Sir Baguio Topics

Week 3. Disturbances in
Visual and Auditory
Function
Topic 3. Eye Disorders

External Structures
1. Eyelids / Palpebrae - moveable folds of skin
covering the eye.
• Palpebral fissure – where the upper and
lower palpebrae open.
• Canthi / Canthus – the part where the
upper and lower eyelids meet. (lateral and
medial – near the nose)
• Meibomian Glands – glands lining the
lashes from below which produce oil.
*Puncti – opening where the tears would be
drained from the eyes and into the nasal area.
2. Orbit – a bony cavity that protects the eyeball.
It is necessary so that your eyeball won’t be
damaged.
7 Facial and cranial bones that make up the orbit:
• Sphenoid Bone
• Palatine Bone
• Frontal
• Lacrimal
• Ethmoid
*Aqueous humor – is produced by the ciliary body.
• Maxillary
Which helps maintain the intraocular pressure
• Zygomatic
(IOP). This fluid fills the eyes. For the IOP to be
3. Conjunctiva – a transparent membrane that is
maintained there should be balance between the
covering the cornea.
production and elimination of aqueous humor.
• Palpebral Drains out through the canal of Schlemm.
• Bulbar
*Choroid – a dark brown layer that contains the
arterioles and venules that supply blood to the
retina. Found underneath the sclera.
*Sclera – white part of the eye.
*Accommodation – the ability of your lens to shift
your gaze from distant to near or vice versa,
making our lens either spherical or flat.
*Cataract – decrease in the transparency of the
lens; clouding of the lens.
*Pupil - is the opening to the lens. Changes to
color white if patient has cataract.
*Iris - It is in-charge of constricting or dilating the
pupil depending on the degree light that is
entering the eye. Therefore, it is not appropriate to
say pupil dilation/constriction. The iris is also a
muscle, and it gives us the eye color, depending
on our race.
*Anterior Chamber – filled with aqueous humor.
*Posterior Chamber – filled with vitreous humor.
Lacrimal System
1) Lacrimal Gland – located at the outer upper
canthus of the eye. It is a gland that produces
tears.
2) Lacrimal Ducts
3) Tears – are not just composed of water. There
are different dissolved particles in our tears,
which includes glucose, salts, urea, lysozyme,
protein. This is one of the first line of defense
of the eye.
*Lysozyme – has the capacity to destroy infection.
*Urea – evidence that tears could also be used as
an excretion site for the end products of
metabolism.
*Blinking – as involuntary; a reflex. It is way to
keep the eyes lubricated and moist. We blink
approx. 20-25 times per minute. But if it is dark
out, the number of times we blink also decreases.
But if we are conscious of our blinking, it increases
the rate.

Internal Structures
1) Outer Layer
• Sclera
• Cornea
2) Middle Layer
• Choroid
• Ciliary Body – help suspend the lens of
the eye to float in the middle of the eyeball
through the use of a fiber.
• Iris - It is in-charge of constricting or
dilating the pupil depending on the degree
light that is entering the eye. Therefore, it
is not appropriate to say pupil
dilation/constriction. The iris is also a
Extra-ocular Muscles muscle, and it gives us the eye color,
Our eyes move because of these muscles: depending on our race.
1) Superior Rectus • Pupil
2) Inferior Rectus 3) Inner Layer
3) Lateral Rectus • Retina – a neural layer. It has 10
4) Medial Rectus microscopic layer which contains ou
5) Superior Oblique photoreceptors: rods and cones. Rods are
6) Inferior Oblique responsible for our peripheral vision and
*These muscles are being regulated and for vision in low illumination. For rods to
innervated by three cranial nerves: (1) be able to see clearly in the dark it needs
Oculomotor, (2) Trochlear, (3) Abducens. Rhodopsin, it is a substance that is
released when we are exposed to the dark
areas, it increases in quantity, with the help
of vitamin A (retinol), and can help us see
clearly in the dark. Cones are responsible
for central vision and color vision. They are
located in the fovea centralis and the
macula lutea.
• Lens
 • Vitreous Humor
• Optic Disk
• Macula Lutea
• Aqueous Humor
• Canal Schlemm

