Care of the Patients with

COMMON EAR
DISORDERS
Reference: Josie Quiambo-Udan
 DIAGNOSTICS TESTS FOR
AUDITORY ACUITY
Tuning Fork Tests
Rinne's Test
Differentiates conductive and sensorineural hearing
loss and air vs. bone conduction.
The vibrating tuning fork is placed against the mastoid
bone/behind the ear lobe (bone conduction) and 2
inches from the ear canal opening (air conduction).
Rinne's Test is more accurate in diagnosing conductive
hearing loss like in otosclerosis.
 DIAGNOSTICS TESTS FOR
AUDITORY ACUITY
Rinne's Test
Interpretation of Result:
Normal: air conduction is better than bone conduction
(the btone is louder in front of the ear)
Conductive hearing loss: bone conduction is better
than air conduction (the tone is louder behind the ear)
Sensorineural hearing loss: same as the normal
finding
 DIAGNOSTICS TESTS FOR
AUDITORY ACUITY
Weber Test
The rounded tip of the handle of the vibrating tuning fork is placed
on the client's head or teeth.
The test is useful in cases of unilateral loss and more accurate in
diagnosing sensorineural hearing loss like in Meniere's disease.

Interpretation of results is as follows:

Normal: tone is heard in center of head or equally in both ears.
Conductive hearing loss: tone is heard in poorer ear, e.g.,
otosclerosis
Sensorineural hearing loss: tone is heard in better ear.
 DIAGNOSTICS TESTS FOR
AUDITORY ACUITY
Whisper Voice Test
The examiner covers one ear with a palm and whispers two-
syllable syllables from 1 or 2 feet away from the unoccluded ear(e.g.,
thirteen, fourteen, fifteen) out of the patient's sight.

The person with normal hearing acuity can correctly repeat what was
whispered.
 DIAGNOSTICS TESTS FOR
AUDITORY ACUITY
Audiometry
It is the single most important diagnostic instrument in detecting
hearing loss.
Types of Audiometry
Pure tone Audiometry. The hearing loss gets worse as the tone gets
louder before the client hears it.
Speech Sound Measuring. Spoken word is used to test how well
someone can hear and tell the difference between sounds and
words. The hearing loss is worsened by sounds that are too
loud for the person to hear.
 DIAGNOSTICS TESTS FOR
AUDITORY ACUITY

Tympanogram or Impedance Audiometry

It changes the air pressure in a sealed ear canal to see how
the middle ear muscles react to sound input and how
flexible the tympanic membrane is.
 DIAGNOSTICS TESTS FOR
AUDITORY ACUITY
Oculovestibular Test / Ice Water Caloric Test
Irrigate the ear with cold water.
Normal result: lateral conjugate nystagmus of the eyes towards
area of stimulation.
Abnormal result: dysconjugate nystagmus of the eyes
Then, irrigate the ear with warm water.
Normal result: lateral conjugate nystagmus of the eyes away from
the area of stimulation.
Abnormal result: dysconjugate nystagmus of the eyes
 SYMPTOMS OF EAR DISEASES

Deafness Indicates a mild or severe hearing loss.

Conductive, sensorineural, or mixed hearing loss
exists.
In children, serous otitis media is the leading cause
of deafness, but in adults, presbycusis.
Presbycusis, or elderly deafness, is sensorineural
hearing loss caused by nerve tissue deterioration.
Men over 50 have it more often.
Presbycusis mostly affects high-pitched sounds like
women's voices.
 SYMPTOMS OF EAR
DISEASES
Otalgia (earache) is prevalent.
Pain
Acute otitis media is the leading cause in children and otitis
externa in adults.
The ear or a nearby nerve supply may cause pain.
Infections or malignant tumors cause throat pain most often.

Discharge Ear discharge can be mucoid, purulent, or bloody. It differs from

normal wax escape.
In otitis media, the tympanic membrane perforates, causing a
discharge.
Avoid ear irrigation if the tympanic membrane has perforated.
 SYMPTOMS OF EAR
DISEASES
Dizziness with a whirling sensation. When the inner ear's
Vertigo
vestibular system is damaged, it's a common symptom.
Nausea and vomiting accompany it.

Tinnitus Ear noise is a typical complaint.

