NCM 216 LEC: EENT

PRELIMS – LECTURE 2

2nd SEMESTER | A.Y. 2022 – 2023

EARS  The client is asked to repeat the

OUTLINE whispered statement
 Each ear is tested separately
I. Anatomy of the ear 2. Watch test
II. Disorders of the ear  A ticking watch is used to test the high-
frequency sounds
 The examiner holds a ticking watch about
ANATOMY OF THE EAR 5 inches from each ear and asks the
Functions of the ear client if the ticking is heard
 Hearing 3. Tuning fork tests
 Balance ➢ Weber test
A. Outer (External) Ear  Normal result: hearing the sound equally in
a. Auricle both ears
✓ Collects sound waves  Findings:
b. External auditory canal ▪ Affected ear – Conductive hearing loss
✓ Glands secretes cerumen which provides ▪ Unaffected ear – Sensorineural hearing loss
protection ● Rinne Tuning Fork Test
c. ✓ Transmits sound waves to tympanic - Air conduction is 2-3 times longer than
membrane bone conduction
d. Tympanic membrane (eardrum) - Normal result: (+) Rinne test
✓ Transmit vibrations to middle ear - The client normally continues to hear the
B. Middle Ear sound 2 times louder in front of the pinna
a. Tympanic membrane - Findings:
✓ Barrier between external ear and middle ear  (-) Rinne test – bone conduction is
b. Ossicles greater than air conduction
- Client may have a conductive hearing loss
✓ Contains 3 small bones:
on the side tested
 ▪ Malleus (hammer)
Vestibular Assessment of the ear
 ▪ Incus (anvil)
● The client normally remains erect with slight
 ▪ Stapes (stirrup)
swaying
✓ Oval Window: an opening between the ● Abnormal result: (+) Romberg sign
middle and inner ear - Presence of significant swaying
c. Eustachian tube DIAGNOSTIC TEST
✓ Connects nasopharynx and middle ear ● Audiometry
✓ Equalizes pressure on both sides of - Measures hearing acuity
eardrum; drainage channel  The patient wears earphones and
C. Inner Ear signals to the audiologist when a tone
➢ Filled with perilymph and endolymph is heard
a. Vestibule  Audiometric evaluations are performed
✓ Entrance space next to oval window in a soundproof room
 Responses are plotted on a graph
b. Cochlea
known as an audiogram
✓ Has organ of Corti, receptor and organ for ● Otoscopic Exam
hearing Guidelines
✓ Contains hair cells that detect vibration from  The speculum is never blindly introduced into
sound and stimulate the eight cranial nerve the external canal
c. Semicircular canals  Tilt the head slightly away and hold the
✓ Organ of balance otoscope upside down as if it were a large pen
d. 8th cranial nerve  Visualize the eternal canal while slowly
inserting the speculum
✓ Cochlear branch
 Normal:
 Transmits neuroimpulses from the cochlea to
- External canal – colored, intact, without
the brain where it is interpreted as sound
lesions
✓ Vestibular branch - Eardrum – shiny, transparent, opaque or
 Maintains balance and equilibrium pearly gray; mobile
ASSESSMENT OF THE EAR  Electronystagmography
1. Voice test (Whisper Test)  Electroencephalographic recordings of
 Ask the client to block one external canal eye movements that provide objective
 The examiner stands 1-2 feet away and documentation of induced and
quickly whispers a statement spontaneous nystagmus