Measurement of Vision
1) Visual Acuity
• Snellen’s Chart
2) Confrontational Test – checks the functioning
of the extraocular muscle functions. To check
for strabismus / lazy eye.
3) Extra-ocular Muscle Function
• Six Cardinal Position of Gaze
4) Color Vision
• Ishihara Chart / Plates

*Optical Illusion – proves that your eyes can

misinterpret what you see. “There is more to what
meets the eye.”
*Only 20% are interpreted from our external
environment by our eyes. That is why kis-a wala
ta gakakita ang mga things na gina pangita ta. Kay
nakita naton sila, pero the brain is not interpreting
it at that time. If beyond that, we can experience
sensory overload.
Pathway for Vision
Light energy reflected from an object → Cornea Diagnostic Tests
→ Aqueous humor → Pupil → Lens → Vitreous • Fluorescein Angiography - Fluorescein is a
Humor → Retina → Photoreceptors convert dye. Angiography means to look. Angio means
image to nerve impulses → Transmit to optic it involves the blood vessels. Dye is used to
nerve via optic disc → Optic Chiasm → Cerebral identify obstruction in the blood vessels in the
Cortex → Interpretation as Sight. eye structures. If we inject dye to the patient,
we should first check for allergies to seafoods.
*eyes serve as the interpreter of the brain. Seafoods because dyes are high in iodine, and
the same goes for seafoods and shellfish.
During injecting the dye, patients can feel a
warm flush feeling. After the procedure, a
series of photographs will be taken through CT
 scan. The dye can also change the color of the
patients urine. Some patients can complain of
urticaria / itchiness of the skin.
• Computed Tomography – CT scan. Used to
outline the inner vascularization of the eye.
Find out if patient is claustrophobic.
• Slit Lamp – an instrument that is used by an
optometrist. A blue light is used to illuminate
the center of eyes, so that the doctor can see
directly into the eye to see any changes in the
eyes and helps measure the angle of the General Implementation
refracture of light. Inform the patient to expect • Promote measures that address the client's
bright lights but they have to maintain still. visual disorder.
• Corneal Staining – stains the cornea using a • Promote measures to prevent or decrease
dye using an eyedrop. Instruct patient to blink pain & discomfort.
a few times to spread the dye. Performed • Promote measures that help prevent & care
usually after trauma to the eye to check if there for injuries to the eye.
is damage to the cornea, which can lead to o After assessment on patient with injury to
astigmatism, or if there are foreign objects the eye, cover the injured eye and have the
inside the eye. A blue light would be directed patient lie down. Instruct the patient not to
to the eye if there are any move the eyes too much.
irregularities/scratches to the eye. o If there is a foreign object stuck to the eye
• Tonometry – used to measure IOP / amount of of the patient, do not remove, protect it
pressure in the cornea. Increased IOP can instead and prepare for surgery.
compress the internal parts of the eye, and can o Tell the patient to avoid rubbing the eye,
lead to obstruction, leading to glaucoma. wash their hands.
Instrument comes into contact with the cornea • Instruct client about the correct way to prepare
that is why we should warn patient of & instill eyedrops.
discomfort and premedicate patient with o When applying on a contaminated eye,
topical analgesic. instill eyedrops on the eye that is
• Gonioscopy – direct visualization of the angle uninfected first to prevent cross
between the iris and the cornea (irido-corneal contamination. Most especially if you use
angle). Used to distinguish what type of ointments.
glaucoma the patient has. In open angled • Encourage the client to carry out ADL's
glaucoma, the angle did not change. If the independently, if possible, to promote a feeling
angle narrows, it is classified as the of self-sufficiency.
narrow/closed angled glaucoma. • Provide post-op nursing intervention following
• Ophthalmoscopic Examination – a routine eye surgery.
initial assessment that uses an
ophthalmoscope. Uses the same principle as 1. Cataracts
the slit lamp. In holding the ophthalmoscope, − Cataract in Greek means “waterfall” because if
hold it on the same hand on the same eye. you look at the cascading water of the
(Right eye, use right hand) waterfall, everything on the other side of the
water is blurry.
− This condition is defined as the gradual and
progressive opacity of the lens / lens capsule
that leads to visual loss. (lens are not
transparent)
− This condition is painless.
− If protein increases, there is a change in the
protein components of the lens, which
hardens it and loses its transparency.
− Cataract is usually bilateral meaning it affects
both eyes. But one eye will be progressing
faster than the other.
Causes:
• Aging Process
o Lens go from transparent →
translucent → opaque.
• Inherited
o A non-modifiable factor.
• Injury
o Repeated injury to the eye.
• Endocrine disorders
o Ex. DM, hyperthyroidism. Lens Replacement
Signs & Symptoms 1) Aphakic Eyeglasses – more convenient but
• Gradual, painless blurring or loss of vision the patient can lose them.
• Photophobia – eye hurts if they meet 2) Contact Lenses
glares from the light. • Hard Lens
• Opaque or cloudy white pupil. • Gas-Permeable Hard Lens
• Decreasing visual acuity • Soft Lens
• Progressive nearsightedness 3) Intraocular Lens Implant – replacing the lens
that has been removed / destroyed from the
A Cataract is an opacity of the normally clear lens surgery so that the patient can see again.
which may develop as a result of aging, metabolic Inform patient for any signs of rejection. Since
disorders, trauma or heredity. the lens is a foreign object.

