Intervention for Clients with Eye and
at a time and vision is not affected.
Vision Problems
Eyelid Disorders
Blepharitis
 Inflammation of the eyelid edges
 Occurs most often in the older adult and
those with dry-eye syndrome.
 Reduced tear production often leads to
bacterial infection of the eye structures,
because tears inhibit bacterial growth.
 Clients have itchy, red and burning eyes.
 Seborrhea or greasy, itchy scaling of the
eyebrows and eyelids is often present.
 Warm moist compress followed by gentle
scrubbing with diluted baby shampoo.
Entropion
 Turning inward of the eyelid causing the
lashes to rub against the eye.
 Caused by muscle spasm or scarring and
deformity of the eyelid secondary to
trauma.
 Feeling of something is in the eye, pain and
tears may also be present.
 The eyelid is turned inward and the
conjunctiva is red.
Ectropion
 Turning outward and sagging of the eyelid
which often occurs with aging.
 It is caused by relaxation of the orbicular
muscle.
 This lid position reduces washing action of
tears leading to corneal dryness and
ulceration.
Hordeolum
 Or stye can be external or internal.
 An external hordeolum is an infection of the
sweat glands in the eyelids.
 An internal hordeolum is caused by
infection of the eyelid sebaceous gland.
 Most common causative agents are
Staphylococcus aureus, S. epidermidis,
Strep.
 Hordeolum usually affects only one eyelid
Chalazion
 Inflammation of the sebaceous gland in the
eyelid.
 Most chalazia protrude on the inside of the
eyelid.
 The client has eye fatigue, light sensitivity
and excessive tears.
 Treatment includes use of warm compress
for 15 minutes four time s a day followed by
instillation of ophthalmic ointment.
Keratoconjunctivitis Sicca
 Dry-eye syndrome results from changes in
tear composition, lacrimal gland
malfunction, or altered tear distribution.
 Decreased tear can be attributed to:
 Use of drugs such as antihistamines,
betaadrenergic blocking agents or
anticholinergic drugs.
 Diseases like: rheumatoid arthritis,
leukemia, sarcoidosis and multiple
sclerosis.
 Radiation or burns to the eye.
 Injury to facial nerve.
 Use of artificial tears (Hypo Tears) is
prescribed for daytime use.
 Lubricating ointment is prescribed for night
use such as Lacri-lube S.O.P. and Refresh
PM
Conjunctival Disorders
Hemorrhage
 Conjunctival blood vessels are fragile and
can break with increased pressure during
sneezing, coughing or vomiting.
 May also occur due to hypertension,
trauma or blood clotting problems.
 It resolves within 14 days without
treatment.
Conjunctivitis
 Infection or inflammation of the
conjunctiva.
 Inflammation occurs from exposure to
allergens or irritants and not contagious.
 Infectious conjunctivitis occurs with
bacterial or viral infection and is rarely
transmitted from person to person.
 Manifestation of allergic conjunctivitis
includes edema, a sensation of burning,
engorgement of blood vessels (bloodshot
appearance) excessive tears and itching.
 Bacterial conjunctivitis or pink eye is
usually caused by Staph Aureus, H.
Influenzae or Pseudomonas. Manifestation
include: blood vessel dilation, mild
conjunctival edema, tears and discharge.
The discharge is watery at first then
becomes thicker with shreds of mucus.
Trachoma
 Chronic bilateral scarring form of
conjunctivitis caused by Chlamydia
trachomatis .
 It is the chief cause of preventable
blindness in the world.
 The incidence is highest in warm, moist
climate where sanitation is poor.
 Incubation period is 5 – 14 days.
 Manifestation include: tears, photophobia,
and edema of the eyelids and conjunctiva.
 As the disease progresses, the eyelids scars
and turns inward, causing the eyelashes to
damage the cornea.
 A 4-week course or oral or topical
tetracycline (Achromycin, Apo-Tetra) or
erythromycin is given.
Corneal Disorders
 Corneal problems may be caused by
 Keratoconus or degeneration of the
cornea.
