
be worn in the ear.
 5.Canal types (ITC and CIC). The hearing aid is so smallthat the entire aid can be
worn in the ear canal withoutprojecting into the concha
Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery P L Dhingra, Shruti
Dhingra 7e pg no; 135

15) What is ototoxicity?

 Ototoxicity can result in temporary/ permanent disturbances of hearing balance or

both. Glycoside are the most common cause of ototoxicity and they destroy the hair
cells in the organ of Corti.
Reference:Brunner and Suddharth's textbook of medical surgical nursing 11th edition
volume 2,page number 2119.
 Ototoxicity is due to drugs or chemicals that damage inner ear or vestibulo-cochlear
nerve, which sends balance and hearing information rom the inner ear to the brain.
o Major locations of ototoxic effects:
 Cochlea-“cochleotoxicity” produces hearing loss.
 Vestibule: “vestibulotoxic” manifests as balance-related problems\
Reference: Sharon L. Lewis, Medical- Surgical Nursing, Third South Asian Edition, RELX
India Pvt. Ltd. 2018, Page:851
16)List any four ototoxicity drugs.

 Aminoglycoside antibiotics- Gentamicin, streptomycin, kanamycin,

Neomycin,Amicacin.
 Anti-neoplastics(anticancer drugs)-Cisplatin,
Carboplatin-cause hearing loss that is massive and permanent.
 Loop diuretics- Bumetimide,fursemide
( Lasix),Torsemide (Demadex ) These drugs cause ringing in the ears/ decreased
hearing that reverses when the drug is stopped.
 Antiepileptic drugs- Phenytoin over dose may be associated with vestibular disorder.
Reference: Lewis's Medical -Surgical Nursing, Volume-I,page no-395