It can sound like a high-pitched whistle, bells, or music.
 CLASSIFICATION OF
HEARING LOSS
Conductive Sensorineural
hearing Mixed hearing
hearing loss loss
loss
It involves interference It results from It involves both
with conduction of disease or trauma to conductive and
sound impulses through the inner ear or sensorineural hearing
the external auditory acoustic nerve. It is loss.
canal, the ear drum or validated by Weber's
the middle ear. It is
Test.
validated by Rinne's
Test.
ASSESSMENT IN THE PATIENTS
WITH HEARING LOSS
Irritable, hostile or hypersensitive in interpersonal relations.
Has difficulty in following directions.
Complains about people mumbling.
Turns up volume on TV.
Asks for frequent repetition.
Answers questions inappropriately.
Leans forward to hear better; face looks serious and strained.
Loses sense of humor; becomes grim and lonely.
Experiences social isolation.
Develops suspicious attitude.
Has abnormal articulation.
Complains of ringing in the ears. o Has unusually soft or loud voice. Dominates
conversation.
GUIDELINES FOR COMMUNICATING WITH
THE PATIENTS WITH HEARING
IMPAIRMENT
✓ Address the person directly. He/she can read lips.
✓ Use plain, natural speech. Be quiet. Shouting is high-pitched. Older
folks find this harder to grasp.
✓ Talk with gestures.
✓ Avoid whispering around the hearing-impaired client.
✓ Talk to hearing-impaired people.
✓ Avoid displaying irritation.
✓ If they don't hear you, move closer or to the better ear.
✓ Talk to the person without smiling, chewing gum, or covering your
mouth. Thus, they can read lips.
✓ Encourage hearing aid use if client has one.
 COMMUNICATION WITH
HEARING IMPAIRED PATIENT
Nonverbal
Use hand gestures.
Have speaker's face in good light.
Avoid covering face and mouth with hands.
Talk without chewing, eating, or smoking.
Eye contact.
Avoid distractions.
Avoid sloppy language the patient may misinterpret.
Move near the better ear.
Avoid light behind speaker. The patient won't see the speaker's face or
facial expressions to assist him understand.
 COMMUNICATION WITH
HEARING IMPAIRED PATIENT
Verbal
Speak normally and slowly.
Do not overexaggerate facial expressions.
Do not overenunciate.
Use simple sentences.
Rephrase sentence; use different words. Write
name or difficult words. Avoid shouting.
Speak in normal voice directly into better ear.
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BAT EAR (OTAPOSTASIS)

The pinna protrudes from the side of the head

because the ridge of the antihelix has not
formed. The child may be the object of
derision.

The antihelix can be reconstructed fairly

easily through an incision on the back of the
pinna.
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WAX (IMPACTED CERUMEN)
The external ear canal produces wax called
cerumen. Epithelial scales and outer ear gland
secretions make it. Wax usually escapes as it forms,
but in some cases, it blocks the ear canal and
causes hearing. Olive oil, liquid paraffin eardrops, or
hydrogen peroxide soften impacted wax for
irrigation.
To avoid dizziness from inner ear stimulation, the
syringe water should be body temperature. The
water jet cleans the ear canal wall. After irrigation,
carefully dry the ear and have a doctor check for
tympanic membrane injury.
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FOREIGN BODIES
The variety of these in children's ears is
remarkable. They can be removed with a
probe or warm water irrigation, but the child is
often scared and unwilling, so a general
anesthesia is needed. To rule out injury,
inspect the ear.

Similar treatment applies to ear insects. If the

foreign body is a vegetable seed, do not
irrigate the ear. Vegetable seeds swell when
wet.
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OTITIS EXTERNA
This is an inflammation of the outer
ear which is lined by skin. The
condition is usually bilateral and the
symptoms start with itching. The
patient scratches the ear which
becomes infected, painful and
sometimes blocked by a thin muco -
purulent discharge.
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OTITIS EXTERNA
This is an inflammation of the outer ear which is
lined by skin. The condition is usually bilateral and
the symptoms start with itching. The patient
scratches the ear which becomes infected, painful
and sometimes blocked by a thin muco - purulent
discharge.

