 DISORDERS OF EAR

 IMPACTED CERUMEN

 Accumulation of cerumen in the external canel in verious amounts.

 CLINICAL MANIFESTATIONS

Otalgia

Hearing loss may or may not be present

 MANAGEMENT

Cerumen can be removed by irrigation , suction or instrumentation.

Gental irrigation usally helps to remove impacted cerumen .

For successful removal, let the water steam to flow behind the obstructing cerumen to move it
first laterally and then out of the canel.

Direct visual removal can be performed on a co operative patient.

Instilling a few drops of warmed glycerin , mineral oil or half strength of hydrogen peroxide into
the ear canel for 30 min can soften cerumen before its removel.

 OTALGIA

It is defined as pain in the ear or earache.

 ETIOLOGY

Bacterial contaminants through insertion of unclean articles such as fingers or toys.

Insertion of any sharp object into ear canal.

Swimming in polluted water

Upper respiratory tract infections.

 Clinical manifestations

 Pain

 A sense of fullness

 Itching

 Throbbing sensation
 Inflammation

 Bleeding

 Decreased hearing

 Management

 Ear irrigation is usually performed . It is avoided in case of foreign bodies and insects
which tend to swell.

 Suction

 Instrumentation

 Sometimes, anesthesia is required to extract foreign bodies.

EXTERNAL OTITIS

 Infections of the external ear are generally termed as external otitis.

CAUSES

 Acute and chronic form of: Dermatitis

 Fungus associated with systemic diseases.

 Diseases of skin of the adjacent face, neck and scalp

 Diseases of the middle ear.

 Trauma

 Primary invasion of organisms.

 Clinical manifestations

 Pain

 Redness

 Scaling

 Itching

 Swelling
  Watery discharge

 Crusting

 Thickening of skin

 Stenosis of external canal.

 Management

 Local treatment may include application of medicated powders and onintments.

 Warm compress to provide heat to area and soften crusts.

 Apply cold applications to lessen inflamation.

 Analgesics

 Antibiotics(neomycin)

 Use sterile techniques to prevent further infection such as: a new application is used each
time the canal is entered.

 Use borrow solution for its astringent action.

 Advice a patient for proper care.

TYMPANIC MEMBRANE PARFORATION

 It is the perforation of eardrum which may cause temporary hearing loss and occasional
discharge.

CAUSES

 The eardrum can became damaged by a direct injury.

 With a cotton tipped swab or another foreign object.

 By hitting the ear with an open hand.

 After a skull fracture.

 Infection.

 Clinical manifestations

 Earache
  Ear drainage

 Ear buzzing

DIGNOSTIC EVALUATION

Direct inspection with otoscope.

 MANAGEMENT

 A perforated eardrum heals itself within 2 months.

 Antibiotic therapy

 Prevent infection

 Analgesics

 A paper patch is placed over the ear drum until the membrane heals.

 SURGICAL MANAGEMENT

 Tympanoplasty (surgical repair of tympanic membrane.

OTITIS MEDIA

 IT IS THE INFLAMMATION OF THE MIDDLE EAR.

 Characterized by the accumulation of fluids in the middle ear, bulging og the eardrum,
pain in the ear.

 CAUSES

 Streptococcus pneumoniae

 Haemophilus influenzae

 Upper respiratory infections

 Client with cleft palate or down syndrome.

 Types

Acute otitis media

 It is the infection of middle ear that last for 6 weeks.

Chronic otitis media

 Chronic otitis media is characterized by chronic purulent dischange from the middle ear.

 Clinical manifestations

 Irritability, fussy, have problems in feeding or sleeping.

 Pain and fullness in the ear.

 Fever.

 Running, stuffy nose or cough

 Rupture of eardrum

 Puss formation in middle in ear

 Management

 Antibiotics

 Observation

SURGICAL MANAGEMENT

 Tympanotomy

NURSING INTERVENTIONS

 Check the level of pain and drainage from the ear.

 Drainage of section into the nasopharynx.

 Equalize the air pressure with atmospheric pressure.

 Check the middle ear pressure.

 Treat the etiology of the otitis media

 Clean the ear with normal saline flush.

 Pour antibiotic in ear and close with cotton

0TOSCLEROSIS

 Otosclerosis invoves the stapes and result from the formation of new , abnormal bone,
especially around the oval window, with resulting fixation of the stapes. It prevents the
efficient transmission of sound.

