Patients With Hearing and Balance Disorders

Chapter 59
Assessment and Management of

Patients with Hearing and
Balance Disorders
Copyright © 2008 Lippincott Williams & Wilkins.

Anatomy of the Ear

Anatomy of the Inner Ear

Bone Conduction Compared to
Air Conduction

Assessment
• Inspection of the external ear
• Otoscopic examination
• Gross auditory acuity
• Whisper test
• Weber test
• Rinne test

Technique for Using an Otoscope

Weber Test

Rinne Test

Speech Discrimination

Diagnostic Evaluation
• Audiometry
• Tympanogram
• Auditory brain stem response
• Electronystagmography
• Platform posturography
• Sinusoidal harmonic acceleration
• Middle ear endoscopy

Hearing Loss
• Affects more than 28 million people in the U.S.
• Increased incidence with age: presbycusis
• Risk factors include exposure to excessive noise levels:
see Chart 59-3
• Types
– Conductive: due to external middle ear problem
– Sensorineural: due to damage to the cochlea or
vestibulocochlear nerve
– Mixed: both conductive and sensorineural
– Functional (psychogenic): due to emotional problem
Manifestations
• Early symptoms include:
– Tinnitus: perception of sound; often “ringing in the
ears”
– Increased inability to hear in a group
– Turning up the volume on the TV
• Impairment may be gradual and not recognized by the
person experiencing the loss
• As hearing loss increases, patients may experience
deterioration of speech, fatigue, indifference, social
isolation, or withdrawal; for other symptoms see Chart
59-2
Guidelines for Communicating
With the Hearing Impaired
• Use a low-tone, normal voice
• Speak slowly and distinctly
• Reduce background noise and distractions
• Face the person and get his attention
• Speak into the less-impaired ear
• Use gestures and facial expressions
• If necessary, write out the information or use a sign
language translator
• See Chart 59-4
Conditions of the External Ear
• Cerumen impaction
– Removal may be by irrigation, suction, or

instrumentation
– Gentle irrigation should be used with lowest

pressure, directing stream behind the
obstruction
 Glycerin, mineral oil, half-strength H2O2 or

peroxide in glyceryl may help soften
cerumen
Conditions of the External Ear (cont.)
• Foreign bodies
– Removal may be by irrigation, suction, or
instrumentation
– Objects that may swell (such as vegetables or
insects) should not be irrigated
– Foreign-body removal can be dangerous and may
require extraction in the operating room
• External otitis
– Inflammation is most commonly due to the bacteria
staphylococcus or pseudomonas, or to fungal
infection due to Aspergillus

Conditions of the External Ear (cont.)
• External otitis (cont.)
– Manifestations include pain and tenderness, discharge,
edema, erythema, pruritus, hearing loss, and feelings
of fullness in the ear
– Therapy is aimed at reducing discomfort, reducing
edema, and treating the infection
– A wick may be inserted into the canal to keep it open
and to facilitate medication administration
• Malignant external otitis: rare, progressive infection that
effects the external auditory canal, surrounding tissue, and
the skull
Conditions of the Middle Ear
• Tympanic membrane perforation
• Acute otitis media
– Most frequently seen in children
– Pathogens are most commonly Streptococcus
pneumonia, Haemophilus influenzae, and Moraxella
catarrhalis
– Manifestations include otalgia (ear pain), fever,
and hearing loss
– Treatment
 Antibiotic therapy
 Myringotomy or tympanotomy
Conditions of the Middle Ear (cont.)
• Serous otitis media: fluid in the middle ear without
evidence of infection
• Chronic otitis media
– Result of recurrent acute otitis media
– Chronic infection damages the tympanic membrane
and ossicle, and involves the mastoid
– Treatment
 Prevent by treatment of acute otitis
 Tympanoplasty, ossiculoplasty, or mastoidectomy
Middle Ear Surgical Procedures
• Tympanoplasty
– Reconstruction of the tympanic membrane
• Ossiculoplasty
– Reconstruction of the bones of the middle ear
– Prostheses are used to reconnect the ossicles to

reestablish sound conduction

Middle Ear Surgical Procedures (cont.)
• Mastoidectomy
– Removal of diseased bone, mastoid air cells,
and cholesteatoma to create a non-infected,
healthy ear
– Cholesteatoma: a benign tumor that is an
ingrowth of skin that causes persistently high
pressure in the middle ear, causing hearing
loss, neurologic disorders, and destroying
structures