Pathophysiology Pharmacological Management

Drugs are not used to treat, but to support.
1) Mydriatics – Pupil Dilator
• Epinephrine, adrenaline, phenylephrine
HCl (Neo-Synephrine, Ocu-phrin).
• They are sympathetic drugs, it causes
a systemic reaction: increased heart
rate, etc.
2) Cycloplegics – Pupil Dilator and Paralysis of
Ciliary Body (to reduce production of aqueous
humor to decrease IOP)
Diagnostic Study • Atropine SO4 (Atropisol), scopolamine
1) Slit Lamp Examination hydrobromide (Isopto-Hyoscine,
2) Ophthalmoscopic Examination should not be given with Morphine
sulfate, because it can cause
Surgical Management temporary amnesia.), cyclopentolate
1) Intracapsular Cataract Extraction (ICCE) – (Cyclogyl)
remove opacified lens from inside the lens • Is also a sympathetic drug.
capsule. 3) Acetazolamide, Mannitol.
2) Extracapsular Cataract Extraction (ECCE) – • Diuretics that can decrease IOP
both the lens capsule and the lens itself are 4) Antibiotics
taken out. • Used as a prophylaxis. (7 to 10 days
3) Phacoemulsification – the most common and post surgery)
modern method. A long needle is used to 5) Mild Analgesics
puncture the cornea and the lens capsule. • For pain.
Uses an ultrasonic vibration to break the
capsule into small pieces, irrigate with NSS
and suction the pieces on the same syringe.
Nursing Care distorts your visual field, this is a sign of
Pre-Op: bleeding and are called your abnormal
• Assess vision on unaffected eye. floaters.
• Administer pre-op medications. • Flashes of light before the eyes.
• Instruct post-op measures to prevent
changes in IOP. Diagnostic Study
Post-Op: 1) Ophthalmoscopic Examination
• Semi-fowlers position
o Optimize lung expansion, and Implementation
facilitate drainage to prevent edema. • Provide bed rest.
• Prevent increase IOP. • Cover both eyes.
• Keep a patch or protective shield on the o Immobilize the eyes.
affected eye. o Retinal detachment is unilateral. But you
• Relieve post-op discomfort. still need to cover both eyes because of
• Keep things on non-operative side. one eye moves, the other also moves.
• Speak before approaching.
2. Retinal Detachment • Position head as prescribed.
− Retina is the inner neural layer. Responsible • Protect from injury.
for the conversion of light energy to electrical
impulses to be sent to the brain to Surgical Procedures
interpretation, analysis and decoding. 1) Cryosurgery – uses a cold probe to reattach.
− Detached from the choroid which is also its 2) Diathermy – uses a heated probe to illicit an
blood supply = hypoxia, ischemia, which can inflammatory response.
lead to necrosis. 3) Photocoagulation – uses laser to seal of small
Causes: retinal breaks before they become severe and
• Trauma – most common. create a huge detachment.
• Retinal degeneration 4) Scleral Buckling – uses a band / scleral buckle
• Tumor in the eye – retinoblastoma. to hold the choroid and retinal together for
• Hemorrhage spontaneous reattachment.
• Cataract Surgery
• Myopia

