Professional Documents
Culture Documents
2. FUNCTION
1. Hearing
2. Sound conduction & transmission
3. Balance & Equilibrium (VBC system)
3. ASSESSMENT
a. Inspection of the External Ear
1. Auricle & surrounding tissues inspected for:
• Deformities
• Lesions
• Discharge – the color, the odor, the amount
• Size, symmetry, and angle of attachment to head
• Pain
• Dermatitis – excema, dermatitis
2. Manipulation of the auricle doesn’t normally elicit pain – if this maneuver is painful, it is
an external problem – probably Acute External Otitis
b. Otoscopic Exam
1. Held in right hand, bottom of scope pointing up
2. With left hand, grasp auricle
a. pull back & up for Adult
b. pull back & down for
Child <3
c. pull back & up for child
>3
3. Looking for position, discharge, inflammation, tympanic membrane
(normal=pearly gray), fluid, air bubbles, blood, masses, foreign bodies.
c. Evaluation of Gross Auditory Acuity – you are trying to determine if it is Conductive or
Sensorineural Hearing Loss:
1. Whisper – stand 1-2’ away and whisper a phrase (have the patient cover one
ear at a time)
2. Weber – use a tuning fork on forehead – can they hear it on both sides
3. Rinne – use a tuning fork – once close to ear & once on mastoid bone – which
is louder – the ear should be
d. Sensorineural Hearing Loss – Inner
Ear
1. loss of hearing due to damage to the inner ear (hearing=Cochlear or Cranial
Nerve VIII=Vestibulocochlear)
e. Conductive Hearing Loss – External Ear &
Middle Ear
1. loss of transmission of sound
2. there is a problem from the external to the internal – remember your inner ear is
responsible for hearing
3. due to a disease process or obstruction
f. Functional Hearing Loss – see what you want to see, hear what you want to hear
(psychogenic) – there is no real organic cause for the hearing loss.
g. Mixed Hearing Loss – combination of conductive and senorineural
More than 26 million people are affected by hearing loss. Approximately 10 million have irreversible
hearing loss. Occupational exposure (coal miners, plumbers) is a major cause of hearing loss.
4. DIAGNOSTIC
a. Audiometry – have child raise hand when they hear the sound
b. Tympanogram
c. Auditory Brain Stem Response
d. Electronystagmography
e. Sinusoidal Harmonic Acceleration
f. Middle Ear Endoscopy
B. Cerumen Impaction
1. cerumen normally accumulates in the external canal in various amounts and
colors
2. sometimes impaction does occur – requiring removal
3. Otalgia – a sensation of fullness or pain in the ear
4. more common in elderly
5. Management
a.Irrigation – warm water gently squirted into ear canal
b. Suction – aural suction – sometimes the cerumen will need to be softened with some
type of softening agent before being suctioned
c.Instrumentation – Cerumen Curette
d. Referral – if the above doesn’t work – ER
C. Foreign Bodies
1. Causes
a. some objects are inserted intentionally in the ear by adults who are
trying to clean the external canal or to relieve itching
b. by children sticking objects in the ear (beads, pebbles, peas, toys)
2. There may be no symptoms or profound pain
3. Management – 3 standard methods
a. Irrigation – Warning: if there is a vegetable or insects in there, don’t
irrigate – it will swell – mineral oil can be used to remove an insect
b. Suction
c. Instrumentation
d. Referral
D. External
Otitis (Otitis Externa)
1. Inflammation of the external auditory canal
2. Causes
a. water in the ear canal (Swimmer’s ear)
b. trauma
c. bacterial or fungal infections
d. dermatitis
e. allergic reactions – hair spray, hair dye, permanents
3.
S&S
a. pai
n
b. discharge – yellow, green, foul
smelling
c. aural tenderness when touching the ears
d. fev
er
e. cellulitis &
lymphadenopathy
f. hearing loss – due to the canal starting to shut off from the
swelling
g. itc
hing
h. feeling of
fullness
i. erythematous and
edematous
4. Medical Management
a. GOAL: relieve discomfort, reduce swelling, ↓ infection
b. analgesics
c. antibiotics - usually something topical like ear drops (if you get into like
cellulites and it gets systemic, then the patient will be put on an oral antibiotic)
d. corticosteroids
e. antifungal
5. Nursing Management
a. Teach patients
1. not to clean the external canal w/cotton-tipped applicators
2. No swimming or use a barrier when swimming
3. do not allow water to enter the ear when shampooing or showering
4. a cotton ball can be covered in water –insoluble gel such as petroleum
jelly and placed in the ear as a barrier
5. Keep water out of the ear canal
b. Prevent infection by using antiseptic otic preparations after swimming
(Swim Ear or Dry Ear)
c. Usually on antibiotics or antifungals for 7 days.
9. OTOTOXICITY
a. A variety of meds can cause this
1. aspirin at high doses
2. quinine
3. aminoglycosides (Vancomycin)
b. Teach patients receiving these meds about their side effects
c. Monitor blood levels - the physician will order the blood work
d. Audiograms 2/week during therapy
13. Impaired adjustment RT disability requiring change in lifestyle due to unpredictability of vertigo
a. encourage pt to identify personal strengths and roles that can still be fulfilled
b. provide info about vertigo and what to expect
c. include family and significant others in rehab process
d. encourage pt to maintain sense of control by making decisions and assuming more
responsibility for care
14. RF Deficient fluid volume RT ↑ fluid output, altered intake, and meds
a. assess, or have pt assess, I&O (including emesis, liquid stools, urine, diaphoresis)
b. monitor lab values
c. assess for dehydration, including BP(orthostasis), pulse, skin turgor, mucous membranes,
and LOC
d. encourage oral fluids as tolerated – discourage beverages containing caffeine
e. administer, or teach administration of, antiemetics, and anti-diarrheal meds
f. teach med s/e
15. Anxiety RT threat of, or change in , health status and disability effects of vertigo
a. assess level of anxiety – help pt identify coping skills used successfully in the past
b. provide information about vertigo and its treatment
c. encourage pt to discuss anxieties and explore concerns about vertigo attacks
d. teach pt stress mgmt techniques or make appropriate referrals
e. provide comfort measures and avoid stress-producing activities
f. instruct pt in aspects of tx regimen
FYI: Air conduction is supposed to be better than bone conduction in normal hearing. in some
disorders, you may have it where air conduction is better than bone conduction. With otosclerosis,
this will not be true, the bone conduction is better than the air conduction.