 Autosomal recessive trait
 Down syndrome
 Aniridia
 Marfan syndrome
 Atopic allergy
 Retinitis pigmentosa
 Deposits in the cornea, reducing the
refracting power (dystrophies)
 Keratitis or irritation or infection of
cornea.
 Ectropion/Entropion
 Exopthalmos
 Neurologic deficits
 Ulceration of cornea
 Mechanical injury
 Chemical injury
 Drying
 Infection
 Client with corneal disorder usually has
pain, reduced vision, photophobia and eye
secretions.
 Cloudy or purulent(pus-filled) fluid may be
present on the eyelids or eyelashes.
 Altered corneal light reflex.
 Fluorescein stain result is green.
 Keratoplasty (cornela transplant) is the
surgical removal of the diseased corneal
tissue and replacement from a human
donor cornea.
Cataract
 Opacity of the lens that distorts the image
projected onto the retina.
 With aging lens gradually loses water and
increases in density.
 As the density increases it becomes opaque
with painless loss of transparency.
 Both eyes may have cataracts but the rate
of progression differs in each eye.
 Common causes of Cataract
 Age Related
 Lens water loss and fiber
compaction.
 Traumatic Cataract
 Blunt injury to the eye or head
 Penetrating eye injury
 Intraocular foreign bodies
 Radiation, exposure therapy.
 Toxic Cataract
 Corticosteroids
 Phenothiazine derivatives
 Miotic agent
 Associated Cataract
 DM
 Hypoparathyroidism
  Down syndrome
 Chronic sunlight exposure
 Complicated Cataract
 Retinitis Pigmentosa
 Glaucoma
 Retinal Detachment
 Manifestation of cataract
 Early
 Blurred vision
 Decreased color perception
 Late
 Diplopia
 Reduced visual acuity progressing
to blindness
 Absence of red reflex
 Presence of white pupil
 No pain or eye redness is associated with
age related cataract formation
 Operative Procedure
 Extracapsular Cataract Extraction
 More common procedure
 The posterior lens capsule is left
inside the eye to anchor the
replacement lens.
 Intracapsular Cataract Extraction
 The lens and capsule are removed
completely.
 Disadvantage of this procedure is
that it places the eye at greater risk
for retinal detachment and the loss
of supportive structure for the
intraocular lens (IOL) implant.
 Phacoemulsion is the use of sound
waves to break the cataractous lens
into small pieces during surgery.
 Aphakia loss of accommodative power
and refractive ability of the eye after
lens removal due to cataract.
 After surgery the eye is usually left
unpatched.
 Instruct the client to wear dark glasses
outdoors or in brightly lit environment until
the pupil responds to light.
 Mild itching is normal so is the bloodshot
appearance.
 Pain early after surgery may indicate a
complication, such as increased IOP or
hemorrhage.
 Activities that increases IOP
 Bending from the waist
 Sneezing, coughing
 Blowing the nose
 Straining to have a vowel movement
 Vomiting
 Sexual intercourse
 Keeping the head in a independent
position
 Wearing tight collared shirts.
 Major complication after surgery is
increased IOP, another complication is
infection.
 Final best vision will not be present until 4-6
weeks after surgery.
 Eye drops are often prescribed for 4-6
weeks after cataract surgery.
Glaucoma
 A group of ocular disease resulting in an
increased IOP.
 IOP is the fluid (Aqueous humor) pressure
within the eye.
 A normal IOP of 10-21 mmHg is maintained
when there is a balance between
production and outflow of aqueous humor.
 IOP can be increased by decreasing the
outflow of aqueous fluid or by
overproducing aqueous humor.
 In people with glaucoma, aqueous humor
builds up inside the eye and the increased
pressure reduced the blood flow to the
optic nerve and retina.
 Glaucoma is usually painless and the client
may be unaware of a gradual reduction in
vision.
 Primary glaucoma is the most common
form of glaucoma. In this the structure
involved in the circulation and reabsorption
of the aqueous humor undergoes direct
pathologic change.
 Primary open-angle glaucoma (POAG) the
most common form of primary glaucoma is
usually bilateral and asymptomatic in the
 early stages. There is reduced outflow of
aqueous humor through the chamber angle.