Post-Op Nursing Management

• Bilateral eyepatch
*Retina does not regenerate, like the brain. • Bed rest for 1-2 days
• Expect redness & swelling of the lids &
Signs and Symptoms conjunctiva.
• Painless blurring of vision • Monitor for hemorrhage.
o Because of the absence of pain sensors. • Monitor IOP 1st 24 hrs.
o Sudden loss of vision. • Encourage deep breathing but not coughing.
• Shadows falling across the visual field. • Limit reading for 3-5 wks.
• Floating spots • Wear dark glasses during the
o 2 types of floaters: Normal floaters and
abnormal floaters. Normal floaters are
transparent molecule like that we see. If
these floaters becomes dark, black and
3. Glaucoma *Peripheral Blindness occurs first in glaucoma,
• Is an eye condition where there is a build up before Central Blindness. No pain is felt.
of IOP within the anterior chamber of the eye.
• Aqueous humor is the one maintaining the IOP Types of Glaucoma
and is being produced in the ciliary body. 1. Chronic Open-Angle Glaucoma
• Ciliary body is a factor that can change the • Primary / Simple / Chronic
shape of the lens for us to use • ↑ 30 – 50 mmHg
accommodation. • Gradual and progressive loss of vision,
• Canal of Schlemm drains the aqueous humor. because there is a gradual buildup of IOP.
• Trabecular Meshwork a filter for the aqueous • Normal IOP: 12-24 mmHg.
prior to the canal of Schlemm. • Open angle because the irido-corneal
• Both the Canal of Schlemm and Trabecular angle is open. There is no obstruction in
Meshwork can be obstructed resulting the the angle. However, there may be a partial
build up of aqueous humor and can increase obstruction to the canal of Schlemm or
IOP. there is overproduction of aqueous humor
• If the irido-corneal angle is normal, there is by the ciliary body.
normal drainage of the aqueous humor, since Signs and Symptoms:
there are no obstructions. If the angle has • No early signs and symptoms
obstruction, it closes the angle, therefore, • Insidious visual impairment
aqueous humor is not being drained, leading o Patient isn’t aware that their
to an increase in IOP. peripheral vision is slowly being
• Bilateral. One eye may progress more than the lost.
other, depending on the cause of the • Diminished accommodation and loss of
glaucoma. peripheral vision.
• Halos around lights.

2. Acute Closed-Angle / Narrow Angle Glaucoma

• Obstruction to outflow or closure of the
irido-corneal angle which can lead to a
diminished outflow of aqueous humor.
• Pressure can reach up to 50 – 70 mmHg.
Signs and Symptoms:
• Transitory attacks of diminished visual
acuity.
o Patient is either near-sighted or
far-sighted.
• Colored halos around light
*How does Glaucoma Damage our eyes? • Excruciating pain
• Pressure builds up in the anterior portion of • Headache, nausea, and vomiting.
the eye, which pushes the anterior parts of
the eye backwards, which also pushes back 3. Congenital Glaucoma – infants are born with
the vitreous humor and leads to the glaucoma. How do we know if infant has
compression of the retina / optic nerve, which glaucoma? If an infant is crying inconsolably; pain
results to disruption of blood flow to the at the eye. Thorough physical exam should be
retina, which can lead to necrosis = done and extensive diagnostic measure should be
permanent blindness. done.
4. Secondary Glaucoma – occurs after primary
injury (ex. Trauma, surgery)
Diagnostic Studies
• Tonometry
• Slit Lamp
• Gonioscopy
• Ophthalmoscopy

