Ear-Disorder Handouts
Ear-Disorder Handouts
B. Weber Test
• The rounded tip of the handle of the vibrating
tuning fork is placed on the client's head or teeth. It is
more accurate in diagnosing sensorineural hearing
loss like in Meniere's disease.
• Interpretation of results is as follows:
o Normal: tone is heard in center of head or equally
in both ears.
o Conductive hearing loss; tone is heard in poorer ear, e.g. otosclerosis
o Sensorineural hearing loss: tone is heard in better ear.
o The test is useful in cases of unilateral loss.
• The examiner covers one ear with the palm of the hand,
then whispers softly 2- syllable words from a distance of 1
or 2 feet from the unoccluded ear, and out of the patient's
sight (e.g. thirteen, fourteen, fifteen).
• The person with normal hearing acuity can correctly
repeat what was whispered.
D. Audiometry
• Types of Audiometry
o Pure-tone Audiometry. The louder the tone
before the client perceives it, the greater the
hearing loss.
• Discharge
o A discharge from the ear may be purulent or bloody. It
must be distinguished from the escape of which is a
normal process
o Commonly the cause of a discharge is otitis externa or
otitis media and in the latter event, a perforation will be
present in the tympanic membrane.
o If perforation of the tympanic membrane is suspected or
diagnosed, irrigation of the ear should be avoided.
•Vertigo
o A form of dizziness where the patient experiences a spinning
sensation. It is a common symptom when the balance or
vestibular system of the inner ear is diseased. It is accompanied
by nausea and vomiting.
• Tinnitus
o Noise in the ear is a very common
complaint.
o Its quality varies from a high-pitched
whistle to the clanging of bells or
recognizable snatches of music.
CLASSIFICATION OF HEARING LOSS
o Conductive hearing loss. It involves
interference with conduction of sound
impulses through the external auditory
canal, the eardrum or the middle ear. It
is validated by Rinne's Test
o Mixed hearing loss. It involves both conductive and sensorineural hearing loss.
B. Verbal Aids
a. Speak normally and slowly.
b. Do not over exaggerate facial expressions.
c. Do not over enunciate
d. Use simple sentences.
e. Rephrase sentence, use different words.
f. Write name or difficult words.
g. Avoid shouting.
h. Speak in normal voice directly into better ear.
Otitis Externa
o This is an inflammation of the outer ear that is
lined by skin. The condition is usually bilateral and
the symptoms start with itching.
o The patient scratches the ear that becomes infected, painful and sometimes blocked by
a thin mucopurulent discharge.
o Allergy, stress and the presence of contaminated water may all play a part but the
treatment is the same.
o Any precipitating cause is removed and a swab is taken for culture and sensitivity. The
ear canal is cleaned gently, thoroughly and frequently using a wisp of cotton wool on the
tip of a suitable probe.
o Drops are then instilled directly or used to infuse a small wick of ribbon gauze which is
left in the ear for one or two days. The drops may be simple disinfectants or may be
combinations of topical antibiotics (to kill the bacteria) and steroids (to reduce
inflammation).
o The condition tends to recur.
Boils
A boil or furuncle is found in the outer hair-bearing skin of the ear canal. It is very
painful because the skin at this site is firmly tethered to the underlying cartilage. Like
boils elsewhere, it is caused by staphylococcus and the relevant antibiotic is only
necessary when the symptoms are severe. Analgesics are necessary and the possibility of
underlying diabetes must be excluded.
Tumors
When the Eustachian tube becomes blocked, the air trapped in the middle
ear is absorbed into the surrounding tissues and is replaced by thin fluid.
In time, small glands appear in the lining of the middle ear and the mucus
which they secrete, explain the popular name of "glue ears" which is
given to this condition.
It is seen most in those children where an immature musculature and repeated upper
respiratory tract infections, predispose to tubal obstruction.
• The child develops a hearing loss that may pass unnoticed.
• However, the parents may have noted that the child's schoolwork has deteriorated or
that he turns up the television.
• There may also be associated episodes of earache caused by a suppurative infection of
the fluid.