Allergy, stress, and contaminated water may

contribute, but therapy is the same. A sample is
obtained for culture and sensitivity after removing
the cause.
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OTITIS EXTERNA
A cotton wool wisp on an appropriate
probe gently, thoroughly, and regularly
cleans the ear canal. Drops are
injected directly or used to impregnate
a small ribbon gauze wick that is left in
the ear for one or two days. The drops
may be disinfectants or topical
antibiotics and steroids to kill
microorganisms and relieve
inflammation. It recurs.
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BOILS
A boil or furuncle forms in the outer
hair-bearing skin of the ear canal.
The skin is tightly attached to the
cartilage, making it highly painful.
It's caused by staphylococcus like
other boils, and antibiotics are only
needed when symptoms are severe.
Analgesics are needed to rule out
diabetes.
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BOILS
A boil or furuncle forms in the outer
hair-bearing skin of the ear canal.
The skin is tightly attached to the
cartilage, making it highly painful.
It's caused by staphylococcus like
other boils, and antibiotics are only
needed when symptoms are severe.
Analgesics are needed to rule out
diabetes.
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TUMOR
Malignant tumors of the ear are
most common in the outer ear
where both basal cell carcinoma
and squamous carcinoma are
found. The small lesion is treated
with radiotherapy but the larger
will need surgical excision.
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SEROUS (SECRETORY)
OTITIS MEDIA
When the Eustachian tube is obstructed, the middle ear
air is absorbed into the tissues and replaced by thin fluid.
This ailment is called "glue ears" because tiny glands
develop in the middle ear lining and leak mucus.

It's especially noticeable in children who turn up the TV or

have undeveloped musculature from frequent upper
work. The parents may have seen the child's school
unnoticed hearing loss occurs in the child.
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SEROUS (SECRETORY)
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OTITIS MEDIA
Suppurative fluid infection may cause earache. A whisper test or
audiogram will show a hearing loss and fluid behind the tympanic
membrane. Most youngsters outgrow transitory or intermittent
conditions. If severe, a different way to let air into the middle ear must be
found. A tiny plastic tube (grommet, dottle, or stopple) is inserted into a
myringotomy to impede healing. Treating sinusitis or swollen adenoids
together.

Hearing is normal if the grommet is in place and unblocked. The grommet

usually falls out after 6 months. Recurring cases may require big tubes to
aerate the middle ear. Most grommet patients can swim with ear plugs. If
fluid reaccumulates, a grommet may need to be reinserted.
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ACUTE OTITIS MEDIA
The nasopharynx and middle ear are connected, making
them susceptible to infection. In serous otitis media, bacteria
have a convenient culture medium. Inflamed middle ear
mucosa swells with pus that leaks through the tympanic
membrane into the external ear.

A child with a cold has a severe earache that stops when the
membrane bursts. After 2–3 days, the perforation heals, but
it should be examined after a month to rule out severe otitis
media.
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ACUTE OTITIS MEDIA
Analgesics and bedrest are needed. Warm olive oil drops and a
covered hot water bottle calm the ear membrane. If a patient is
seen before the perforation, penicillin should be given for at least
5 days until the inflammation subsides. The discharge ear should
be swabbed for culture and sensitivity. Complications are
infrequent currently.

Acute mastoiditis—an abscess in the mastoid bone that bursts

behind the ear—is the most prevalent. It now only affects children
with impaired immune systems.
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CHRONIC OTITIS MEDIA
Chronic otitis media is a long-term ear
infection. The tympanic membrane and
ossicles are permanently damaged, leaving
the patient deaf with a big central
perforation and a constant discharge.
Because contaminated fluids move up the
Eustachian tube, colds are more likely to
induce discharge.
) ) ) ) ) ) ) ) ) CHRONIC OTITIS MEDIA
Regular irrigation and ear drops help minimize local discharge and
eradicate any nasal or nasopharyngeal infection. Perforation
surgery is possible if the ear has been dry for months. Thin fascia
from the temporalis muscle is transplanted over the perforation.
Myringoplasty involves placing the graft on the inner or outer
tympanic membrane. Repositioning or replacing a damaged
ossicle with bone or a prosthetic can also restore continuity. This
is tympanoplasty. A cadaver's tympanic membrane and ossicles
can now be removed in one piece. Homograft tissues can be
implanted into eligible patients, although the procedure is
complicated.
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OTOSCLEROSIS

Otosclerosis causes unusual, spongy, highly

vascularized bone to grow over the oval
window and to the stapes footplate,
preventing vibration. Women are more
afflicted. Early adulthood deafness worsens.
Conductive hearing loss results. Bone
conduction outperforms air conduction,
according to Rinne's test.
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OTOSCLEROSIS
A hearing aid or stapedectomy is the
treatment. The footplate is drilled and the
movable stapes removed. A piston or similar
prosthesis is put in the hole and hooked
around the incus to restore sound
transmission. The patient must understand
that the operation risks the inner ear.
Antivertigo medicines treat temporary
dizziness.
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CHOLESTEATOMA