Management
1) Topical Miotics – Pupil Constrictor
• pilocarpine (Pilocar) Nursing Management
• When we have pupil constriction, it draws Pre-Op
the eyelids away from the angle, and • Administer prescribed medications.
widens the angle between the iris and the • Routine pre-op procedure
cornea. Which helps facilitate the outflow Post-Op
of aqueous humor. • Position according to physicians’ orders
2) Topical Epinephrine – Pupil Dilator • Administer eyedrops / medications as
• Epinephrine ordered.
• Only given to open angle glaucoma. With • Orient patient to environment
this drug, we can prepare the patient for • Avoid activities tat may raise IOP.
possible surgery. • Observe for complications.
3) Topical Beta-Blockers – Suppress Secretion
of AH (aqueous humor) Other Disorders
• betaxolol (Betoptic), metipranol • Myopia (nearsightedness) – Management:
(Optipranolol), timolol (Timoptoc) Biconcave lens
• Contraindicated in patients with bronchial • Hyperopia / Hypermetropia (far-sightedness)
asthma – because it can cause – Management: Biconvex Lens
bronchoconstriction. • Presbyopia (due to old age) – Management:
4) Oral Carbonic Anhydrase Inhibitors – reduces Biconvex Lens
production of AH • Astigmatism (has multiple focal points) –
• acetazolamide (Diamox) Management: Astigmatic lens.
• May cause malaise, and fatigue but do not
d/c drug.
5) Osmotic Diuretic / Hyperosmotic Agents
• Mannitol (Glycerol), glycerine (Glyrol,
Osmoglyn)
• Reduces IOP in the eye.