Because the fluid cannot leave the eye at
the same rate it is produced, IOP increases.
 Angle-closure glaucoma (aka closed-angle
glaucoma, narrow-angle glaucoma or acute
glaucoma)
 is less common
 has sudden onset
 emergency case
 Basic problems are a narrowed
angle and forward displacement of
the iris.
 Movement of the iris against the
cornea narrows or closes the
chamber angle, obstructing the
outflow of aqueous humor.
 Can occur suddenly and without
warning.
 Secondary glaucoma results from ocular
diseases that cause a narrowed angle or an
increased volume of fluid within the eye.
 Common causes of glaucoma
 Primary Glaucoma
 Aging
 Hereditary
 Central retinal vein occlusion
 Secondary Glaucoma
 Uveitis
 Iritis
 Neovascular disorders
 Trauma
 Ocular tumors
 Degenerative diseases
 Eye surgery
 Associated Glaucoma
 DM
 Hypertension
 Severe myopia
 Retinal detachment
 Clinical Manifestation
 Cupping and atrophy of the optic disc.
 The disc becomes wider and deeper
and turns white to gray.
 Seeing colored halos around lights and
sudden blurred vision with decreased
light perception.
 Tonometry to measure IOP. IOP is elevated
in glaucoma. In open-angle glaucoma = 22-
32 mmHg for angle-closure glaucoma = 30
mmHg or higher.
 Flat tracing in Tonography indicates
reduced outflow of aqueous humor as in
glaucoma.
 Miotics or drugs that constrict the pupils
are used to treat glaucoma.
 Prostaglandin agomist are used to control
the flow of aqueous humor.
 Beta blockers are used to reduce aqueous
humor production without causing papillary
constriction.
 Carbonic anhydrase inhibitors reduces
aqueous humor production to maintain
lowered IOP.
 Epinephrine 0.5% and 2% also reduces
aqueous humor.
 Epinephrine-containing agents are not
used in angle-closure glaucoma because
they dilate the pupil.
 Osmotic drugs may be given angle-closure
glaucoma as part of emergency treatment
to rapidly reduce IOP.
Vitreous Hemorrhage
 The vitreous is the gel that fills the posterior
2/3 of the eye and maintains the eye’s
shape.
 Vitreous hemorrhage may result fromaging,
systemic diseases or trauma or it may occur
spontaneously.
 Main manifestation is reduced visual acuity.
 Mild hemorrhage may cause the client to
see a red haze or “floaters”
 Moderate may cause the client to see
“black streaks” or tiny “black dots”
 Severe hemorrhage may reduce visual
acuity to hand motion.
 Eye examination shows a reduced red
reflex because light rays are blocked from
reaching the retina.
Uveitis
 Three related parts: iris, ciliary body and the
choroid.
 Uveitis may occur in the anterior or
posterior portion of the eye.
 Anterior Uveitis is the inflammation of the
iris, inflammation of the ciliary body or
both.
 Cause is unknown but often follows
exposure to allergens, infectious agents,
trauma or systemic disease (RA, herpes
simplex, herpes zoster).
 It can follow any local or systemic
bacterial infection.
 Manifestation includes: aching around
the eye, tearing, blurred vision,
photophobia, small non-reactive pupil
and a “bloodshot” appearance of the
sclera.
 Posterior Uveitis is a common term for
retinitis and chorioretinitis (both choroid
and retina)
 Occurs with TB, syphilis and
toxoplasmosis.
 The onset of symptoms is slow and painless.
 The pupil is small, non reactive and
irregularly shaped.
 Black dots are visible against the red
background of the fundus.
 Lesions appear as grayish yellow patches on
the retinal surface.
 Treatment involves resting the ciliary body
with a cycloplegic agent.
 The pupil is dilated to prevent adhesions
between the iris and the lens.
 Steroid drops are given hourly to reduce
inflammation and to prevent the adhesion
of iris to the cornea and lens.
Retinal Disorders
Hypertensive Retinopathy
 Retinopathy due to hypertension.