This cyst has squamous epithelium and

epithelial scales. The cyst occurs when
the top tympanic membrane pouches
into the middle ear. As the pouch
narrows, epithelial scales are maintained
and collect. Cholesteatomas are
remarkable in that they erode most
tissues. Infected cyst contents can cause
persistent otitis media.
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CHOLESTEATOMA
Cholesteatoma growth direction
determines harm. An upward extension
causes brain abscesses or meningitis. A
downward extension may cause facial
paralysis or inner ear injury. Deafness
and a foul discharge plague the sufferer.
A marginal hole with white epithelial
scales in the ear may indicate a problem.
Radical mastoidectomy removes
cholesteatomas.
 DISEASES OF
THE INNER EAR
 INNER EAR DISEASES DESTROY FRAGILE NERVE ENDINGS
THAT CONTROL HEARING AND BALANCE, CAUSING VERTIGO,
DEAFNESS, AND TINNITUS.

AVOID TRAUMA, HARSH NOISES, AND MEDICINES THAT CAN

DAMAGE THE INNER EAR. MENIERE'S ILLNESS CAUSES SEVERE
VERTIGO DUE TO INNER EAR ENDOLYMPH BUILD UP.
 MENIERE'S DISEASE
(ENDOLYMPHATIC HYDROPS)
IT IS CHARACTERIZED BY ACCUMULATION OF ENDOLYMPH
IN THE INNER EAR. IT IS CHRONIC, WITH
EXACERBATIONS.

CAUSES
UNKNOWN
VIRUS
EMOTIONAL STRESS
 MENIERE'S DISEASE
(ENDOLYMPHATIC HYDROPS)
ASSESSMENT IN MENIERE'S DISEASE
VERTIGO (MOST CHARACTERISTIC MANIFESTATION)
UNILATERAL / BILATERAL GRADUAL HEARING LOW "DROP ATTACKS" (THE PATIENT
EXPERIENCES THE FEELING OF
BEING PULLED TO THE GROUND)
FEELING OF AS IF ONE IS WHIRLING IN SPACE
TINNITUS (DESCRIBED AS "ROAR" OR "LIKE THE OCEAN")
NAUSEA AND VOMITING
WEBER TEST SHOWS THAT TONE LATERALIZES BETTER IN THE GOOD EAR.
 MENIERE'S DISEASE
(ENDOLYMPHATIC HYDROPS)
COLLABORATIVE MANAGEMENT FOR THE PATIENTS WITH
MENIERE'S DISEASE INCLUDE THE FOLLOWING:

BED REST DURING EXACERBATION.

LOW SODIUM DIET. TO PREVENT RETENTION OF WATER. AVOID
DRINKING LARGE VOLUMES OF FLUIDS.
AVOID READING DURING VERTIGO.
PROVIDE QUIET, DARKENED ROOM DURING VERTIGO.
 MENIERE'S DISEASE
(ENDOLYMPHATIC HYDROPS)
COLLABORATIVE MANAGEMENT FOR THE PATIENTS WITH MENIERE'S DISEASE
INCLUDE THE FOLLOWING:

PROVIDE SOFT, MELLOW MUSIC DURING TINNITUS TO DIVERT THE PATIENT'S

ATTENTION.
AVOID ALCOHOL, CAFFEINE, AND TOBACCO. THESE CAUSE EXACERBATION
OF SYMPTOMS.
STRESS THERAPY.
MEDICATIONS: TRANQUILIZERS, VAGAL BLOCKERS (ATROPINE),
ANTIHISTAMINES
TO REDUCE VERTIGO, THE FOLLOWING MEDICATIONS MAY BE DIAZEPAM
(VALIUM) MECLIZINE (ANTIVERT / BONAMINE PLUS NICOTINIC ACID)
FENTANYL WITH DROPERIDOL (INNOVAR)
 DIFFERENT TYPES OF EAR
SURGERIES
MYRINGOPLASTY. IT INVOLVES CLOSURE OF PERFORATED TYMPANIC
MEMBRANE.
TYMPANOPLASTY. IT INVOLVES CLOSURE OF PERFORATED 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.
CARE OF THE PATIENTS
UNDERGOING EAR SURGERY
POST-OP

LIE ON THE UNOPERATED SIDE.

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.
CARE OF THE PATIENTS
UNDERGOING EAR SURGERY
POST-OP

KEEP EAR DRY FOR 6 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.
CARE OF THE PATIENTS
UNDERGOING EAR SURGERY
POST-OP

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.
Thank you!