Surgical Management
1) Laser Trabeculoplasty – repair the trabecular
meshwork using a laser to create bigger holes
in the trabecular meshwork.
2) Trabeculectomy – removal of the entire
trabecular meshwork.
3) Peripheral Iridectomy – removal of the distal
segment of the iris which connects to the
irido-corneal angle.
4) Cyclotherapy / Cyclodestructive Procedure –
destroy the structure that is causing the
problem. If the one causing the problem is the
ciliary body, you destroy the ciliary body. Uses
a freezing probe.
 Sir Baguio Topics can also be a reason for us to develop
Week 3. Disturbances in vertigo.
o Utricle and Saccule – these are small
Visual and Auditory sacs inside the vestibule. Responsible
Function in containing fluid inside the labyrinth.
Topic 4. Ear Disorders • Cochlea – snail-like structure. Receives
vibration from the ossicles.
Anatomy and Physiology o Organ of Corti. – while vibration is
travelling through the cochlea from the
*We need vibrations to hear.
ossicles, which receives the
*Ears are for hearing and balance.
information, converts it to electrical
1.) External Structures (structures that capture
impulse, interprets and then delivers it
sound vibration)
to the acoustic nerve (Cranial Nerve 8:
• Auricle / Pinna – cartilaginous structure.
Vestibulocochlear)
Made up of skin and cartilage. It has
• Fluid
groves and folds, in order to capture
o Perilymph – static fluid
sound vibration.
o Endolymph – mobile fluid. If this fluid
• External Auditory Canal – ear canal. An S-
increases it creates pressure inside
Shaped canal that is directed inward,
the inner ear, which can lead to
forward and then downward. (If we assess
Meniere’s Disease.
the auditory canal in adults: pull the pinna
up and backward. If in children below 3
years old: pull the pinna down and back.)
Has defense mechanisms to capture dust
particles and organisms which are the (1)
cilia, and (2)ceruminous gland which
produces ear wax.
• Tympanic Membrane (Eardrum) – pearly
gray membrane that is initiating
mechanism vibration when in contact with
the sound vibration.
2.) Middle Ear (relays the sound, it is an air-filled
compartment))
• Ossicles
o Mallus (Hammer)
o Incus (Anvil)
o Stapes (Stirrups)
• Eustachian Tube – brings pressure to the
ears if we go to high altitude places. This
tube is normally closed, we can open it
however to release pressure in the ear
when there are changes to the altitude by
yawning, holding the nose, etc. Is
connected to the nasopharynx which can
be a way for infection to travel and can lead
to otitis media.
3.) Inner Ear (interprets the sound)
• Vestibule
o Semicircular Canals – arch like
Diagnostics Studies
structures. They are specialized
receptors, they detect head movement • Otoscopic Examination – uses a handheld,
as they relate to gravity for us to not portable instrument. Uses otoscope with a
fall down. They are so sensitive which speculum. Uses a light source and
magnification. (Hold otoscope like a pen and
place wrist in the side of the patients head to
 prevent the patients head from moving and • Romberg’s Test – test for ataxia. Ask the
therefore, prevent further injury) patient to stand, close their eyes, and assess
for swaying. Patient who have ear problems,
• Hearing Acuity Screening Test have balance problems.
o Voice – tests patients’ ability to hear • Electronystagmography – use electricity to
conversation. (2-3 feet away from the measure/ illicit nystagmus, which is a rapid,
patient, stand at the back of the patient jerky, involuntary movement of the eye. The
and whisper a two-syllable word and to patient is going to be placed an electrode on
repeat it while the patient is looking the skin over the eye and be electrocuted with
forward) a very small voltage. If the patient does not
o Watch (ticking) – used to identify high respond = abnormal.
frequency sound. Ask the patient is • Caloric Test – also known as biothermal test.
they can hear the ticking sound. For us It stimulates the vestibule to illicit nystagmus.
to make sure that the patient is telling By using either cold or warm solution, the
the truth, ask the patient to count along eyes should move. If no response =
with the ticks of the watch. abnormal.
• Weber test – uses a tuning fork, which is an *Cold water – other eye should move to the
instrument that is placed on the middle of the other side.
forehead or at the lip over the teeth, provided *Hot Water – eye should move to the same
that it is at the center of the skull. This is done side of the same ear.
to apply vibration on the skull of the patient,
so that this vibration will be even on both
sides of the skull. Ask the patient if they can
hear the sound. Patient should be able to hear
the sound equally in both ears. If not, patient
can have conductive hearing loss, this is
called lateralization. Conductive hearing loss
occurs in the ear where the patient can hear
the sound better because this means that the
ear is relying on bone conduction.
o *Air conduction – hear other people.
Should be two or three times greater
than bone conduction. Meaning, we Types of Ear Disorders
hear better with air conduction. 1. Conductive Hearing Loss – there is obstruction
o *Bone conduction – hear sounds that which prevents the vibration to enter the inner ear.
travel through the bones. It reversible as long as the vibration can reach the
• Rinne Test – verifies the result of the weber inner ear.
test by placing the tuning fork on the ear. Test − Hearing Aids – can help in amplifying the
for both air conduction and bone conduction. sound vibration. It makes the sound
Ask the patient to compare which sound was louder, not clearer. Are small devices that
better. are being inserted in the external auditory
o *Normal: Hear better when the tuning canal.
fork is placed 2-3 inches from the ear, 2. Sensorineural Hearing Loss – permanent
rather than when the tuning fork is hearing loss, hearing cannot be restored. The
placed behind the ear. problem here is damage to the nerves.
• Audiometry – done when we need − Cochlear Implant – devices implanted into
information on the type of hearing loss, and the skull and ear of the patient. Takes the
its extent and magnitude of hearing loss. responsibility of the inner ear.
Uses earphones. 3. Psychogenic Hearing Loss – caused by an
o Pure tone – uses varying decibels. abnormal interpretation of the brain.
Increasing the decibels until the − *Two Types: (1) Acute Psychogenic
patient hears the sound. Hearing Loss – after seeing/experiencing
o Speech – examiner is speaking, while a traumatic experience, you lose your
the patient repeats the words. hearing senses A.K.A. Conversion
 Disorder. And (2) Chronic Psychogenic Signs and Symptoms
Hearing Loss – pabungol-bungol = you are • 3 Cardinal signs: tinnitus – ringing of the ears
training your brain to stop hearing, so (constant roaring), vertigo, hearing loss
nadayonan kana na bungol. Merisi. (permanent)
• Nausea/vomiting, nystagmus, severe
headache.
• Warning sign of an attack: Plugged feeling in
the ear. (Address the safety of the patient,
have the patient sit down or lie down. Make
sure to provide a safe place in case of any
thrashing.)
• Vertigo lasts for the whole day.