 As BP increase, retinal arterioles narrow
and take a classic “copper wire”
appearance.
 Nicking or narrowing of the vessel at
arteriovenous crossing is present.
 Cotton wool or soft exudates spots
develops if the BP remains elevated as a
result of blood vessel occlusion.
 Small hemorrhage may be seen
 Client may also have headache and vertigo
 If left untreated it can lead to retinal
detachment
Diabetic Retinopathy
 Is a retinal blood vessel complication
 The longer the person has Diabetes, the
greater the incidence and severity of
retinopathy.
 Types of Retinopathy
 Background Diabetic Retinopathy
 The cells of the retinal vessels die
and fluid leaks into the eye.
 Thick yellow-white hard exudates
are formed.
 The capillaries lose their ability to
transport needed oxygen and
nutrients.
 Small outpouches (microaneurysm)
form in the walls of capillaries.
 These fragile capillaries bleed easily
and cause hemorrhage in the nerve
layer of the retina.
 Visual acuity is reduced by retinal
ischemia or by macular edema.
 Proliferative Diabetic Retinopathy
 Network of fragile new blood
vessels develop leaking blood and
protein into the surrounding tissue.
  These new blood vessels are
stimulated by retinal hypoxia that
results from poor capillary
perfusion of retinal tissue.
 Vitrectomy is performed if frequent
bleeding into the vitreous occurs and
fibrin bands threaten to detach the
retina.
Macular Degeneration
 Deterioration of the macula, the area of
central vision.
 Can be atrophic (age related or dry) or
exudative (wet).
 Age related degeneration is caused by
gradual blockage of retinal capillaries,
allowing retinal cells in the macula to
become ischemic and necrotic.
 Rod and cone photoreceptors die.
 Central vision decline.
 Client describe “mild blurring and
distortion”
 Increase intake of antioxidants and
carotenoid lutein and zeaxanthin to prevent
macular degeneration.
Retinal Hole and Detachment
 Break in retina.
 A retinal tear is a jagged and irregularly
shaped break in the retina.
 A retinal detachment is the separation of
the retina from the epithelium.
 Detachment are classified:
 Rhegmatogenous detachments occur
following a hole or tear in the retina
caused by mechanical force, creating an
opening for the vitreous to move under
the retina. When sufficient fluid
collects in this space, the retina
detaches.
 Traction detachment occurs when the
retina is pulled away from the support
tissue by bands of fibrous tissue in the
vitreous.
 Exudative detachment is caused by
fluid collecting under the retina. This
often occurs with a systemic disease or
with ocular tumor. No retinal break
occurs.
 Retinal detachment is painless because
there are no pain fibers in the retina.
 Client may see bright flashes of light
(photopsia) or floating dark spot in the
affected eye.
 Initial phase of detachment client may
describe the sensation as curtain being
pulled over part of the visual field.
 Treatment involves creating the
inflammatory response with cryotherapy
(freezing probe), photocoagulation (laser)
or diathermy (high frequency current).
 Scleral buckling is a common repair
procedure where wrinkles or folds in the
retina are repaired.
Retinitis Pigmentosa
 A condition in which retinal nerve cells
degenerate and the pigmented cells of the
retina grow and move into the sensory
areas of the retina causing further
degeneration.
 The most common early manifestation is
night blindness often occurring in
childhood.
Refractive Errors
 Ability of the eye to focus images on the
retina depends on the length of the eye
from front to back and the refractive
power of the lens system.
 Myopia or nearsightedness the refractive
ability of the eye is too strong for the eye
length; images are bent and fall in front of,
not on the retina.
 Hyperopia or farsightedness the refractive
ability of the eye is too weak, causing the
image to be focused behind the retina. A
short eye length may contribute to the
development of hyperopia.
 Presbyopia as people age, the lens looses
its elasticity and is less able to alter its
shape to focus the eye for close work
(Presbyopia). As a result, images fall behind
 the retina. It usually occurs in people in
their 30s and 40s.
 Astigmatism occurs when the curve of the
cornea is uneven. Because light rays are
not refracted equally in all directions, the
image does not focus on the retina.