BSN 3D
  Used to evaluate the oculomotor and
vestibular systems to differentiate the
cause of vertigo, tinnitus, and hearing
loss of unknown origin
 Nursing considerations
- Avoid heavy meal before the
procedure
- Avoid caffeine and/or alcohol
– 48 hours before the
procedure
- Medications that may affect
the vestibular system
(sedatives, antianxiety agents,
antihistamines, and
medications ordered for
dizziness) – withheld for up to
5 days before the procedure
DISORDERS OF THE EAR
Hearing Loss
• Normal hearing
• 2 different pathways by which sound waves
produced the sensation of hearing:
➢ Air conduction
➢ Bone conduction
• Hearing loss is any degree of
impairment of the ability to apprehend
sound
• Disruption of the sound wave path
Types of Hearing Loss
A. Conductive Hearing Loss
 Occurs when sound waves are
blocked to the inner ear fibers
because of external ear or middle ear
disorders
 Reversible
Etiology:
 Otosclerosis
 Changes in eardrum such as bulging
 Obstructed external ear canal
Common causes of hearing loss
 Perforated tympanic membrane
 Dislocated ossicle
 Otitis media
 Otitis externa
Manifestations:
 Sound is perceived as a distant or
faint (decreased sensitivity)
 Complain that hearing is worse while
eating crisp or crunchy foods
Diagnostic tests:
 Weber’s test: lateralization on affected
ear
 Rinne’s test: BC>AC
B. Sensorineural Hearing Loss
 Results from damage to the inner ear
and/ auditory nerve
 Sensitivity to sounds/ discrimination to
sounds are impaired
 Irreversible
BSN 3D
Etiology:
 Exposure to noise
 Presbycusis
 Meningitis
 Ototoxic drugs
 Acoustic neuroma
 Syphilis
 Diabetes mellitus
 Menieres disease
 Acoustic trauma
 Barotrauma (pressure trauma) or ear
squeeze
 Vascular diseases (problems with
blood vessels)
Manifestations
 Sound is distorted and faint
 Sounds “F”, “S”, and “Z” are not heard
 High tones are less audible
Diagnostic test
 Weber’s test: lateralization on
unaffected ear
C. Otitis Media
 Infection of the middle ear occurring
as a result of a blocked eustachian
tube, which prevents normal drainage
 A common complication of an acute
respiratory infection
 Primary causative agents: H.
influenzae, Strep., Staph, E. coli
 Infants and children are more prone
 Main causes:
- Allergy
- Infection
- Blockage of the eustachian
tube and nutritional deficiency
Signs and Symptoms
 Bulging and immobile tympanic
membrane • Fullness in the ear
 With slight hearing loss
 Vertigo
 Pain – usually the first symptom
 Fever
Management
M - easures to open Eustachian tube
E - radicate the cause
D- econgestant & Anti-histamine
I- nstruct to avoid colds & barotrumas
A - nalgesics
Nursing Care
 Apply heat locally for 20 minutes 3 times a
day
 Administer analgesics, antipyretics,
antibiotics (amoxicillin, clarithromycin,
cefuroxime)
 Ears should be kept clean and dry
 Use earplugs for swimming
 Instruct the client that cotton-tipped
applicators should not be used to dry ear
 Instruct the client that irritating agents
such as hair products or headphones
should be discontinued
  Prepare for myringotomy - Mild sedation may help the patient
D. Mastoiditis relax
 Infection of the mastoid air cells Nursing
 Secondary disorder resulting from - Avoid turning the head quickly to
untreated otitis media help alleviate the vertigo
 Caused by Strep, Pnuemoniae, and H. - Place on bed rest
influenzae - Assist to cope with anxiety that
 Most often affects children Signs and may be present because of the
Symptoms frustration surrounding hearing
 Dull, post-auricular pain/ swelling loss or loss of work
F. Meniere’s Syndrome
 Cellulitis of area involved
• Chronic recurrent disorder of the inner
 Low-grade fever
ear; endolymphatic hydrops
 Anorexia • Refers to dilatation of the
 Tender and enlarged lymph nodes endolymphatic system by either
Diagnostic test overproduction or decreased
 Otoscopic exam reabsorption of endolymphatic fluid
- Reddened, dull, thick, • With remissions and exacerbations
immobile tympanic membrane Causes
with or without perforation • Any factor that increases
 Xray endolymphatic secretion in the
- Shows bone destruction labyrinth:
Management  Viral and bacterial infections
 Antibiotics  Allergic reactions
- surgery (myringotomy;  Vascular disturbances
mastoidectomy)  High salt intake
 Head trauma
E. Labyrinhitis  Smoking
 An inflammation of the inner ear Manifestations
structure called labyrinth (a maze of  Triad: tinnitus, unilateral sensorineural
interconnected fluid) hearing loss, and vertigo
 Filled channels and canals Causes  Nausea and vomiting
 Usually follows a viral illness  Depression
 Trauma or injury to the head or ear  Headache
 Bacterial infection (otitis media)
- Fluid to collect in the labyrinth
(serous labyrinthitis)
- Fluid to directly invade the
labyrinth, causing pus
(suppurative) labyrinthitis
Manifestations
• Common symptoms
- ➢ Vertigo
- ➢ Tinnitus
- ➢ Sensorineural hearing loss
• Other symptoms
- ➢ Nystagmus
- ➢ Pain
- ➢ Fever
- ➢ Ataxia
- ➢ Nausea and vomiting
Diagnostic Tests
 CBC
 Rinne and Weber tests can
indicate conductive or
sensorineural hearing loss
Management
Medical
- Antibiotics; vestibular
suppressants; antiemetics

BSN 3D