Diagnostic Test
• Caloric Test
• Electronystagmography
• Audiometry
1. Meniere’s Disease (Endolymphatic Hydrops)
− Attacks the inner ear. Management
− There is a build up of fluid in the inner ear. • Furstenberg Diet – low salt with unrestricted
− Often mistaken as seizures / epilepsy since protein. Protein helps in the healing of the
the disease occurs/attacks via a thrashing tissues.
around due to the severe vertigo that the • Vasodilators (facilitates blood flow),
patient is feeling. Antihistamines (bcos of allergic reactions),
− Sometime can manifest nausea and Mild sedatives (to calm the patient down.)
vomiting. • Diuretics (reduction in the accumulation of
− Can be caused by anything that can fluid)
increase the amount of endolymph fluid in During attack: assume comfortable position.
the ear. Instruct patient to lie down on the unaffected ear
Causes: with the eyes turned toward the affected ear. In
• Unknown order to fix the eye of the patient, because if we
• May be related to the degeneration of allow the patients eye to move, it can induce
cochlear hair cells / organ of corti. nausea and vomiting.
• Hypernatremia Surgery: Labyrinthectomy – removal of the entire
o increase in sodium. (135- 145 inner ear.
mEq/L). Where salt goes, water
follows. = increased water in the Presbycusis – No effective medical or surgical
body. therapy. Since it is a hearing loss related to aging.
• Endocrine disturbances Because the inner ear loses its elasticity. Cochlear
o Ex. Hyperthyroidism implant can be of big help to the elderly.
o Cushing’s Syndrome.
• Emotional disorders Nursing Management
• Allergic reactions • Assess the severity and frequency of attack,
any associated ear symptoms (hear loss,
tinnitus).
• Help patient prevent from aura [plugged
feeling in the ear], so patient has time to
prepare for an attack.
• Encourage patient to lie down during attack in
safe place.
• Put side rails in the bed if the patient is in bed.
• Place pillow to restrict movement.
2. Otosclerosis
− Disease in the ossicles.
− Ossicles are fixated because of spongy bone
formation. (Which occurs on the three
smallest bones, Stapes is usually the site of
infection).
− Gradual hearing loss.
− There are no problems in the inner ear, the
only problem is in the middle ear.
− Symptoms can include paracusis of Willis. –
ability to hear conversation better in a noisy
environment. But can’t hear in a silent
environment.
− The ultimate management here is
Stapedectomy (removal of the Stapes) and is
being replaced.
− Nursing Management:
• Regulate the amount of calcium in the
blood. (8.5 – 10.5 mg/dL)
• Pre-op, intra-op and post-op routine
management.
• Do not position the patient on the
affected side to avoid pressure. Unless
the patient has edema / drainage.
• Always speak to the patient on the
unaffected side.
• Monitor for imbalance since inner ear
may be affected after surgery.
• Assist patient on ambulation or prevent
from standing up from the bed until
she/he is stable.