 Vision enhancing surgeries include radial
keratotomy, photorefractive keratotomy,
laser in-situ keratomileusis (LASIK) and
placement of Intacs corneal ring segment.
 Radial Keratotomy (RK) is an outpatient
surgical procedure for the treatment of mild
to moderate myopia. Eight to 16 diagonal
incisions are made through 90% of the
peripheral cornea. The incision flattens the
cornea allowing the images to be focused
closer to retina.
 Photorefractive Keratotomy (PRK) is used
for people with mild to moderate stable
myopia and low astigmatism. It is also used
to correct corneal complications following
other type of surgeries for myopia.
 Not a laser version of radial keratotomy
but a complete different procedure.
 Removes small portion of the tissue
surface, reshaping the cornea to
properly focus an Image on the retina.
 One eye is treated at a time at least 3
months apart.
 The eye is patched after surgery.
 Complete healing to best vision may
take up to 6 months.
 Side effect: pain, hazy vision, light
sensitivity, tearing and pupil
enlargement.
 Complication: reduced night vision,
corneal clouding, undercorrection, far-
sightedness, increased IOP, chronic dry
eyes and glare.
 Laser In-Situ Keratomileusis (LASIK) is a
popular procedure for correcting near
sightedness, far-sightedness and
astigmatism using the excimer laser.
 Usually both eyes are treated at the
same time.
 Intacs Corneal ring enhances vision for
near-sightedness.
 Does not involve use of laser and has
advantage of being reversible.
 Shape of the cornea is changed by
placing a flexible ring in the outer edge
of the cornea (outside the optical zone).
 Performed on both eyes during one
surgery under local anesthesia
Trauma
Hyphema
 Hemorrhage in the anterior chamber.
 Due to force applied to the eye and breaks
the blood vessels.
 Treated by bed rest in semi fowler’s
position or use of gravity to keep hyphema
away from the optical center of the cornea.
Ocular Melanoma
 Melanoma is the most common malignant
eye tumor in adults.
 This tumor occurs most often in the uveal
tract among people in the 30s and 40s.
 Enucleation or surgical removal of the
entire eyeball is performed under GA.
 After surgery a ball implant is inserted to
provide a base for socket prosthesis.
 Radiation therapy can reduce the size and
thickness of melanomas.
Assessment of the Ear and Hearing
The three divisions or parts:
External Ear
 Collects sound waves and channels them
inward
 Develops in the embryo at the same time as
the kidney and urinary tract.
 Any person with a defect of the external ear
should also be examined for possible
problems with renal or urinary system.
 Composed of
 Pinna
 External auditory canal (2.5 to 3.75 cm)
 Mastoid process
Middle Ear
 Conveys sound to the oval window.
 Small air filled cavity in the temporal bone.
 Separated from the external ear by the
tympanic membrane and from the Inner ear
by the oval and round window.
 Begins at the medial side of the eardrum
 Consist of
 Epitympanun a compartment
containing the three bony ossicles
smallest bones): malleus (hammer),
incus (anvil) and stapes (stir-ups).
 Tymphanic membrane
 The beginning of Eustachian tube also
opens in the middle ear.
 The tymphanic membrane (eardrum) is a
thick transparent sheet of tissue providing a
barrier between the external and the
middle ear.
 Pars flaccida and pars tensa are part of the
eardrum.
 Eardrum is usually transparent opaque or
pearly gray and it moves when air is
injected into the external canal.
 Eustachian tube allows the pressure on
both sides of the eardrum to equalize.
 Secretions from the middle ear drain thru
the Eustachian tube.
 The round window is enclosed by a
membrane called secondary tympanic
membrane.
 Tensor tympani muscle supplied by
mandibular branch of trigeminal (V) nerve
prevents damage to the inner ear from loud
noise.
 Strapedius muscle supplied by facial nerve
(VII) which is the smallest skeletal muscle in
the human body protects the oval window
and decreases sensitivity to hearing.
Inner Ear or Internal Ear or the labyrinth
 Lies on the outer side of the oval window.