 CAUSES

Metabolic disorders

Immune disorders

Vascular disease

infection

 Classification

 Histological

 Clinical

• Stepedial: ankylosis of the stapes causing conducing deafness.

• Cochlear otosclerosis: the otosclerotic process encroaches upon the membraneous

labyrinth producing sensorineural deafness.

• Mixed: it cause both the fixation of the stapes as well as involvement of the labyrinth so
that there are mixed hearing loss.

 Clinical manifestations

 Deafness

 Client can not hear low pitched sounds or that they can no longer hear a whisper

 Tinnitis

 Mild vartigo

DIAGNOSTIC EVALUATION

 Otoscopic examination

 Rinne’s test

 Weber’s test

 Audiogram
  Tympanometry

 Management

 Medical managemaent

Sodium floride with vit. D, CaCO3 TO Retard bone growth reabsorption and encourage
calcification of bone lesions.

 Surgical management

Stapedectomy : a tiny hole is made in the footplate either with a microdrill or with a laser and a
prosthesis is placed to touch this area with movement of the tympanic membrane.

 MENIERE,S DISEASE

 It is the disorder of the inner ear that is characterized by episodes of dizziness and tinnitus
and progressive hearing loss, usually in one ear.

 CAUSES

Head trauma

Upper respiratory tract infection.

Aspirin

Smoking cigarettes.

Drinking alcohol

Excessive consumption of salt in some patients.

 Clinical manifestations

 Periodic episodes of rotary vertigo or dizziness.

 Fluctuating ,progressive, unilateral or bilateral hearing loss.

 Unilateral or bilateral tinnitus

 A sensation of fullness or pressure in one or both ears.

 Nausea

 Vommiting

 Sweating
  Nystagmus

 Dignostic evaluation

 Audiometric tests

 MRI of head

Management

low sodium diet typically one to two grams per day is recommended.

Advice client to avoid caffeine ,alcohol and tobacoo.

Antihistamines , anticholinergics steroids and diuretics and prescribed .

The anti herpes virus drug acyclovir has also been used.

Surgery may be recommended if medical management does not control vertigo.

 Nursing management

 Nurses need to give assurance especially during acute attacks.

 If patient is smoker, he should stop it as cigarette has nicotinic acid which causes
vasospasm.

 Patient should be given low salt diet and take only required amount of fluids.

 Avoid exercise where body balance can not be maintained e.g : swimming , driving, races
and mountaineering .

DISORDERS OF NOSE AND THROAT

Rhinitis

 Rhinitis is inflammation and swelling of the mucous membrane of the nose, characterized
by a runny nose and stuffiness and usually caused by the common cold or allergy.

 CLASSIFICATION

Allergic rhinitis :also known as acute condition

Non allergic rhinitis: chronic condition caused by repeated acute attacks

• Infections
 • Drug induced

• Occupational

Risk factors

 Rhino virus, adeno virus, entero virus

 Environmental factors

 Health changes

 Infections

 Food and beverages

 Certain medication

 Health problems

 Weak immune system

CLINICAL MANIFESTATIONS

 Dryness of nose, eyes, soft palate

 General malaise

 Fever shivering

 Headache

 Obstruction to nasal breathing due to swelling of the mucous membrane.

 Profuse watery nasal discharge

 Sneezing

 Tearing of eye

 Nasal irritation

 Restlessness

 Discomfort

Management

 Provide proper bed rest

  Plenty of fluids

 Steam inhalation

 Antihistamines drugs

 Not to blow the nose too hard

 Nasal drops

 Antibiotics

Sinusitis

 It is the inflammation of the paranasal sinuses , which may or may not be result of
infection from bacterial, fungal ,viral, allergic or autoimmune issues.

 Etiology

• Streptococcus pneumoniae

• Staphylococcus aureus

• Heamophilus influenza

 Types

 Acute : when symptoms are present for 4 weeks or less . It is caused by bacteria growing
in the sinuses.

 Etiology:

small hair in sinuses ( cilia) became impaired functioning.

Colds and allergies may cause too much mucus production.

A deviated septum, nasal bone spur or nasal polyps may block the opening of the sinuses.

 Clinical manifications

 The symptoms of acute sinusitis in adults usually follow a cold that does not improve or
one that gets worse after 5-7 days of symptoms

 Fever

 Cough often worse at night

  Fatigue and generally not feeling well

 Bad breath or bad smell

 Headache , pressure like pain , pain behind the eyes , toothache or tenderness of the face

 Nasal stiffness and discharge

 Sore throat and postnasal drip

 Chronic : when swelling and inflammation of the sinuses are present for longer than 3
months , it is caused by bacteria and fungus.