•An examination of the ear will reveal the presence of fluid behind the tympanic
membrane and a simple whisper test or an audiogram will confirm the presence of a
hearing loss.
• If the condition is temporary or intermittent, nothing needs to be done since most
children outgrow the condition.
• If it is more severe, an alternative means of allowing air into the middle ear, must be
found.
• A hole is made in the tympanic membrane (a myringotomy) and the hole is prevented
from healing by inserting a small plastic tube (grommet, dottle or stopple).
• At the same time, any underlying cause (sinusitis or enlarged adenoids) is treated.
• As long as the grommet remains in place and remains unblocked the hearing is normal.
• However, the grommet drops out after tubes may be the middle ear. The majority of
patients with grommets in place can be allowed to go swimming although earplugs are
advisable.
• It is hoped that the patient will have outgrown the problem by then, but a grommet may
need to be reinserted if fluid reaccumulates.
Cholesteatoma
•Medications:
• tranquilizers, vagal blockers (atropine), antihistamines, vasodilators, diuretics
• To reduce vertigo, the following medications may be prescribed:
• Diazepam (Valium) o Meclizine (Antivert/ Bonamine plus nicotinic acid)
• Fentanyl with Droperidol (lnnovar)
Acoustic neuroma•
A benign tumor of the vestibular
or acoustic nerve.
• The tumor may cause damage to
hearing and to facial movements
and sensations.
• Symptoms begin with tinnitus
and progress to gradual
sensorineural hearing loss.
• Treatment includes surgical removal of the tumor via craniotomy.
• Care is taken to preserve the function of the facial nerve.
• Postop nursing care is similar to post operative craniotomy care.
• “An acoustic neuroma expands out of the internal auditory canal, displacing the
cochlear, facial, and trigeminal nerves located in the cerebellopontine angle.
*Note: After surgery, the patient may experience asymmetry of the face due to
affectation of the facial nerve. This will spontaneously be resolved in few months.
• There will be dryness of the eye on the affected side and this eye will not be able to
produce tears for sometime. Artificial tears may be instilled into the eye at regular basis
to prevent corneal ulceration.
• *There will be absent or diminished taste sensation due to affectation of the facial
nerve.
Different Types of Ear Surgeries
• Myringoplasty. It involves closure of perforated tympanic membrane.
• Tympanoplasty. It involves closure of perforated tympanic membrane, if the middle
ear is involved.
• Myringotomy. It involves a simple incision in the tympanic membrane.
• Ossiculoplasty. It involves ossicular reconstruction.
• Stapedectomy. It involves surgical removal of the stape followed by replacement with
prosthesis
• Stapedotomy. It involves use of laser to create a hole in the footplate of the stapes and
prosthesis is placed in the hole.
• Labyrinthectomy. It involves surgical removal of the membranous labyrinth through
the oval window or through the mastoid bone.
Post-operative Care
• Instructions include the following:
• Lie on the unoperated side.
• Blow nose gently one side at a time, sneeze or cough with mouth open for 1 week after
surgery.
• Avoid strenuous physical activity like heavy lifting for 1 week and avoid exercises or
sports for three weeks postop.
-Change cotton ball in ear daily.
-Keep ear dry for6 weeks postop.
-Do not shampoo hair for 1 week
-Protect ear with 2 pieces of cotton (outer piece saturated with petrolatum)
• Avoid airplane travel for 1 week postop. For sensation of ear pressure hold nose, close
mouth and swallow to equalize pressure
• Report any drainage other than slight amount of bleeding to the physician.
• Avoid reading, watching TV or fast moving objects for 1 week postop. This is to
prevent vertigo
• Advise patient to seek for supervision when ambulating for the first time, dizziness or
lightheadedness may occur. This is to prevent falls.
REFERENCES
Brunner & Suddarth Textbook of Medical-Surgical Nursing, 14th edition Phildelphia,
Wolters Kluwer
Special thanks to
Neugene Rowan S. Cu, MAN, RN, RM, CNN, CSSYB, Faculty FEU-IN