 It contains the
 Semicircular canals are tube made up
of cartilage that contains fluid and hair
cells. These canals are connected to the
sensory nerve fiber of the vestibular
portion of the 8th cranial nerve. The
fluid and hair cells helps to maintain
sense of balance.
 Cochlea, the spinal organ of hearing is
divided into
 Scala tympani filled with perilymph
 Scala vestibuli filled with perilymph
 Scala media filled with endolymph
 The perilymph and endolymph protects
the cochlea and the semicircular canals
by allowing these structures to float in
the fluid and be cushioned against
abrupt head movement.
 Vestibule contains receptors for
equilibrium
 Distal end of the eight cranial nerve.
 The Organ of Corti is the receptor end-
organ of hearing located on the basilar
membrane of the cochlea.
 Transduction (conversion) of vibration to
action potential happens in the cochlea
(coming from the stapes)
Interventions for Clients with Ear
and Hearing Problems
Conditions Affecting the External Ear
External Otitis
 Painful condition caused when irritating or
infective agent come into contact with the
skin of the external ear.
 Allergic external Otitis is commonly caused
by contact with cosmetics, hair sprays,
earphones, earrings or hearing aids.
 Occurs most often in hot, humid
environments, especially in the summer and
is commonly referred to as swimmer’s ear.
 Necrotizing or malignant Otitis is the most
virulent form of external Otitis.
 Clients have pain with movement of the
pinna or tragus or when upward pressure is
applied to the external canal.
 Feeling of plugged ear and reduced hearing.
 Treatment focuses on reducing
inflammation, edema and pain.
 Heat is applied for 20 minutes three time a
day using towel warmed with water and
then wrapped in plastic bag.
 Topical antibiotics and steroids are used to
decrease inflammation and pain.
 Use of earwick with medicated drops is
inserted inside the ear when obstruction is
present due to edema.
 After the inflammation has subsided diluted
alcohol may be used to keep it dry and to
prevent recurrence.
Furuncle
 Is a localized external Otitis caused by
bacterial infection usually staphylococcus of
a hair follicle. Most furuncle occur on the
outer half of the external canal.
 An earwick may be used with one half
strength Burow’s solution to relieve pain.
 The furuncle may be incised and drained if
it does not resolve with the use of
antibiotics.
Cerumen or Foreign Bodies
 Cerumen (wax) is the most common cause
of an impacted canal.
 Irrigation is a slow process of removing
Cerumen impaction and between 50-70 ml
of solution is the maximum amount that the
client can tolerate at one sitting.
 Do not irrigate an ear that has an eardrum
perforation or Otitis media.
 Another way to soften Cerumen is to add 3
drops of glycerin or mineral oil to the ear at
bedtime and 3 drops of hydrogen peroxide
twice a day.
Conditions Affecting the Middle Ear
Otitis Media
 The three most common forms of Otitis
Media are
 Acute Otitis Media and Chronic Otitis
Media also know as suppurant or
purulent OM are similar. Acute disease
has a sudden onset and duration of 3
weeks or less. Chronic OM often
follows repeated acute episodes, has a
longer duration and causes greater
middle-ear injury.
 Serous OM
 Chief complaint with acute or chronic OM is
ear pain with or without movement of the
external ear.
 Pain with chronic OM is much less severe
than that occurring with acute OM.
 Hearing is reduced and distorted.
 There may be sticking or cracking sounds in
the ear on yawning and swallowing or
presence of tinnitus.
 Conductive hearing loss may occur.
 Headache, malaise, fever, nausea and
vomiting, dizziness and vertigo.
 If the disease progresses, the eardrum
spontaneously perforates and pus or blood
drains from the ear.
 A simple perforation does not interfere with
hearing unless the ossicles of the middle ear
are damaged or the perforation is large.
However, repeated perforation with
extensive scarring can cause hearing loss.
 Myringotomy (surgical opening of the pars
tensa of the eardrum) is performed to drain
the middle-ear fluid and to relieve pain.
 For the relief of pressure a small grommet
(polyethylene tube) may be surgically
placed through the tympanic membrane to
allow continuous drainage of middle ear
fluids.