 ETIOLOGY

 Nasal polyps and tumours

 Allergic reactions

 Deviated nasal septum

 Trauma to the face

 Respiratory infections

 Problems related to Immunity

Clinical manifestations

 drainage of thick, yellow or greenish discharge from the nose or down the back of the
throat.

 Nasal obstruction or congestion causing difficulty in breathing through your nose.

 Pain, tenderness and swelling around your eyes, cheeks, nose or forehead.

 Reduced sense of smell and taste.

 Ear pain

 Sore throat

 Bad breath

 Nausea

Diagnostic evaluation

 X rays
  Endoscopy

 Rhinoscopy

 CT scan

 MRI

MANAGEMANT

 ANTIBIOTIC THERAPY

 ANTIHISTAMINES

 NASAL DECONGESTIONS

 STEAM INHALATIONS

 SELF CARE

 SALINE NASAL SPRAY

 CORTICOSTEROIDS

 SURGICAL MANAGEMENT

 Antrum puncture

 Intranasal antrostomy

 Balloon sinuplasty

Pharyngitis

 It is the inflammation of the pharynx. Acute pharyngitis is a most common throat

inflammation. It be caused by hemolytic streptococci, strephylococci or other bacteria or
filtrable viruses.

 Types :

Acute

chronic

 Causes

 Bacterial infections: streptococcus

  Viral infections: rhinovirus

 Immunocompromised

 Young children

 Smoking

 Endotracheal intubation

 Clinical manifestations

 Dryness of mouth, throat

 Redness

 Soreness

 Severe pain

 Difficulty in swallowing

 Hacking cough

 Irritation

 discomfort

Dignostic test

 Throat swab culture

 Physical examination

 CT SCAN

 X rays

Management

 Antibiotic drugs

 Corticosteroids

 Antifungal drugs

 Analgesics

Nursing management:
  Bed rest

 Hot saline gargles

 Ice coller

 Moist/steam inhalation

 Antipyretics for fever

Tonsilitis

 It is the inflammation of the palatine tonsils. It may to occur when the patient resistence
is low and is common in children .

 ETIOLOGY

 Acute: bacterial/virus

 Recurrent / sub acute : caused by bacterium

 Chronic : which can last for long period if not treated

 Peritonsillor abscess: bacterial infection

Clinical manifestations

 Sore throat

 Pain

 Difficulty in swallowing

 Fever

 Chillis

 General muscle aching

 Malaise

 Redness

 Irritation and discomfort

 Complications

 Heart and kidney damage.

  Pneumonia and chorea

Management:

 Strict bed rest

 Plenty of fluids

 Warm saline solution

 Antibiotics

Surgical management

 Tonsillectomy :most physician believe that patient

Who have recurrent attacks of tonsillitis should have a tonsillectomy. This procedure is usually
done from 4 to 6 weeks often an acute attack has subsides.

Laryngitis

 It is the inflammation of the larynx. It can cause hoarseness or loss of voice due to acute
infection or irritation by gases. It is of two types:

 Acute:

It is the inflammation of the mucous membrane lining the larynx , accompained by edema of the
vocal cords.

 Causes

• Cold

• Changes in temperature

• Irritating fumes

• smoking

 Chronic laryngitis

 Laryngitis that lasts for more than 3 weeks. It can be caused by:

 Chronic sinusitis, bronchitis

 Gestroesophageal reflux disease

  Vocal cord strain

 Smoking, allergens

 Infections such as tuberculosis

 Clinical manifestations

 Dryness

 Harsh cough

 Hoarseness

 Slight huskiness to complete

 Sore throat

 Fever

 Irritation

 Discomfort

 Respiratory distress

Dignostic evaluation

 Complete history

 Physical examination

 X rays of neck

 Laryngoscopy

 Biopsy

Management

 The patient is advised to stay indoors in an even temperature

 Instruct a patient to avoid talking for several days or weeks.

 Give steam inhalations with tincture of benzoin or oil of pine and methol for soothing
effects.

 Advice to take cough syrups.

  Give advice to advice smoking

 Warm steam inhalation may be used to provide humidity and liquify secreations.

BIBLIOGRAPHY

 Kaur lakhwinder, ‘ textbook of medical surgical nursing , first edition, published by lotus
publications,

 Chintamani lewis, ‘ medical surginal nursing, first edition, published by elsevier volve.

 www. Wikipedia. Com .