Stapedectomy for Otosclerosis

Nursing Process—Assessment of the
Patient Undergoing Mastoid Surgery
• Health history
• Include data related to the ear disorder, hearing

loss, otalgia, otorrhea, and vertigo
• Medications

Nursing Process—Diagnosis of the Patient
Undergoing Mastoid Surgery
• Anxiety
• Acute pain
• Risk for infection
• Disturbed auditory sensory perception
• Risk for trauma related to imbalance or vertigo
• Disturbed sensory perception related to damage to
facial nerve
• Impaired skin integrity
• Deficient knowledge
Nursing Process—Planning the Care of the
Patient Undergoing Mastoid Surgery
• Major goals include:
– Reduction of anxiety
– Freedom from pain and discomfort
– Prevention of infection
– Stable or improved hearing and communication
– Absence of vertigo and injury
– Absence of or adjustment to altered sensory
perception, return of skin integrity
– Increased knowledge of disease
– Surgical procedure and postoperative care
Interventions
• Reduce anxiety
– Reinforce information and patient teaching
– Provide support and allow patient to discuss
anxieties
• Relieve pain
– Medicate with analgesics for ear discomfort
– Occasional sharp, shooting pains may occur as
the eustachian tube opens and allows air into
the middle ear; constant throbbing pain and
fever may indicate infection
Interventions (cont.)
• Prevent injury
– Implement safety measures such as assisting with
ambulation
– Provide antiemetics or antivertigo medications
• Improve communication and hearing
– Hearing may be reduced for several weeks following
surgery due to edema, accumulation of blood and
fluid in the middle ear, and dressings and packings
– Use measures to improve hearing and communication
as discussed in “Communicating With the Hearing
Impaired”
Interventions (cont.)
• Preventing infection
– Monitor for signs and symptoms of infection
– Administer antibiotics as ordered
– Prevent contamination of ear with water from

showers, washing hair, etc.

Patient Teaching
• Medications teaching; analgesics and antivertigo
medications
• Activity restrictions
• Gently blow nose on only one side at a time;

sneeze and cough with mouth open
• Patient may need instruction to avoid heavy

lifting, exertion, and nose blowing to prevent
dislodgement of grafts or prostheses

Patient Teaching (cont.)
• Safety issues related to potential vertigo
• Instruction regarding potential complications

and reporting of problems
• Avoid getting water in ear
• Follow-up care
• See Chart 59-6

Conditions of the Inner Ear
• Disorders of the vestibular system affect more
than 30 million in the U.S.; falls resulting from
these disorders result in 100,000 hip fractures
a year
• Dizziness: any altered sense of orientation in
space
• Vertigo: the illusion of motion or a spinning
sensation
• Nystagmus: involuntary rhythmic movement of
the eyes associated with vestibular dysfunction
Conditions of the Inner Ear (cont.)
• Tinnitus
• Labyrinthitis
• Benign positional vertigo (BBPV)
• Ototoxicity: see Chart 59-9
• Acoustic neuroma: tumor of cranial nerve VIII

Ménière’s Disease
• Abnormal inner ear fluid balance caused by

malabsorption of the endolymphatic sac or
blockage of the endolymphatic duct
• Manifestations include fluctuating, progressive

hearing loss; tinnitus; feeling of pressure or
fullness; and episodic, incapacitating vertigo
that may be accompanied by nausea and
vomiting

Ménière’s Disease (cont.)
• Treatment
– Low-sodium diet, 2000 mg a day: see Chart 59-7
– Meclizine (Antivert), tranquilizers, antiemetics,
and diuretics
– Surgical management to eliminate attacks of
vertigo; endolymphatic sac decompression;
middle and inner ear perfusion; and vestibular
nerve sectioning

Patients With Hearing and Balance Disorders

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Patients With Hearing and Balance Disorders

Uploaded by

Copyright:

Available Formats

Chapter 59

Assessment and Management of

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

• Inspection of the external ear

• Gross auditory acuity

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

– Removal may be by irrigation, suction, or

– Gentle irrigation should be used with lowest

 Glycerin, mineral oil, half-strength H2O2 or

Copyright © 2008 Lippincott Williams & Wilkins.

– Reconstruction of the tympanic membrane

– Reconstruction of the bones of the middle ear

– Prostheses are used to reconnect the ossicles to

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

• Include data related to the ear disorder, hearing

Copyright © 2008 Lippincott Williams & Wilkins.

– Monitor for signs and symptoms of infection

– Administer antibiotics as ordered

– Prevent contamination of ear with water from

Copyright © 2008 Lippincott Williams & Wilkins.

• Gently blow nose on only one side at a time;

• Patient may need instruction to avoid heavy

Copyright © 2008 Lippincott Williams & Wilkins.

• Safety issues related to potential vertigo

• Instruction regarding potential complications

• Avoid getting water in ear

• See Chart 59-6

Copyright © 2008 Lippincott Williams & Wilkins.

• Benign positional vertigo (BBPV)

• Ototoxicity: see Chart 59-9

• Acoustic neuroma: tumor of cranial nerve VIII

Copyright © 2008 Lippincott Williams & Wilkins.

• Abnormal inner ear fluid balance caused by

• Manifestations include fluctuating, progressive

Copyright © 2008 Lippincott Williams & Wilkins.

Copyright © 2008 Lippincott Williams & Wilkins.

You might also like