Mastoiditis
 Infection of the mastoid air cells caused by
untreated or inadequately treated OM. This
infection can be acute or chronic.
 Antibiotic therapy is aimed at treating the
middle-ear infection before it progresses to
Mastoiditis.
 Swelling behind the ear and pain with
minimal movement of the tragus, the pinna
or the head.
 Pain is not relieved by Myringotomy.
 Intravenous antibiotic are prescribed to
prevent the spread of infection.
 Simple or modified radical mastoidectomy
with tympanopalsty is the most common
surgical procedure if antibiotic therapy fails.
 Complications include damage to cranial
nerve VI and VII decreasing client’s ability to
look laterally and drooping of the mouth on
the affected side.
 Other complications include vertigo,
meningitis, brain abscess, chronic purulent
OM and wound infection.
Trauma
 Trauma and damage may occur to the
eardrum and ossicles by infection, by direct
damage or thru rapid change in pressure in
the middle ear.
 Most eardrum perforation heals within 1-2
weeks.
 Repeated perforation heals more slowly
with scarring.
Neoplasm
 The most common type of tumor is the
glomus jugulare, a highly vascular benign
lesion arising from the jugular vein.
 Malignant ear tumor includes
adenocarcinoma, adenoid cystic carcinoma
and mucoepidermoid carcinoma.
 Clients have progressive hearing loss and
tinnitus.
 Infection and pain rarely occurs with glomus
jugulare tumors.
Conditions Affecting the Inner Ear
Tinnitus
 Is the continuous ringing or noise
perception in the ear.
 Is a common ear or hearing disorder.
 Symptoms range from mild ringing to a loud
roaring in the ear.
 Caused by: presbycusis, otosclerosis
(irregular bone growth around ossicles),
Meniere’s disease, certain drugs, exposure
to loud noise and other inner ear problem.
Vertigo and Dizziness
 Dizziness is a disturbed sense of a person’s
proper relationship to space.
 True vertigo is a real sense of whirling and
turning in space.
 Factors affecting ear that causes vertigo
include: Meniere’s disease, labyrinthitis,
acoustic neuromas, motion sickness and
drug and alcohol ingestion.
 Manifestation include: nausea, vomiting,
falling, nystagmus, hearing loss and tinnitus.
Labyrinthitis
 Infection of the labyrinth which may occur
as a complication of acute or chronic OM.
 Usually occur from the growth of
cholesteatoma (benign overgrowth of
squamous cell epithelium) from the middle
ear to the semicircular canal.
 Labyrinthitis may follow middle-ear or
inner-ear surgery when infection is present.
 Manifestation includes hearing loss,
tinnitus, spontaneous nystagmus to the
affected side and vertigo with nausea and
vomiting.
 Meningitis is a common complication of
labyrinthitis.
Meniere’s disease
 Have three main features: tinnitus, one-
sided sensorineural hearing loss and
vertigo.
 Due to either overproduction or decreased
reabsorption of endolymphatic fluid,
causing a distortion of the entire inner-
canal system.
 Often occurs with infections, allergic
reaction and fluid imbalances and long term
stress.
 Usually occurs between the age of 20 and
50 years, greater in men than in women.
 Manifestations are usually unilateral.
 Mild diuretics are prescribed to decrease
endolymph volume.
 Nicotinic acid has been found to be useful
because of its vasodilatory effect.
 The most radical procedure involves
resection of the vestibular nerve or total
removal of the labyrinth.

Acoustic Neuroma
 Benign tumor of cranial nerve VIII.
 Manifestation begins with tinnitus and
progresses to gradual sensorineural hearing
loss in most clients. Later clients have
constant mild vertigo

Hearing Loss
 May be conductive, sensorineural or a
combination.
 Conduction hearing loss occurs when sound
waves are blocked from contact with inner-
ear nerve fiber because of external or
middle-ear disorder.
 If the inner-ear nerve or sensory fiber that
leads to the cerebral cortex are damaged
the hearing loss is termed as sensorineural
hearing loss

Presbycusis
 Sensorineural hearing loss that occur as a
result of aging